Assessing Environmental Consequences of Ticcing in Youth With Chronic Tic Disorders: The Tic Accommodation and Reactions Scale

Abstract

Tics associated with Tourette syndrome and other chronic tic disorders (CTDs) often draw social reactions and disrupt ongoing behavior. In some cases, such tic-related consequences may function to alter moment-to-moment and future tic severity. These observations have been incorporated into contemporary biopsychosocial models of CTD phenomenology, but systematic research detailing the nature of the relationship between environmental consequences and ticcing remains scarce. This study describes the development of the Tic Accommodation and Reactions Scale (TARS), a measure of the number and frequency of immediate consequences for ticcing experienced by youth with CTDs. Thirty eight youth with CTDs and their parents completed the TARS as part of a broader assessment of CTD symptoms and psychosocial functioning. The TARS demonstrated good psychometric properties (i.e., internal consistency, parent-child agreement, convergent validity, discriminant validity). Differences between parent-reported and child-reported data indicated that children may provide more valid reports of tic-contingent consequences than parents. Although preliminary, results of this study suggest that the TARS is a psychometrically sound measure of tic-related consequences suited for future research in youth with CTDs.

Clinical Aspects of Premonitory Urges in Patients with Tourette’s Disorder

“…Aversive experiences resulting from tics, such as pain during tics, bullying by peers, or attracting attention from others, are thought to be associated with premonitory urges [31]. If the patient does not perform tasks that he or she doesn't want to do (i.e., homework or errands) because of tic symptoms, the onset or progression of premonitory urges will be affected [31][32][33][34]. In a study of adolescents aged 9 to 17 years old, Rozenman et al [35] reported that the severity of anxiety and panic symptoms or somatic symptoms assessed using the Screen for Child Anxiety-Related Emotional Disorders-Child Version is associated with the PUTS score.…”

An initial study of family accommodation in children and adolescents with chronic tic disorders

“…Additionally, emerging data suggests that expression of tic symptoms can also result in environmental consequences [17]. For instance, it has been a common clinical observation in youth with TS to have family members accommodate tic expression in efforts to reduce the intensity and/or frequency of tics.…”

“…1 Meanwhile positive environmental contingencies (e.g., rewarding the child for using a competing response) were associated with positive outcomes. Providing further preliminary data on accommodation in TS samples, Capriotti et al [17] developed the Tic Accommodation and Reactions Scale (TARS), an assay of tic-related environmental consequences. While not a direct assessment of family accommodation, the subscales included a variety of tic-related environmental consequences, including attention, escape, and aversive consequences across home, school, and public settings.…”

Current behavioral assessments of movement disorders in children

“…However, recent relevant studies have seldom used these tools, given the limitations of self‐reporting in children. Although some studies have used the Premonitory Urge for Tics Scale (PUTS) to evaluate tic‐related premonitory urges, this tool does not assess tics; rather, it is a 10‐item scale that assesses 10 somatic sensations related to tics. The scores from this scale range from 0 (never) to 4 (severe).…”