Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic Universitari, c/ Villarroel 170, Section 11 Floor 3, 08036, Barcelona, Spain.
Departments of Psychology and Research Institute on Health Sciences, University of the Balearic Islands, Palma, Spain.
Eur Child Adolesc Psychiatry. 2022 Oct;31(10):1539-1548. doi: 10.1007/s00787-021-01751-4. Epub 2021 May 4.
Tic disorders have a strong male predominance, with a male-to-female ratio of 4:1 in Tourette syndrome (TS) and 2:1 in persistent tic disorders. In other neurodevelopmental conditions, such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), the disparity in sex distribution has been partially related to differences in symptom presentation between males and females. In tic disorders, however, little research has been conducted on this topic, probably due to the limited access to large samples with a significant proportion of females. The aim of this study was to describe sex differences in the clinical presentation of tic disorders in children and adolescents in one of the largest pediatric samples with TS/persistent tic disorders (n = 709, 23.3% females) recruited as part of the European Multicenter Tics in Children Study (EMTICS). Validated measures assessed the severity of tics and comorbid psychiatric symptoms. Using mixed-effect models, we found that sex had a significant influence on the severity of tics, ADHD symptoms, ASD symptoms, and emotional problems. Males had more severe symptoms than females, except for emotional problems. We also observed a statistically significant interaction between sex and age on the severity of tics and compulsions, with females showing higher symptom severity with increasing age than males. These findings indicate that the clinical presentation of TS/persistent tic disorders varies with sex. Males seem to exhibit a more noticeable pattern of clinical symptoms at a younger age that may contribute to their earlier detection in comparison to females.
抽动障碍男性患病率明显高于女性，图雷特综合征（TS）男女患病率之比为 4:1，持续性抽动障碍为 2:1。在其他神经发育障碍中，如自闭症谱系障碍（ASD）和注意缺陷多动障碍（ADHD），性别分布的差异部分与男女症状表现的差异有关。然而，在抽动障碍中，针对这一主题的研究较少，这可能是由于难以获得具有大量女性样本的情况下进行研究。本研究旨在描述儿童和青少年抽动障碍临床特征的性别差异，该研究纳入了欧洲儿童多发性抽动症研究（EMTICS）中的最大儿科样本之一（n=709，女性占 23.3%）。采用经过验证的测量工具评估抽动和共患精神症状的严重程度。使用混合效应模型，我们发现性别对抽动、ADHD 症状、ASD 症状和情绪问题的严重程度有显著影响。男性的症状比女性更严重，除了情绪问题。我们还观察到性别和年龄对抽动和强迫症严重程度的交互作用具有统计学意义，女性的症状严重程度随年龄增长比男性更高。这些发现表明，TS/持续性抽动障碍的临床表现存在性别差异。与女性相比，男性在年龄较小的时候可能表现出更明显的临床症状模式，这可能有助于他们更早地被发现。
