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From prediction to action: developing a risk-stratified management tool for children with new-onset tic disorders
Yifang Qian1, Qinyu Li2, Hongjie Mao1
1Department of Developmental and Behavioral Pediatrics, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China.
Insights
A new tool helps predict which children with provisional tic disorder (PTD) will develop chronic tics. It identifies risk factors like tic duration, vocal scores, and comorbidities for better early intervention.
Area of Science:
- Neurology
- Child Psychiatry
- Clinical Epidemiology
Background:
- Provisional tic disorder (PTD) often progresses to chronic tics in children.
- Early identification of children at high risk for chronic tic development is crucial but lacks effective tools.
Purpose of the Study:
- To develop and validate a predictive model for 12-month progression from PTD to chronic tic disorders in children.
- To establish risk stratification thresholds for proactive management.
Main Methods:
- Prospective cohort study of 108 children with new-onset PTD.
- Multivariable logistic regression model developed and internally validated.
- Decision curve analysis used for risk threshold definition.
Main Results:
- Identified three key predictors: longer tic duration, higher Parent Tic Questionnaire (PTQ) vocal score, and presence of a comorbidity.
- Developed a dual-threshold model defining low (<30%), intermediate (30-56%), and high (≥56%) risk strata.
- High-risk group showed a 70.5% progression rate versus 27.3% in the low-risk group.
Conclusions:
- A validated predictive model and risk stratification tool (nomogram, online calculator) are available for children with new-onset PTD.
- This tool can support proactive, resource-efficient management for children at risk of chronic tic development.
- Further validation and implementation in clinical practice are warranted.
Abstract:
Many children with provisional tic disorder (PTD) progress to chronic tics, but early risk stratification tools are lacking. In a prospective cohort of children with new-onset PTD, we developed a multivariable logistic regression model to predict 12-month progression to chronic tic disorders. The model was internally validated (bootstrap) and decision curve analysis was used to define risk thresholds. The final analytic cohort comprised 108 children. Three independent predictors of progression were identified: longer tic duration (adjusted odds ratio [aOR] = 1.18 per month, 95% CI: 1.01-1.38), higher parent tic questionnaire (PTQ) vocal score (aOR = 1.09 per point, 95% CI: 1.02-1.16), and presence of a comorbidity (aOR = 2.84, 95% CI: 1.01-8.02). A dual-threshold approach defined low- (< 30%), intermediate- (30-56%), and high-risk (≥ 56%) strata. The high-risk group had a 70.5% progression rate (vs. 27.3% in low-risk), a relative risk of 2.58, and a number needed to intervene of 2.3. The model was translated into a nomogram, online calculator, and risk-stratified management pathway. We provide a preliminary risk-stratified management tool that may support proactive and resource-efficient care for children with new-onset tics.
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