We've all been wrong about provisional tic disorder

Area of Science:

• Child neurology
• Neurodevelopmental disorders
• Pediatric psychiatry

Background:

• Provisional Tic Disorder (PTD) is common in childhood.
• Clinical experience suggests PTD is mild and short-lived, with few tics and low comorbidity.
• This perception may stem from biased ascertainment and limited follow-up in previous observations.

Purpose of the Study:

• To investigate the natural history and clinical characteristics of childhood Provisional Tic Disorder.
• To challenge the traditional clinical distinction between recent-onset and chronic tic disorders.

Main Methods:

• Prospective study of 89 children with tics onset within 9 months.
• Follow-up assessments at 12, 24, 36, and 48 months post-first tic.
• Included children with diverse tic presentations and comorbidities, with data collection from clinical and non-clinical sources.

Main Results:

• At onset, many children had comorbidities like ADHD (39%), anxiety (27%), and OCD (9%).
• Most children presented with multiple tics (mean 6.9 motor, 2.0 phonic), complex tics (41%), and suppressible tics (69%).
• At 12 months, 78/79 children still had tics, often persistent but with low medical impact; many tics were only observed via monitoring.

Conclusions:

• The study findings challenge the clinical lore that PTD is typically mild and transient.
• Data support discontinuing the arbitrary separation of tic disorders into recent-onset versus chronic categories.
• PTD may represent a more persistent neurodevelopmental condition than traditionally assumed.