Comparative Study Of Attention And Behavioral Problems In Children With Chronic Tic Disorders

ObjectiveTic disorders are common neuropsychological disorder in children. It is reported that tic disorders affect 4-18% of children at some stage of their development and the incidence is still arising. The cause of tic disorders is unknown. Both chronic tic disorders (CTD) and Tourette syndrome (TS) last more than 1 year, cause significant impairment in cognitive function and social life. Many studies suggest that patients with tics have some neuropsychological deficit, but the results are not in accordance. Some studies abroad find TS children showed significantly slower reaction times than controls during a continuous performance test (CPT) , suggesting that TS children have apparent deficits in attention, but other studies find impaired sustained attention and impulsivity on a CPT were uncommon in the TS - only patients, but common in TS comorbid attention -deficit hyperactivity disorder (ADHD) , suggesting that the inattention is the result of coexisting ADHD. The only - one study we found in our nation takes different view that TS children have normal attention abilities. The discordance may be due to different methods of study. The integrated visual and auditory CPT (IVA - CPT) is a computerized, standardized test developed for the assessment of response inhibition and attention problem. No report was found in our nation about investigating the attention and integration ability in children with tics by using IVA - CPT. So it is necessary to research the characteristics of attention and cerebral integration of children with tics, explore the pathogene-sis and look for more effective management.Patients with tic disorders often have a variety of behavioural symptoms. The most common reported comorbidity is ADHD. ADHD occurs in about 35 -90% of children with TS. Studies abroad suggest that tic disorders with ADHDhave more severe behavioral problems, but the cause is not known. Some studies support the view that comorbid ADHD is highly associated with behavior and functional impairment in children with TS;while other studies take the view that the severity of tic disorders is associated with higher rates of emotional and behavioral disturbances. Studies in our nation also suggest that children with TS have apparent behavioral problems;TS with ADHD have more severe behavioral problems than TS only. The relation between tic severity and course with behavioral problems has no definite conclusion. Research the behavioral problems and its correlated factors will provide theoretical basis in management of tic disorders , thus improve the life quality of children with tic disorders. Since the prevalence of CTD is much higher than that of TS, and CTD is more frequently seen in clinics, so we select children with CTD as subjects to investigate the attention and behavioral problems.MethodsSubjects were the children aged 6-14 years with CTD in our developmental paediatrics department from December 2004 to February 2006. A total of 54 patients met DSM - IV criteria for CTD participated, ranging in age from 6 to 13 years, IQ was above 85, and did not use psychotropic medication in the past three months. To determine the attention - deficit hyperactivity disorder ( ADHD) status of the patients with a definite CTD, we used the DSM - IV criteria for ADHD. Of the 54 patients with CTD, 30 received a diagnosis of CTD -only, 24 had a diagnosis of CTD plus ADHD. The control group consisted of 30 children matched for sex and ages with the case group. They came from our department for physical examination and recruited to participate in the study. The control group was screened and had a negative history of neurological problems, with normal intelligence, normal vision and audition.All individuals in the CTD and control groups completed IVA - CPT. The Chinese revised Wechsler intelligence scales for children ( C - WISC) full scale IQ were obtained. All testing were completed in accordance with the standardized procedures outlined in the administration manuals of the IVA and C -WISC. Parents were asked to complete two questionnaires, the general information questionnaire made by ourselves, and the Child Behavior Checklist (CBCL). The general information questionnaire includes several main factors which effect childrens behavior problems. The CBCL contains 122 items and can be divided into eight different scales. To assess the tic severity of the patients, we used the Yale Global Tic Severity Scale ( YGTSS) , which consists of separate scales for motor and vocal tics complemented with a separate rating of impairment. SPSS 11.0 software was used to make analyses. Variance analyses and SNK test was used to analyze scores of IVA - CPT and CBCL between three groups. Independent - Samples T test was used to analyze scores between two groups. Chi - square test was used to analyze categorical variables, multiple regressions and correlation analysis was also used. All tests of significance used the . 05 level of significance and were two tailed.Results1, Analyses of IVA - CPT scales of children with CTD - only, CTD + ADHD and control groupThe results showed control group scored highest, while CTD + ADHD group scored the lowest except the Visual and Auditory Stamina scale. Variance analysis for Full Scale Response Quotient, Visual and Auditory Response Quotient, Full Scale Attention Quotient, Auditory Attention Quotient, Visual and Auditory Prudence, Visual and Auditory Consistency, Auditory Speed, Visual and Auditory Focus were significant. The CTD + ADHD group scored significantly lower than the other two groups on the scales above. Although most of the scales of CTD - only group scored lower than control group, there were significant differences on Full Scale Response Quotient, Auditory Response Quotient, Full Scale Attention Quotient, Auditory Prudence, Auditory Consistency, Auditory Speed, Visual and Auditory Focus. There were significant differences on Full Scale Response Quotient, Visual and Auditory Response Quotient, Visual and Auditory Prudence, Visual Consistency and Auditory Focus Quotient between children with CTD - only and CTD + ADHD group.2. Correlation analyses of IVA - CPT of CTD groupThe IVA - CPT results were not correlated with age, IQ and tic severity. But the course was correlated with the Visual Response and Visual Prudence Quotient.3. Analyses of behavioural problems of CTD - only, CTD + ADHD and control groupThe difference of behavioural problems rate screened by CBCL was significant between three groups. Behavioural problems subscales and total scores in CTD + ADHD group were significantly higher than that of CTD - only and control group except somatic complaints problem. There were no differences between CTD - only and control group except obsessive compulsive problem. But CTD + ADHD group had significantly higher disruptive behaviour, depression behaviour, social problems, social withdrawal problems, hyperactivity behaviour, aggressive behaviour and total scores than CTD - only group.4. Correlation analyses of behavioural problems of CTD groupSocial problems, hyperactivity behaviour, aggressive behaviour, delinquent behaviour and total scores were negative correlated with IQ. Disruptive behaviour, depression, social problems, obsessive compulsive behaviour, somatic complaint problem, social withdrawal and total scores were positive correlated with tic severity. Delinquent behaviour was positive correlated with course.ConclusionsThe ability of response control and attention of children with CTD - only was impaired. Comorbid ADHD was associated with more response control and attention impairment as well as behavioural problems. Behavioural problems of children with CTD were correlated with tic severity and IQ.