Vermilion Jennifer A, Bitsko Rebecca H, Danielson Melissa L, Bonifacio Kristen P, Dean Shannon L, Hyman Susan L, Augustine Erika F, Mink Jonathan W, Morrison Peter E, Vierhile Amy E, Sulkes Stephen B, van Wijngaarden Edwin, Adams Heather R
Department of Neurology, Division of Child Neurology, University of Rochester Medical Center (URMC), Rochester, NY.
Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
Evid Based Pract Child Adolesc Ment Health. 2024;9(2):245-261. doi: 10.1080/23794925.2023.2272948. Epub 2023 Nov 8.
Youth with intellectual and developmental disabilities typically have higher rates of tics and stereotypies compared to children with otherwise typical development. Differentiating between these two pediatric movement disorders can be challenging due to overlapping clinical features, but is relevant due to distinct treatment modalities. The current study evaluated sensitivity and specificity of a tic screening measure, the Motor or Vocal Inventory of Tics (MOVeIT) in a pediatric sample enriched for stereotypy and tics. Children (n=199, age 2-15 years old) receiving care in a developmental-behavioral pediatrics clinic underwent a gold-standard diagnostic assessment by a tic expert; these evaluations were compared to the MOVeIT. The MOVeIT demonstrated good sensitivity (89.8%) and relatively lower specificity (57.1%) compared to tic expert for detecting tics in the overall sample. Specificity of the MOVeIT to identify tics improved to 75% when excluding children with co-occurring stereotypy. For children with tics and co-occurring stereotypy, sensitivity remained high (91.9%) but specificity was low (39.1%). The area under the curve (AUC) value to detect tics on the MOVeIT compared to the tic expert gold standard was significantly higher for children without stereotypy (AUC=85.7%) than those with stereotypy (AUC=64.3%, p <0.01). Overall, the ability to detect tics was better in those without co-occurring stereotypy symptoms. Further work is needed to establish the utility of the MOVeIT in populations where there is a high likelihood of co-occurring tics and stereotypy and in general population settings. Accurate distinction between tics and stereotypy will guide choices for intervention and anticipatory guidance for families.
与发育正常的儿童相比，患有智力和发育障碍的青少年通常有更高的抽搐和刻板动作发生率。由于临床特征重叠，区分这两种儿科运动障碍可能具有挑战性，但由于治疗方式不同，这一点很重要。本研究评估了抽动筛查量表——抽动运动或发声量表（MOVeIT）在一个富含刻板动作和抽动的儿科样本中的敏感性和特异性。在发育行为儿科诊所接受治疗的儿童（n = 199，年龄2至15岁）由抽动症专家进行了金标准诊断评估；这些评估结果与MOVeIT进行了比较。与抽动症专家相比，MOVeIT在检测总体样本中的抽动方面表现出良好的敏感性（89.8%）和相对较低的特异性（57.1%）。排除同时患有刻板动作的儿童后，MOVeIT识别抽动的特异性提高到75%。对于同时患有抽动和刻板动作的儿童，敏感性仍然很高（91.9%），但特异性很低（39.1%）。与抽动症专家的金标准相比，MOVeIT检测抽动的曲线下面积（AUC）值在没有刻板动作的儿童中（AUC = 85.7%）显著高于有刻板动作的儿童（AUC = 64.3%，p <0.01）。总体而言，在没有同时出现刻板动作症状的儿童中，检测抽动的能力更好。需要进一步开展工作，以确定MOVeIT在抽动和刻板动作同时出现可能性较高的人群以及一般人群中的效用。准确区分抽动和刻板动作将指导干预选择和为家庭提供预期指导。
