Chronic Tic Disorders in Youth: Clinical Phenotypes and Response to Pharmacological Treatment with Aripiprazole.

BACKGROUND/OBJECTIVES: Tic disorders are neurodevelopmental conditions often associated with comorbidities like attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Our aims were: (a) in a sample of youth with tic disorders to explore the clinical and psychopathological characteristics of different phenotypes based on the presence of comorbid ADHD and/or ASD and gender; (b) in a subgroup of patients treated with Aripiprazole, to evaluate symptoms variation over time and to identify potential predictors of response.

METHODS

A total of 95 subjects with tic disorders (age range 6 to 17.9 years, mean 11.1 ± 2.11 years, 80 males) were naturalistically recruited. Questionnaires and semi-structured interviews were administered to assess the symptomatology and investigate the presence of psychiatric comorbidities (Clinic Global Impression-Severity (CGI-S), Children's Global Assessment Scale (C-GAS), Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale (PUTS), Child Yale-Brown Obsessive Compulsive Scale for Children (CYBOCS), Child Behavior Checklist 6-18 (CBCL 6-18), Conners' Parent Rating Scale-Revised-short form (CRSR-S), Reactivity Intensity Polarity Stability Questionnaire-youth version (RIPoSt-Y), and Social Communication Questionnaire-lifetime version (SCQ); Autism Diagnostic Observation Scale-second version (ADOS-2) and Autism Diagnostic Interview-revised version (ADI-R) were administered where ASD was suspected). A total of 22 subjects treated with Aripiprazole were reassessed through the use of some of the clinical measures used at baseline.

RESULTS

The presence of ADHD was associated with higher externalizing problem scores on the CBCL 6-18, while ASD was linked to higher internalizing problem scores. A positive correlation was found between the ADHD-ASD interaction and increased internalizing symptoms on CBCL 6-18 and higher ADOS-2 scores. Patients treated with Aripiprazole showed significant improvement across all scales during follow-up. ADHD was identified as a negative predictor of reduced tic severity on the YGTSS.

CONCLUSIONS

Comorbid neurodevelopmental disorders, such as ADHD or ASD, result in worse emotional and behavioral functioning in patients with tic disorders. ADHD-ASD interaction may be linked to more internalizing symptoms and autistic behaviors. Aripiprazole improves overall clinical outcomes, although comorbid ADHD may hinder the reduction of tic symptoms.