Year: 1989
Type: article
Abstract: Children and adults evaluated for Tourette's syndrome (TS) by child psychiatrists and pediatric neurologists very commonly suffer from more than motor and phonic tics.Associated difficulties may include hyperactivity and attentional difficulties, obsessions and compulsions, school problems and learning disabilities, immaturity, anxiety and depression, as well as aggressivity and behavioral problems.Some investigators have considered the association between these behavioral problems and TS to be largely coincidental (Shapiro et aI., 1988).Others have felt that some specific difficulties, particularly the obsessions and compulsions, are intrinsically related to the underlying TS vulnerability (Cohen et al., 1982;Pauls and Leckman, 1986).A third group (Comings, 1987; Comings and Comings, 1987, 1988) has argued that the biological predisposition for TS expresses itself in a vast array of behavioral problems, which include conduct disorder, major affective and panic disorders, phobias and other conditions, in addition to those mentioned above.An area of special controversy has focused on the relation between attention-deficit hyperactivity disorder (ADHD) and TS.There have been several types of questions: Do stimulants trigger tics or TS?If so, what is the time course?Does this occur only in individuals who are "genetically" vulnerable to develop tics?Do stimulants exacerbate the tics ofTS?Should children with TS and ADHD be treated with stimulants?If so, under what circumstances?Are there any short-or longterm dangers of stimulant treatment in individuals with TS?If tics worsen with stimulants, is there any harm in simultaneously prescribing medications (such as haloperidol) that could be expected to diminish the tics but at the same time expose children to another major medication?(Shapiro and Shapiro, 1981; Comings and Comings, 1988).Most clinical series of patients with TS show that a high proportion (50 to 60%) of patients aged 6 to 18 years, have coexisting ADHD.In many cases, the symptoms of ADHD and TS are inextricably fused in the child's behavior and in the minds of their parents and teachers.Based on the weight of this clinical experience, some investigators have felt that ADHD can be a prodromal or an earlier manifestation of the TS diathesis (Cohen et aI., 1982;Comings and Comings, 1984).A major advance in the understanding of TS has emerged from family genetic studies that have demonstrated that TS appears to be the result of a single, dominant, autosomal gene.This TS gene has a high degree of penetrance in males, with
Authors: DONALD J. COHEN, JAMES F. LECKMAN
Institution: Yale University
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: hybrid
Estimated APC paid: $3,710
OpenAlex ID: W4247303785