Children and Their Parents' Perceptions of Symptom Severity and Treatment Preference for Tourette Syndrome
Ghanizadeh, Ahmad, Mohammadi, Mohammad-Reza, Dehbozorgi, Gholam Rreza, Iranian Journal of Psychiatry
Objective: This study surveys children and their parents' perceptions, and their treatment preference of significant/bothersome symptoms in children with Tourette syndrome.
Methods: Thirty five children and adolescents who referred to an out-patient clinic of a Child Psychiatry Clinic were selected as subjects for this study. The children and their parents were interviewed about their perception of significant/bothersome symptoms of motor tics, vocal tics, learning difficulties, attention deficit disorder, hyperactivity, obsessions, compulsions, and rage attacks.
Results: About two thirds of the subjects had symptom of rage. Inattentiveness and hyperactivity were observed in more than half of the children. There was a statistically significant difference between parents and their children in frequency of motor tics and rage attacks . Children reported the necessity for controlling and management of these symptoms less than their parents.
Discussion: The rates of motor, vocal tics and rage attacks in the Iranian sample are similar to other studies. Rage attack is one of the most common significant/bothersome symptoms reported that should be treated. While motor tics were not rated among the most common features that should be treated in a study in Canada, it was the most common significant/bothersome symptom in Iran. Parents perceive motor tics and rage attacks as more significant/bothersome symptoms compared to children.
Keywords: Attitude, Child, Iran, Parent, Tourette syndrome
Iran J Psychiatry 2010; 5:93-96
Tics are only part of the picture of Tourette syndrome (TS). In TS, motor and phonic tics have persisted for at least more than a year. The age of onset for tics is usually between 5 and 6 years of age (1) . The peak of tic severity is usually between 10 and 12 years of age (2). Another study reported that the age at the onset of tics was 7.6±3.5 years, and the mean delay in diagnosis of TS was about 3.9 years (3). About 29% of the patients had anger control problem (3).
Of course, most patients with TS have only minimal symptoms that do not interfere with their daily functioning (4). In many children with TS, the associated behavioral problems are more impairing than their tics (5). A study on 12 children with TS suggests that rage attack is related to the presence of co-morbid disorders (6). Socially inappropriate behaviors, such as arguing or insulting others are more common in children with TS (7). Even children with TS-only have a broad range of behavioral problems and some of these problems are related to the severity of tic symptoms (8). Aggressive behavior is independent of tic severity or age (4). In addition, about two-thirds of children with TS have co-morbid ADHD, conduct disorder, or oppositional defiant disorder (9). More aggressive behavior in children with TS is associated with co-morbid ADHD or OCD.
Therefore, the presence of explosive outbursts in children with TS should alert the clinicians to evaluate the presence of underlying co-morbid conditions (10). A study on 138 children with TS showed that the rate of a specific learning disorder was 22% , and tics were not a predictor of academic problems. They reported that the school-related difficulties are associated with co-morbid attention-deficit hyperactivity disorder (11). Therefore, the co-occurring problems should be considered and managed in these children.
Tourette severity affects parenting stress (12). One of the most difficult problems to be controlled in children with TS is the outburst of rage (6). Parents report that problems related to ADHD and LD are the most difficult problems in TS (13). More than half of the children with TS experience serious difficulties in emotional-behavioral interactions (14). Families often report that aggression (rage) is more disruptive than tics (13). Thus, parent-child interaction is not easy for the parents. Meanwhile, it is very important for children with TS to be understood and accepted by their family members (2). …