Children and adolescents with Tourette’s disorder in the USA versus Argentina: behavioral differences may reflect cultural factors

Abstract

To explore behavioral differences as possible cultural factors in presentation of psychiatric comorbidity in two clinically referred, consecutively ascertained samples of youth with Tourette's disorder (TD) from New York and Buenos Aires. Subjects were evaluated between 2002 and 2010 at the Tics and Tourette's Clinical and Research Program at the New York University Child Study Center in New York and the Interdisciplinary Center for Tourette's, Obsessive Compulsive Disorder (OCD) and Associated Disorders (CITTTA)/Institute of Cognitive Psychology (INECO) in Buenos Aires. Demographic, diagnostic, tic severity (Yale Global Tic Severity Scale; YGTSS), clinical (Child Behavior Check List-Parent version; CBCL), and global functioning (Global Assessment of Functioning; GAF) data were compared using descriptive statistics. The sample included 111 subjects ages 6-17 years, who met DSM-IV-TR diagnostic criteria for TD. Findings revealed that the BA sample (n = 35) was significantly older at initial evaluation at the tic specialty clinic, and had higher frequency of oppositional defiant disorder (ODD), mood and non-OCD anxiety disorders than the NY sample (n = 76). There were no differences in gender distribution, age at tic onset or TD diagnosis, tic severity, proportion with current diagnoses of OCD/OC behavior or attention deficit hyperactivity disorder (ADHD), CBCL internalizing, externalizing, or total problems scores, YGTSS scores, or GAF scores. The observed similarities in demographic features, clinical presentation, rates of ADHD and OCD/OCB, and global impairment may reflect similar phenomenology and illness-related characteristics of TD in these referred youth. Differences in age at initial specialty clinic evaluation and rates of ODD, mood and non-OCD anxiety disorders may need further exploration before they may be considered to reflect cultural factors. Because of these limitations (e.g. small sample size), these results can be regarded only as preliminary.

Core features and associated psychopathology of Tourette syndrome: modifications by cultural aspects?

“…This corresponds to the findings of Samar et al [4] and supports the existence of some ''culturally resistant'' core features of TS. Also, the later referral in BA was reflected in our SAdata (Table 1, age at tic diagnosis, age at tic initial evaluation).…”

“…We agree, since there is a clear yearly wise increase of the rate of these disorders' co-existence with TS [2]. Finally, Samar et al [4]) suggest that their results may be generalized to other referred samples, specifically to those from other TS speciality clinics. Hence, to check this assumption we analyzed a large scale worldwide cross-sectional data set of children and adolescents (N = 5,060) with TS from tertiary centres [1][2][3].…”

“…Specifically, there exists some uncertainty concerning ''culturally sensitive'' features in TS (like depression, anxiety and externalizing problems). The results of Samar et al [4] are not robust in respect to the before mentioned dichotomy. On the one hand, there were significantly higher values in BA vs. NY for ODD, mood disorders and non-OCD-anxiety.…”

“…The difference in ''age at Tic onset'' (SA later) might be a kind of anamnestic precursor of the later referral. So far, some findings of Samar et al [4] may be generalized to other samples of the same cultural difference. The ''culturally sensitive'' feature of later referral in BA and SA samples supports the interpretation of the authors, that in SA the mental health care system for children needs to learn more about TS and its course.…”

“…In accordance with Samar et al [4], we used the same variables (see their Tables 1 and 2) and compared them descriptively between our TS-subsamples from the USA (N = 1,185) and South-America (SA: Argentina N = 62, Brazil N = 32) of our worldwide data set, using group statistics (Chi-square and t test). Results are listed in Table 1 (demographic features) and Table 2 (clinical correlates).…”