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. 2017 Jul;56(7):610-617.e1.
doi: 10.1016/j.jaac.2017.05.002. Epub 2017 May 11.

Autism Spectrum Symptoms in a Tourette's Disorder Sample

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Free PMC article

Autism Spectrum Symptoms in a Tourette's Disorder Sample

Sabrina M Darrow et al. J Am Acad Child Adolesc Psychiatry. .
Free PMC article

Abstract

Objective: Tourette's disorder (TD) and autism spectrum disorder (ASD) share clinical features and possibly an overlapping etiology. The aims of this study were to examine ASD symptom rates in participants with TD, and to characterize the relationships between ASD symptom patterns and TD, obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD).

Method: Participants with TD (n = 535) and their family members (n =234) recruited for genetic studies reported TD, OCD, and ADHD symptoms and completed the Social Responsiveness Scale Second Edition (SRS), which was used to characterize ASD symptoms.

Results: SRS scores in participants with TD were similar to those observed in other clinical samples but lower than in ASD samples (mean SRS total raw score = 51; SD = 32.4). More children with TD met cut-off criteria for ASD (22.8%) than adults with TD (8.7%). The elevated rate in children was primarily due to high scores on the SRS Repetitive and Restricted Behaviors (RRB) subscale. Total SRS scores were correlated with TD (r = 0.27), OCD (r = 0.37), and ADHD (r = 0.44) and were higher among individuals with OCD symptom-based phenotypes than for those with tics alone.

Conclusion: Higher observed rates of ASD among children affected by TD may in part be due to difficulty in discriminating complex tics and OCD symptoms from ASD symptoms. Careful examination of ASD-specific symptom patterns (social communication vs. repetitive behaviors) is essential. Independent of ASD, the SRS may be a useful tool for identifying patients with TD with impairments in social communication that potentially place them at risk for bullying and other negative sequelae.

Keywords: Tourette's disorder; attention-deficit/hyperactivity disorder; autism; heritability; obsessive-compulsive disorder.

Figures

Figure 1
Figure 1
Social Responsiveness Scales (SRS) raw score distribution among adults and children affected and unaffected by Tourette syndrome (TS). Note: Range of SRS total raw scores for unaffected samples is 23–35, for mixed or non-autism spectrum disorder (ASD) clinical samples, 40–75, and for ASD-affected samples, 86–116, taken from the published literature.
Figure 2
Figure 2
Percent of those meeting Social Responsiveness Scale cut-off score (T-score ≥75) on treatment subscales among adults and children affected and unaffected by Tourette syndrome (TS). Note: Children without TS were excluded due to small numbers (n=10). RRB = restricted interests and repetitive behaviors.
Figure 3
Figure 3
Social Responsiveness Scale (SRS) Total score and DSM-5 subscale scores among Tourette syndrome (TS) sub-phenotypes. Note: letters indicate significant differences between 2 classes (p<.01; a=TS-OCD-ADHD, b=OCD symmetry, c=TS-ADHD, d=tics only, e=unaffected). ADHD = attention-deficit/hyperactivity disorder; ASD = autism spectrum disorder; OCD = obsessive-compulsive disorder; RRB = restricted interests and repetitive behaviors; SCI = social communication and interaction deficits.

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