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Provisional Tic Disorder is not so transient
Soyoung Kim1, Deanna J Greene1,2, Emily C Bihun1
1Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States.
Insights
Most children diagnosed with Provisional Tic Disorder do not experience tic remission within a year. This study found tics persist in all children, challenging previous assumptions about tic disorder outcomes.
Area of Science:
- Childhood neurology
- Neurodevelopmental disorders
- Pediatric psychiatry
Background:
- Motor and vocal tics are common in childhood.
- Current clinical understanding suggests Provisional Tic Disorder (PTD) is typically temporary.
- This belief is based on limited and potentially biased data.
Purpose of the Study:
- To prospectively evaluate the 12-month outcome of children with PTD.
- To challenge the prevailing notion of spontaneous tic remission in PTD.
- To identify predictors of long-term tic disorder outcomes.
Main Methods:
- Prospective study design.
- Recruited 43 children with recent onset tics (mean 3.3 months).
- Re-examined 39 children at the 12-month tic onset anniversary.
Main Results:
- Tic symptoms improved on a group level, with minimal impairment in most children.
- Tics remained present in all children at 12-month follow-up, sometimes only detectable via remote video observation.
- Remission of PTD was found to be uncommon.
Conclusions:
- The assumption of frequent remission in PTD is likely inaccurate.
- Baseline tic severity, subsyndromal autism spectrum symptoms, and comorbid anxiety predict 1-year tic disorder outcomes.
- Further research is needed to refine diagnostic criteria and treatment approaches for childhood tic disorders.
Abstract:
Motor and vocal tics are common in childhood. The received wisdom among clinicians is that for most children the tics are temporary, disappearing within a few months. However, that common clinical teaching is based largely on biased and incomplete data. The present study was designed to prospectively assess outcome of children with what the current nomenclature calls Provisional Tic Disorder. We identified 43 children with recent onset tics (mean 3.3 months since tic onset) and re-examined 39 of them on the 12-month anniversary of their first tic. Tic symptoms improved on a group level at the 12-month follow-up, and only two children had more than minimal impairment due to tics. Remarkably, however, tics were present in all children at follow-up, although in several cases tics were apparent only when the child was observed remotely by video. Our results suggest that remission of Provisional Tic Disorder is the exception rather than the rule. We also identified several clinical features present at the first examination that predict one-year outcome; these include baseline tic severity, subsyndromal autism spectrum symptoms, and the presence of an anxiety disorder.
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