The TAND checklist: a useful screening tool in children with tuberous sclerosis and neurofibromatosis type 1

Abstract

Background Tuberous Sclerosis Complex (TSC) and Neurofibromatosis type 1 (NF1) are neurocutaneous disorders commonly characterized by neuropsychiatric comorbidities. The TAND (Tuberous Sclerosis Associated Neuropsychiatric Disorders) Checklist is currently used to quickly screen for behavioural, psychiatric, intellectual, academic, neuropsychological and psychosocial manifestations in patients with TSC. We administered the authorized Italian version of the TAND Checklist to the parents of 42 TSC patients and 42 age- and sex-matched NF1 patients, for a total of 84 individuals, aged 4–20 years. Aims of this study: - to test the overall usability of the TAND Checklist in NF1, −to compare the results between children and adolescents with TSC and NF1, and -to examine the association between neuropsychiatric manifestations and severity of the phenotype in terms of epilepsy severity in the TSC cohort and disease severity according to the modified version of the Riccardi severity scale in the NF1 cohort. Results TSC cohort: 35.6% had Intellectual Disability (ID), 11.9% Specific Learning Disorders (SLD), 50.0% Attention Deficit Hyperactivity Disorder (ADHD) and 16.6% anxious/mood disorder. 33.3% had a formal diagnosis of Autism Spectrum Disorder (ASD). Paying attention and concentrating (61.9%), impulsivity (54.8%), temper tantrums (54.8%), anxiety (45.2%), overactivity/hyperactivity (40.5%), aggressive outburst (40.5%), absent or delayed onset of language (40.5%), repetitive behaviors (35.7%), academic difficulties (> 40%), deficits in attention (61.9%) and executive skills (50.0%) were the most commonly reported problems. NF1 cohort: 9.5% had ID, 21.4% SLD, 46.6% ADHD, and 33.3% anxious/mood disorder. No one had a diagnosis of ASD. Commonly reported issues were paying attention and concentrating (59.5%), impulsivity (52.4%), anxiety (50.0%), overactivity/hyperactivity (38.1%), temper tantrums (38.1%), academic difficulties (> 40%), deficits in attention (59.5%), and executive skills (38.1%). Neuropsychiatric features in TSC vs NF1: Aggressive outburst and ASD features were reported significantly more frequently in TSC than in NF1. Neuropsychiatric manifestations and phenotype severity: Depressed mood, absent or delayed onset of language, repetitive language, difficulties in relationship with peers, repetitive behaviors, spelling, mathematics, dual-tasking, visuo-spatial tasks, executive skills, and getting disoriented were significantly different among TSC patients with different epilepsy severity. No statistically significant differences in the NF1 subgroups were noted for any of the items in the checklist. Conclusion The TAND Checklist used for TSC is acceptable and feasible to complete in a clinical setting, and is able to detect the complexity of neuropsychiatric involvement in NF1 as well. NF1 is mainly characterized by an ADHD profile, anxiety problems and SLD, while ASD features are strongly associated with TSC. In conclusion, the TAND Checklist is a useful and feasible screening tool, in both TSC and NF1.

Epilepsy in adult patients with tuberous sclerosis complex

“…As a result, neuropsychiatric complications may remain underdiagnosed even in expert centres. 40 For these purposes, a wider diffusion of easy to use tools, such as the TAND-Checklist (https://www.tscin terna tional.org/wpconte nt/uploa ds/2018/11/TAND_check list-2014.pdf), is mandatory in this population. Our results strongly support the need for specialized teams who can diagnose and treat such comorbidities, and warrant the implementation of programmes dedicated to giving the opportunity to treat such comorbidities.…”

Comparing Advanced with Basic Telerehabilitation Technologies for Patients with Rett Syndrome—A Pilot Study on Behavioral Parameters

“…All attended schools or socio-educational centers. A general assessment was carried out by a psychologist using the Vineland Adaptive Behavior Scale (VABS) [ 32 ] and the Rett Assessment Rating Scale (RARS) [ 33 , 34 , 35 , 36 ]. Table 1 shows the characteristics of the groups.…”

“…The total alpha was 0.912, and the internal consistency of the sub-scales is high (from 0.811 to 0.934). GAIRS [ 30 ] is a global assessment and intervention rating scales checklist for Rett syndrome coming from the items of assessment in multi-disability disorders [ 17 , 27 , 33 , 34 , 35 , 37 , 38 , 39 ] that was adapted for Rett syndrome. Through a global analysis, it gives an overview of the different areas and is intended for use in the functional analysis of the overall abilities of the patient.…”

The GAIRS Checklist: A Useful Global Assessment Tool In Patients With Rett Syndrome

“…GAIRS is a global assessment and intervention rating scales checklist for Rett syndrome with items coming from the items of assessment in multi-disability disorders [33] adapted to Rett syndrome [31,32,28,43,29,27]. Tthrough a global analysis, it gives an overview of the different areas and is intended for use in a functional analysis of the overall abilities of the patient.…”