For children with Tourette syndrome (TS), tics associated with the disorder are likely to attenuate over time, investigators have found, but obsessive-compulsive disorder (OCD) symptoms may be more persistent.

"Thus, educating patients and their parents about the possibility of developing clinically significant OCD symptoms at a point later in childhood and adolescence, even if OCD symptoms are not evident at the time of initial evaluation, may be important," say Michael Bloch (Yale University School of Medicine, New Haven, Connecticut, USA) and colleagues.

The researchers conducted a structured clinical evaluation of 46 children with TS when aged an average of 11.4 years. Tic and OCD symptom severity was then measured at a follow-up interview an average of 7.6 years later.

On average, the participants experienced their worst-ever tics when aged 10 to 11 years, but most experienced a marked attenuation of tic severity during adolescence. Just 22% continued to experience mild or greater tic symptoms at the second interview, as indicated by a Yale Global Tic Severity Scale (YGTSS) score of 10 or above, while nearly a third of participants had a complete remission of their tic symptoms.

The only childhood clinical measure that predicted increased tic severity at follow-up was greater tic severity at the first interview.

As tic symptoms are likely to decrease during adolescence, Bloch and team suggest that support and tolerance from family, teachers, peers, and healthcare professionals may reduce or eliminate the need for exposure to medications.

In contrast, OCD symptoms reached their worst severity at around 12 to 13 years of age, with the majority of patients who had OCD symptoms at follow-up reporting the onset of such symptoms in late childhood or early adolescence.

Bloch et al report in the Archives of Pediatrics and Adolescent Medicine that IQ was strongly associated with the subsequent development of OCD symptoms in children with TS.

Indeed, the risk of clinically significant OCD symptoms by early adulthood was eight-times higher for children with an IQ of 120 compared with those with an IQ of 100.

The researchers say that "periodic monitoring for OCD symptoms after the initial evaluation by experts in tic disorders and OCD may be warranted, given the importance that OCD symptoms have in contributing to later psychosocial functioning."

Arch Pediatr Adolesc Med 2006; 160: 65-69

Thanks to Psychlinks for bringing his article to our attention