This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Leckman, J. F.
Right arrow Articles by Peterson, B. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Leckman, J. F.
Right arrow Articles by Peterson, B. S.
Related Collections
Right arrow Neurology & Psychiatry

PEDIATRICS Vol. 102 No. 1 July 1998, pp. 14-19

Course of Tic Severity in Tourette Syndrome: The First Two Decades

Received Jul 22, 1997; accepted Dec 9, 1997.

James F. Leckman*, Heping ZhangDagger , Amy Vitale*, Fatima Lahnin*, Kimberly Lynch*, Colin Bondi*, Young-Shin Kim*, and Bradley S. Peterson*

From the * Child Study Center, the Children's Clinical Research Center, and the Departments of Pediatrics and Psychiatry; and the Dagger  Division of Biostatistics, the Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut.

Objective.  Prevalence studies indicate a 10-fold higher rate of Tourette syndrome (TS) among children compared with adults. The purpose of this investigation was to examine the course of tic severity during the first 2 decades of life.

Method.  A birth-year cohort of 42 TS patients followed at the Yale Child Study Center was recontacted an average of 7.3 years after their initial clinical evaluation. Data concerning the onset and course of tic severity until 18 years of age were available on 36 TS patients. A variety of statistical techniques were used to model aspects of the temporal patterning of tic severity.

Results.  Mean (SD) tic onset at 5.6 (2.3) years of age was followed by a progressive pattern of tic worsening. On average, the most severe period of tic severity occurred at 10.0 (2.4) years of age. In eight cases (22%), the frequency and forcefulness of the tics reached a severe level during the worst-ever period such that functioning in school was impossible or in serious jeopardy. In almost every case this period was followed by a steady decline in tic severity. By 18 years of age nearly half of the cohort was virtually tic-free. The onset of puberty was not associated with either the timing or severity of tics.

Conclusions.  A majority of TS patients displayed a consistent time course of tic severity. This consistency can be accurately modeled mathematically and may reflect normal neurobiological processes. Determination of the model parameters that describe each patient's course of tic severity may be of prognostic value and assist in the identification of factors that differentially influence the course of tic severity.

Key words: Tourette syndrome, natural history, growth curve analysis, puberty.




This article has been cited by other articles:


Home page
 Arch Gen PsychiatryHome page
B. S. Peterson, H. A. Choi, X. Hao, J. A. Amat, H. Zhu, R. Whiteman, J. Liu, D. Xu, and R. Bansal
Morphologic Features of the Amygdala and Hippocampus in Children and Adults With Tourette Syndrome
Arch Gen Psychiatry, November 1, 2007; 64(11): 1281 - 1291.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
D. L. Gilbert
January 9 Highlight and Commentary: Deep brain stimulation for a teen with tics?
Neurology, January 9, 2007; 68(2): 85 - 85.
[Full Text] [PDF]

Home page
 J Child NeurolHome page
J. F. Leckman, M. H. Bloch, L. Scahill, and R. A. King
Tourette Syndrome: The Self Under Siege
J Child Neurol, August 1, 2006; 21(8): 642 - 649.
[Abstract] [PDF]

Home page
 J Child NeurolHome page
L. Scahill, D. G. Sukhodolsky, K. Bearss, D. Findley, V. Hamrin, D. H. Carroll, and A. L. Rains
Randomized Trial of Parent Management Training in Children With Tic Disorders and Disruptive Behavior
J Child Neurol, August 1, 2006; 21(8): 650 - 656.
[Abstract] [PDF]

Home page
 J Child NeurolHome page
C. Gaze, H. O. Kepley, and J. T. Walkup
Co-occurring Psychiatric Disorders in Children and Adolescents With Tourette Syndrome
J Child Neurol, August 1, 2006; 21(8): 657 - 664.
[Abstract] [PDF]

Home page
 J Child NeurolHome page
D. Gilbert
Treatment of Children and Adolescents With Tics and Tourette Syndrome
J Child Neurol, August 1, 2006; 21(8): 690 - 700.
[Abstract] [PDF]

Home page
 The Annals of PharmacotherapyHome page
K. N Fountoulakis, M. Siamouli, S. Kantartzis, P. Panagiotidis, A. Iacovides, and G. S. Kaprinis
Acute Dystonia with Low-Dosage Aripiprazole in Tourette's Disorder
Ann. Pharmacother., April 1, 2006; 40(4): 775 - 777.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
M. H. Bloch, B. S. Peterson, L. Scahill, J. Otka, L. Katsovich, H. Zhang, and J. F. Leckman
Adulthood Outcome of Tic and Obsessive-Compulsive Symptom Severity in Children With Tourette Syndrome
Arch Pediatr Adolesc Med, January 1, 2006; 160(1): 65 - 69.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
H. S. Singer
Discussing Outcome in Tourette Syndrome
Arch Pediatr Adolesc Med, January 1, 2006; 160(1): 103 - 105.
[Full Text] [PDF]

Home page
 ChestHome page
R. S. Irwin, W. B. Glomb, and A. B. Chang
Habit Cough, Tic Cough, and Psychogenic Cough in Adult and Pediatric Populations: ACCP Evidence-Based Clinical Practice Guidelines
Chest, January 1, 2006; 129(1_suppl): 174S - 179S.
[Abstract] [Full Text] [PDF]

Home page
 Behav ModifHome page
L. E. Packer
Tic-Related School Problems: Impact on Functioning, Accommodations, and Interventions
Behav Modif, November 1, 2005; 29(6): 876 - 899.
[Abstract] [PDF]

Home page
 NeurologyHome page
M. H. Bloch, J. F. Leckman, H. Zhu, and B. S. Peterson
Caudate volumes in childhood predict symptom severity in adults with Tourette syndrome
Neurology, October 25, 2005; 65(8): 1253 - 1258.
[Abstract] [Full Text] [PDF]

Home page
 Postgrad. Med. J.Home page
J S Stern, S Burza, and M M Robertson
Gilles de la Tourette's syndrome and its impact in the UK
Postgrad. Med. J., January 1, 2005; 81(951): 12 - 19.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. PsychiatryHome page
K. J. Plessen, T. Wentzel-Larsen, K. Hugdahl, P. Feineigle, J. Klein, L. H. Staib, J. F. Leckman, R. Bansal, and B. S. Peterson
Altered Interhemispheric Connectivity in Individuals With Tourette's Disorder
Am J Psychiatry, November 1, 2004; 161(11): 2028 - 2037.
[Abstract] [Full Text] [PDF]

Home page
 J. Neurol. Neurosurg. PsychiatryHome page
C A Mathews, J Waller, D Glidden, T L Lowe, L D Herrera, C L Budman, G Erenberg, A Naarden, R D Bruun, N B Freimer, et al.
Self injurious behaviour in Tourette syndrome: correlates with impulsivity and impulse control
J. Neurol. Neurosurg. Psychiatry, August 1, 2004; 75(8): 1149 - 1155.
[Abstract] [Full Text] [PDF]

Home page
 Arch Gen PsychiatryHome page
B. S. Peterson, P. Thomas, M. J. Kane, L. Scahill, H. Zhang, R. Bronen, R. A. King, J. F. Leckman, and L. Staib
Basal Ganglia Volumes in Patients With Gilles de la Tourette Syndrome
Arch Gen Psychiatry, April 1, 2003; 60(4): 415 - 424.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. PsychiatryHome page
H. S. Singer, S. Szymanski, J. Giuliano, F. Yokoi, A. S. Dogan, J. R. Brasic, Y. Zhou, A. A. Grace, and D. F. Wong
Elevated Intrasynaptic Dopamine Release in Tourette's Syndrome Measured by PET
Am J Psychiatry, August 1, 2002; 159(8): 1329 - 1336.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
J. Jankovic
Tourette's Syndrome
N. Engl. J. Med., October 18, 2001; 345(16): 1184 - 1192.
[Full Text] [PDF]

Home page
 J Child NeurolHome page
L. Burd, J. Kerbeshian, A. Barth, M. G. Klug, K. Avery, and B. Benz
Long-Term Follow-up of an Epidemiologically Defined Cohort of Patients With Tourette Syndrome
J Child Neurol, June 1, 2001; 16(6): 431 - 437.
[Abstract] [PDF]

Home page
 Arch Gen PsychiatryHome page
B. S. Peterson, L. Staib, L. Scahill, H. Zhang, C. Anderson, J. F. Leckman, D. J. Cohen, J. C. Gore, J. Albert, and R. Webster
Regional Brain and Ventricular Volumes in Tourette Syndrome
Arch Gen Psychiatry, May 1, 2001; 58(5): 427 - 440.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
H. S. Singer, J. Wendlandt, M. Krieger, and J. Giuliano
Baclofen treatment in Tourette syndrome: A double-blind, placebo-controlled, crossover trial
Neurology, March 13, 2001; 56(5): 599 - 604.
[Abstract] [Full Text] [PDF]

Home page
 Arch NeurolHome page
C. H. Kwak, P. A. Hanna, and J. Jankovic
Botulinum Toxin in the Treatment of Tics
Arch Neurol, August 1, 2000; 57(8): 1190 - 1193.
[Abstract] [Full Text] [PDF]

Home page
 J. Neurol. Neurosurg. PsychiatryHome page
S. Chouinard and B. Ford
Adult onset tic disorders
J. Neurol. Neurosurg. Psychiatry, June 1, 2000; 68(6): 738 - 743.
[Abstract] [Full Text] [PDF]

Home page
 BrainHome page
M. M. Robertson
Tourette syndrome, associated conditions and the complexities of treatment
Brain, March 1, 2000; 123(3): 425 - 462.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
M. M. Robertson, S. Banerjee, R. Kurlan, D. J. Cohen, J. F. Leckman, W. McMahon, D. L. Pauls, P. Sandor, and B. J. M. van de Wetering
The Tourette Syndrome Diagnostic Confidence Index: Development and clinical associations
Neurology, December 1, 1999; 53(9): 2108 - 2108.
[Abstract] [Full Text]

Home page
 Evid. Based Ment. HealthHome page
P. Sandor
Tic symptoms in Tourette's syndrome reached their worst level of severity in middle childhood and then declined
Evid. Based Ment. Health, February 1, 1999; 2(1): 24 - 24.
[Full Text]

Home page
 JWatch PsychiatryHome page
The Natural History of Tourette's Syndrome in Children
Journal Watch Psychiatry, September 1, 1998; 1998(901): 17 - 17.
[Full Text]

Home page
 JWatch GeneralHome page
The Natural History of Tourette Syndrome in Children
Journal Watch (General), July 31, 1998; 1998(731): 1 - 1.
[Full Text]