Childhood cognitive control as a predictor of long-term clinical and functional outcomes in Tourette syndrome

Tourette syndrome (TS) is a childhood-onset neuropsychiatric condition characterized by motor and vocal tics. Many individuals with TS continue to experience tics and functional difficulties into adulthood, yet the factors influencing these long-term trajectories remain poorly understood. Cognitive control processes, implicated in the etiology and treatment of TS, may serve as indicators of later clinical and functional outcomes.

This study tested whether childhood cognitive control predicted outcomes in early adulthood. Participants were 80 individuals with TS (M_age = 22.8 years, SD = 2.7) who had entered a randomized clinical trial of behavioral therapy as children and completed a follow-up evaluation an average of 11.7 years (SD = 1.3) later. Childhood assessments measured tic severity and neurocognitive domains, including processing speed, inhibition, set-shifting, and working memory. Follow-up assessments evaluated clinical, functional, and quality of life outcomes.

Results showed that greater inhibition, set-shifting, and processing speed in childhood predicted lower tic severity and impairment, greater odds of tic remission, and higher quality of life in early adulthood. Greater working memory and response flexibility predicted higher educational attainment and income. These relationships remained significant after accounting for treatment conditions and comorbid attention-deficit/hyperactivity disorder and obsessive-compulsive disorder.

Findings highlight childhood cognitive control as an important predictor of clinical and functional outcomes in TS and a viable target for intervention.