Umberto Balottin

19 Impact of co-morbid attention-deficit and hyperactivity disorder on cognitive function in male children with tourette syndrome: a controlled study

Objective Neuropsychological studies have highlighted the presence of specific cognitive deficits in two neurodevelopmental disorders affecting more commonly male children and often presenting in co-morbidity, Tourette syndrome (TS) and attention-deficit and hyperactivity disorder (ADHD). It is estimated that over 60% of children with TS present with co-morbid ADHD and the assessment of the relative contribution of tic symptoms and ADHD symptoms to cognitive problems in this patient population poses considerable challenges. We set out to determine the impact of co-morbid ADHD on cognitive function in male children with TS by conducting a controlled study with a comprehensive battery of neuropsychological tests. Method Participants included four groups of unmedicated age- and gender-matched children (mean age 10–12u2009years, range 6–15u2009years; 85%–100%u2009male gender): TS group (n=13u2009children with a diagnosis of uncomplicated or ‘pure’ TS), TS+ADHD group n=8u2009children with TS and co-morbid ADHD), ADHD group (39 children with ADHD in the absence of tics) and controls n=66u2009healthy children). All patients had a DSM-validated diagnosis and were recruited from the Child Neuropsychiatry Unit, Varese, Italy, whereas healthy controls were randomly selected from a pool of research volunteers from local schools. Following clinical assessment, each participant completed a standardised battery of neuropsychological tests: the Wechsler Intelligence Scale for Children-III (Block Design test, Vocabulary test), Italian Battery for ADHD (Walk-Don’t Walk test, Sustained Auditory Attention test, Stroop test, Sentence Completion test, Matching Familiar Figures test, Sustained Visual Attention test), Tower of London test, Corsi test, and Digit Span test. Results All patient groups reported significantly lower scores than healthy controls across the neuropsychological tests involving executive functions. A specific pattern in cognitive performances emerged, showing that the TS+ADHD group was the most severely affected, followed by the ADHD group and the TS group. This was particularly evident from the results of the tests assessing planning ability (Block Design test, Matching Familiar Figures test, Tower of London test), inhibitory function (Walk-Don’t Walk test, Stroop test, Matching Familiar Figures test), working memory (Sustained Auditory Attention test, Corsi test, Digit Span test) and visual attention (Walk-Don’t Walk test, Matching Familiar Figures test, Sustained Visual Attention test), but not auditory attention (Sustained Auditory Attention test). Conclusion Although problems in executive functions are more common in all patient groups than healthy controls, deficits in planning ability, inhibitory function, working memory and visual attention reported by children with TS appear to be more strongly related to the presence of co-morbid ADHD symptoms.

PA.12 A controlled study of mother–child agreement on behavioural symptoms in Tourette Syndrome

Aims Tourette syndrome (TS) is increasingly recognised as a neurodevelopmental disorder associated with a spectrum of behavioural problems. We conducted a case-control study to compare childrens self-report measures of behavioural symptoms with their parents ratings. Methods Our sample consisted of 28 patients (25 males; mean age 14.1u2005years; range 12.0–18.1u2005years) diagnosed with TS according to DSM-IV criteria, and a control group of 61 subjects randomly chosen among sex- and age-matched school peers. All parents completed the Child Behaviour Checklist (CBCL) and the Conners Parents Rating Scales-R (CPRS-R) for ADHD; all children completed the Youth Self Report (the self assessment version of CBCL). We carried out the following comparisons: TS parents vs controls parents (CBCL and CPRS-R); TS children vs control children (YSR); TS parents vs TS children (CBCL vs YSR), and controls’ parents vs control children (CBCL vs YSR). Results Children with TS show higher scores on various subscales of the CBCL compared with control subjects (eg, Total Problems: 70.0±8.6 vs 49.1±8.9, p<0.001; Internalising Scale: 58.1±9.7 vs 51.9±9.4, p=0.005; Externalising Scale: 56.5±9.1 vs 47.2±8.1, p<0.001) and consider themselves more symptomatic than sex- and age-matched school peers on the YSR Problems and Competences Scales (eg, Problem Scales: Tought 53.0±4.6 vs 52.2±6.2, p=0.027; Attention 61.2±10.1 vs 54.0±6.2, p=0.001; Competence Scales: Total 42.9±10.2 vs 49.9±9.3, p=0.002; Social 46.0±7.2 vs 48.8±7.2, p=0.033; 2.3±0.6 vs 2.6±0.4, p=0.002). However, their own reports of behavioural problems are significantly lower than their parents reports (eg, CBCL/YSR total scores: 53.4±11.2 vs 61.0±8.6, p=0.001). Conclusions Parents ratings (CBCL) identify more behavioural symptoms than childrens self-report measures (YSR). However, self-report measures such as the YSR are useful in highlighting the areas where children with TS feel more problematic than controls, including social interactions and relationships with peers.

PA.09 Self- and proxy-reported measures of behavioural symptoms in young patients with Tourette syndrome: A Controlled Study

Aims Tourette syndrome (TS) is a neurodevelopmental disorder characterised by multiple tics and associated with co-morbid behavioural problems (TS-plus). We investigated the usefulness of self-report vs parent- and teacher-report instruments in assisting the specialist assessment of TS-plus in a child/adolescent population. Methods Twenty-three patients diagnosed with TS (19 males; age 13.9±3.7u2005years) and 69 matched healthy controls participated in this study. All recruited participants completed a standardised psychometric battery, including the Childrens Depression Inventory (CDI), the Self Administrated Psychiatric Scales for Children and Adolescents (SAFA) and the State–Trait Anger Expression Inventory (STAXI). Parents completed the Child Behavior Checklist (CBCL) and Conners Parent Rating Scales–Revised (CPRS-R). Participants teachers completed the Conners Teacher Rating Scales–Revised (CTRS-R). Results were compared with similar data obtained from controls. Results Nineteen patients (82.6%) fulfilled DSM-IV-TR criteria for at least one co-morbid condition: obsessive-compulsive disorder (OCD, n=8; 34.8%); attention deficit-hyperactivity disorder (ADHD, n=6; 26.1%); OCD+ADHD (n=5; 21.7%). Scores on self-report instruments failed to show any significant differences between TS and controls. Most subscores of the CPRS-R, CTRS-R, and CBCL were significantly higher for the TS group than controls. The TS+OCD subgroup scored significantly higher than the TS-OCD subgroup on the CBCL-Externalising, Anxious/Depressed and Obsessive-Compulsive subscales. Conclusions Self-report instruments appear to have limited usefulness in assisting the assessment of the behavioural spectrum of young patients with TS. However, proxy-rated instruments differentiate TS populations from healthy subjects, and the CBCL can add relevant information to the clinical diagnosis of co-morbid OCD.