Self-, parent-, and teacher-reported behavioral symptoms in youngsters with Tourette syndrome: a case-control study

Tourette syndrome (TS) is a neurodevelopmental disorder characterized by multiple tics and associated with co-morbid behavioral problems (TS-plus). We investigated the usefulness of self-report versus parent- and teacher-report instruments in assisting the specialist assessment of TS-plus in a child/adolescent population.

Twenty-three patients diagnosed with TS (19 males; age 13.9 ± 3.7 years) and 69 matched healthy controls participated in this study. All recruited participants completed a standardized psychometric battery, including the Children's Depression Inventory (CDI), the Self Administrated Psychiatric Scales for Children and Adolescents (SAFA) and the State-Trait Anger Expression Inventory (STAXI). Parents completed the Child Behavior Checklist (CBCL) and Conners' Parent Rating Scales-Revised (CPRS-R). Participants' teachers completed the Conners' Teacher Rating Scales-Revised (CTRS-R). Results were compared with similar data obtained from controls.

Nineteen patients (82.6%) fulfilled DSM-IV-TR criteria for at least one co-morbid condition: obsessive-compulsive disorder (OCD, n = 8; 34.8%); attention deficit-hyperactivity disorder (ADHD, n = 6; 26.1%); OCD + ADHD (n = 5; 21.7%). Scores on self-report instruments failed to show any significant differences between TS and controls. Most subscores of the CPRS-R, CTRS-R, and CBCL were significantly higher for the TS group than controls. The TS + OCD subgroup scored significantly higher than the TS-OCD subgroup on the CBCL-Externalizing, Anxious/Depressed and Obsessive-Compulsive subscales.

Self-report instruments appear to have limited usefulness in assisting the assessment of the behavioral spectrum of young patients with TS. However, proxy-rated instruments differentiate TS populations from healthy subjects, and the CBCL can add relevant information to the clinical diagnosis of co-morbid OCD.