Urge-tic associations in children and adolescents with Tourette syndrome

Abstract

Premonitory urges preceding tics are a cardinal feature of Gilles de la Tourette syndrome (GTS), a developmental disorder usually starting during middle childhood. However, the temporal relation between urges and tics has only been investigated in adults. In 25 children and adolescents with GTS (8–18 years), we assess urge-tic associations, including inter-individual differences, correlation to clinical measures, and in comparison to a previously reported sample of adult GTS patients. Group-level analyses confirmed positive associations between urges and tics. However, at the individual level, less than half of participants showed positive associations, a similar proportion did not, and in two participants, the association was reversed. Tic expression and subjective urge levels correlated with corresponding clinical scores and participants with more severe tics during the urge monitor exhibited stronger urge-tic associations. Associations between reported urge levels and instantaneous tic intensity tended to be less pronounced in children and adolescents than in adult GTS patients. The observed heterogeneity of urge-tic associations cast doubt on the notion that tics are directly caused by urges. More severe tics may facilitate anticipation of tics and thereby lead to more pronounced urge-tic associations, consistent with a hypothesis of urges as a byproduct of tics.

Impact of movie and video game elements on tic manifestation in children

“…Modeling premonitory sensory phenomena in children under 10 is challenging due to their limited awareness [37]. The link between urges and immediate tic intensity is weaker in this age group [38]. Moreover, individuals exhibit variable responses to increasing urges, either overexpressing or under‐expressing tics [39], resulting in significant inter‐individual differences in the urge‐tic relationship and temporal lag.…”

“…Modeling premonitory sensory phenomena in children under 10 is challenging due to their limited awareness [37]. The link between urges and immediate tic intensity is weaker in this age group [38].…”

“…38 = 0.21, p = 0.89) or chest type (F 2,38 = 0.15, p = 0.86; H7), or by whether the opponent was allegedly human or bot (t 19 = 0.36, p = 0.72; H8). Tic frequency was neither correlated with the distance between the player's and the leading opponent's tile (z = 1, p = 0.32; H9) nor with a composite measure of the distance between the player's and the opponent's position divided by the distance between the player's tile and the ending point (z = −0.91, p = 0.37; H10).…”

Sensory Phenomenon Assessment Scale (SPAS): a New Tool for Assessment of Tic-associated Sensations

“…These high correlations of theirs may derive from similar neural mechanisms; for example, both motor tic and PU production are correlated with right insula (9), cingulate cortex volume (10). PU is related to the production, duration, and inhibitory control of tics (11,12). Fostering awareness and understanding of PU stands as the foundational and pivotal stage in a well-established behavioral intervention for treating TD, Habit Reversal Training (HRT) (13,14), for example.…”

“…Assessing PU objectively holds signi cance in the examination of TD. Methods devised for evaluating PU encompass both neuropsychological paradigms (11) and assessment scales (15)(16)(17)(18)(19)(20). Neuropsychological paradigms were discouraged in clinical evaluation due to their complexity and high demand for equipment.…”