Individuals with chronic tic disorders (CTDs) frequently describe aversive subjective sensory sensations that precede their tics. The first aim of the present study was to explore the psychometric properties of a standardized self-report measure to assess premonitory urges in CTDs, The Premonitory Urge for Tics Scale (PUTS), by replicating the analyses of Woods et al. (J Dev Behav Pediatr 26:397-403, 2005) using a sample twice the size of theirs. The second aim was to conduct an exploratory factor analysis of the PUTS. Eighty-four youth with CTDs, recruited from a pediatric OCD and tic specialty clinic, completed the PUTS while their caregivers completed The Parent Tic Questionnaire (PTQ) and a demographic measure. Consistent with (Woods et al. J Dev Behav Pediatr 26:397-403, 2005), the PUTS was found to be internally consistent (α = 0.82) and significantly correlated with overall tic severity as measured by the PTQ (r = 0.24, p < 0.05) as well as the PTQ number (r = 0.34, p < 0.01) and intensity (r = 0.24, p < 0.05) subscales. A factor-analysis of the PUTS revealed a two-factor solution with one factor capturing the quality of premonitory sensations while the other factor assessed the overall intensity of the urges. These results support the use of the PUTS in reliably measuring premonitory urges, particularly in children over the age of 10 years. Additionally, these findings highlight that urges are uniformly reported across gender and age and are more closely associated with number of tics than the frequency or intensity of tics.

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The relation between metabolic control (HbA1c) and achievement (grade point average [GPA]) was examined over a period of 2.5 years (every 6 months) employing a dynamical systems approach that allowed for the examination of whether HbA1c was associated with change in subsequent GPA and vice versa. Metabolic control tends to deteriorate (i.e., with higher HbA1c reflecting poorer metabolic control) during adolescence. It was hypothesized that these higher levels of HbA1c would limit subsequent increases in GPA. The sample included 252 adolescents (Mbaseline age = 12.49 years, SD = 1.53; 53.6% female) with type 1 diabetes. Mothers’ report and school records provided information on relevant demographics and GPA; medical records provided values of HbA1c. Two simultaneous coupled change equations (i.e., examining current values in one variable associated with changes in the other) controlling relevant risk indicators (i.e., age, sex, disease duration, insulin delivery method, IQ) revealed higher levels of HbA1c limited increases in GPA. Higher levels of GPA, however, were not associated with change in HbA1c except for two instances where moderation existed by disease duration and IQ. Higher GPA was associated with slower increases in HbA1c over time for youth with shorter disease duration and lower IQ. These results affirm the importance of maintaining good metabolic control to facilitate adequate school performance across the adolescent years. Further, the results suggest that factors related to school achievement may protect adolescents who are newly diagnosed or who have low cognitive ability from subsequent deterioration in metabolic control.

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