(PS9-52) Evaluation of Psychiatric Comorbidity in Young Adults with Tic Disorders who Received the Comprehensive Behavioral Intervention for Tics as Children

Abstract Text:

Objective: Chronic Tic disorders (CTDs) are neurodevelopmental conditions characterized by the presence of sudden, rapid, recurrent, nonrhythmic motor movements and/or vocalizations. CTDs characteristically co-occur with psychiatric illness in childhood, most commonly ADHD, OCD and non-OCD anxiety disorders. The current study is a cross-sectional evaluation of psychiatric comorbidity in the largest, best characterized sample of young adults who previously received non-pharmacological treatment for CTDs.

Methods: A subset of the child and adolescent participants (n = 126) from the Comprehensive Behavioral Intervention for Tics study (CBIT; Piacentini et al., 2010) were recontacted. Successfully recontacted participants (n=80; 63.4%) were young adults with an average age of 22.87 (SD = 2.70) years who completed all study procedures at long term follow-up (LTF, M = 11.17 years, SD = 1.25). At LTF, participants completed various dimensional variables of tic severity and psychiatric comorbidity. Participants also completed structured clinical interviews conducted by trained evaluators. Descriptive analyses, correlational analyses, t-tests, and Fisher’s exact test were used to evaluate tic severity and psychiatric comorbidities at LTF.

Results: There were no significant differences found in baseline clinical characteristics between those who chose, or declined, to participate in the LTF (Espil, 2021). The majority (52.5%, n = 42) of the sample had one or more psychiatric comorbidities. For participants who did have comorbidities at LTF, the number of comorbidities was positively correlated with tic severity (r = .29, p < .01). The most commonly observed comorbidities at LTF were social anxiety (16.3%), substance abuse (15%), alcohol abuse (13.8%), and ADHD (13.9%).

Conclusion: Although more commonly observed in children (64%), the current study confirms high rates of co-occurring psychiatric conditions in individuals with CTDs in young adulthood. ADHD and social anxiety were reported comorbidities during both childhood and young adulthood, while substance and alcohol abuse were newly identified comorbidities in adulthood. Common comorbidities reported during childhood, including social phobia, generalized anxiety disorder, and OCD, were surprisingly uncommon in young adults. Infrequent early childhood disorders, including separation anxiety disorder, oppositional defiant disorder, and enuresis had remitted as anticipated. While CBIT has been successful in reducing tic severity, it does not directly address comorbidity. Therefore, it is imperative to evaluate and treat psychiatric conditions that co-occur with CTDs. Treatment plans that fail to identify and address comorbid psychiatric conditions can result in greater morbidity and poorer functional outcomes. Future research directions should include more closely examining environmental factors, major life events, and treatment seeking behavior of participants in the interim period between original characterization and LTF to more comprehensively understand why certain comorbidities persist and develop.