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ObjectiveTreatment guidelines for Tourette's Disorder (TD) are based on patients' degree of tic severity and impairment. However, clear benchmarks for determining tic severity and impairment have not been established. This study examined benchmarks of tic severity and tic impairment using the Yale Global Tic Severity Scale (YGTSS) and the Clinical Global Impression of Severity (CGI-S).MethodIndividuals with TD or another Tic Disorder (N = 519) recruited across nine sites were administered a diagnostic interview, the YGTSS, and the CGI-S. Correlations and trend analyses contrasted YGTSS scores across CGI-S ratings. A logistic regression model examined predictive benchmarks for tic severity, tic impairment, and global severity. Model classifications were compared against CGI-S ratings, and agreement was examined using kappa.ResultsSpearman correlations between the CGI-S and YGTSS scores ranged from 0.54 to 0.63 (p

ObjectiveTo examine the internal consistency and distribution of the Yale Global Tic Severity Scale (YGTSS) scores to inform modification of the measure.MethodsThis cross-sectional study included 617 participants with a tic disorder (516 children and 101 adults), who completed an age-appropriate diagnostic interview and the YGTSS to evaluate tic symptom severity. The distributions of scores on YGTSS dimensions were evaluated for normality and skewness. For dimensions that were skewed across motor and phonic tics, a modified Delphi consensus process was used to revise selected anchor points.ResultsChildren and adults had similar clinical characteristics, including tic symptom severity. All participants were examined together. Strong internal consistency was identified for the YGTSS Motor Tic score (α = 0.80), YGTSS Phonic Tic score (α = 0.87), and YGTSS Total Tic score (α = 0.82). The YGTSS Total Tic and Impairment scores exhibited relatively normal distributions. Several subscales and individual item scales departed from a normal distribution. Higher scores were more often used on the Motor Tic Number, Frequency, and Intensity dimensions and the Phonic Tic Frequency dimension. By contrast, lower scores were more often used on Motor Tic Complexity and Interference, and Phonic Tic Number, Intensity, Complexity, and Interference.ConclusionsThe YGTSS exhibits good internal consistency across children and adults. The parallel findings across Motor and Phonic Frequency, Complexity, and Interference dimensions prompted minor revisions to the anchor point description to promote use of the full range of scores in each dimension. Specific minor revisions to the YGTSS Phonic Tic Symptom Checklist were also proposed.

We investigated the presentation and correlates of hoarding behaviors in 204 children aged 7-13 with autism spectrum disorder (ASD) and comorbid anxiety or obsessive-compulsive disorder (OCD) symptoms. Approximately 34% of the sample presented at least moderate levels, and with 7% presenting severe to extreme levels of hoarding. Child gender predicted hoarding severity. In addition, child ASD-related social difficulties together with attention-deficit and hyperactivity disorder symptom severity positively predicted hoarding controlling for child gender and restricted and repetitive behaviors. Finally, child anxiety/OCD symptoms positively predicted hoarding, controlling for all other factors. These results suggest hoarding behaviors may constitute a common feature of pediatric ASD with comorbid anxiety/OCD, particularly in girls and children with greater social difficulties and comorbid psychiatric symptom severity.

We evaluated the construct validity of the Child Yale-Brofwn Obsessive-Compulsive Scale (CYBOCS) in a large clinical sample (N=730) using confirmatory factor analysis. Results found inadequate fit for a priori models, though a model accounting for overlapping item content displayed good fit. Parallel obsessions/compulsions items may provide largely redundant information on the CYBOCS. Findings suggest modifying the CYBOCS to reduce burden on researchers, patients, and clinicians, and to more accurately measure pediatric obsessive-compulsive disorder (OCD).

Clinically elevated anxiety is a common, impairing feature of autism spectrum disorders (ASD). A modular CBT program designed for preteens with ASD, Behavioral Interventions for Anxiety in Children with Autism (BIACA; Wood et al., 2009) was enhanced and modified to address the developmental needs of early adolescents with ASD and clinical anxiety. Thirty-three adolescents (11-15 years old) were randomly assigned to 16 sessions of CBT or an equivalent waitlist period. The CBT model emphasized exposure, challenging irrational beliefs, and behavioral supports provided by caregivers, as well as numerous ASD-specific treatment elements. Independent evaluators, parents, and adolescents rated symptom severity at baseline and posttreatment/postwaitlist. In intent-to-treat analyses, the CBT group outperformed the waitlist group on independent evaluators' ratings of anxiety severity on the Pediatric Anxiety Rating Scale (PARS) and 79% of the CBT group met Clinical Global Impressions-Improvement scale criteria for positive treatment response at posttreatment, as compared to only 28.6% of the waitlist group. Group differences were not found for diagnostic remission or questionnaire measures of anxiety. However, parent-report data indicated that there was a positive treatment effect of CBT on autism symptom severity. The CBT manual under investigation, enhanced for early adolescents with ASD, yielded meaningful treatment effects on the primary outcome measure (PARS), although additional developmental modifications to the manual are likely warranted. Future studies examining this protocol relative to an active control are needed.

Symptoms of autism spectrum disorder may influence alliance in psychotherapy. This study examined therapeutic alliance and its relationship with child characteristics and anxiety treatment outcomes in youth with autism spectrum disorder. Youth (N = 64) with autism spectrum disorder and co-occurring anxiety (7-16 years, IQ > 70) received 16 sessions of modular cognitive-behavioral therapy. Post-treatment therapist, youth and parent ratings of alliance as well as pre- and post-treatment ratings of child behavior were gathered. Ratings of alliance were commensurate to ratings seen in children without autism spectrum disorder. Measures of treatment outcome, but not pretreatment characteristics, were significantly associated with therapist ratings of alliance strength. Data suggest that therapeutic alliance may not be impaired in anxious youth with autism spectrum disorder and may be associated with treatment outcome.

This study combines data from five studies in a quantitative modeling approach to improve identification of tics and tic disorders using two questionnaires (the Motor or Vocal Inventory of Tics and the Description of Tic Symptoms), administered to parents and children (N = 1,307). Combining final diagnoses (positive or negative for tic disorder) with data from recently developed questionnaires implemented to assist in the identification of tics and tic disorders in children, we investigate methods for predicting positive diagnosis while also identifying which items in the questionnaires are most predictive. Logistic regression and random forest models are compared using various summary statistics. We further discuss the differences in errors (false positives versus false negatives) in the specification of predictive model tuning parameters. Compared to logistic regression models, random forest models provided comparable and often superior predictive abilities and were also more useful in summarizing the contributions to predictions from individual questions. The combined analyses identified a subset of screener questions that were the best predictors of tic disorders; the identified questions differed based on parent or self-report. These results provide information to inform the future development of tools to screen for tics in a variety of healthcare and epidemiological settings. [ABSTRACT FROM AUTHOR]

Tics are unwanted, repetitive movements and sounds that frequently present during childhood. They are typically brief and purposeless, but can create significant distress for individuals, and often co-occur with other neuropsychiatric conditions. Thus, early identification of tics is warranted. Unfortunately, tics are often misdiagnosed, and because tics may wax and wane, identification can be difficult, especially in the context of routine clinical visits. There are limited tools that can be used to reliably identify tics in clinical practice, especially in non-specialty settings. The purpose of the current study was to evaluate the performance of the Motor tic, Obsession and compulsion, and Vocal tic Evaluation Survey (MOVES), a self-report scale with some support as a screening tool. In addition, the performance of a subset of questions (the MOVES-6) was evaluated for rapid screening. Participants were recruited across two study sites and included children and adolescents diagnosed with Tourette syndrome (n = 151) or another persistent tic disorder (n = 10) and community controls (n = 74). Results suggest that both MOVES and the MOVES-6 have high sensitivity (90% and 88%, respectively) and at least acceptable specificity (77% and 86%, respectively) compared with expert assessment of tic disorders, suggesting that both versions can identify tic disorders without high proportions of false negatives. Both versions were highly sensitive with acceptable specificity regardless of sex, race/ethnicity, and age. The MOVES and MOVES-6 show promise as a screener for tics or tic disorders, but additional research is needed, particularly in a general population setting. [ABSTRACT FROM AUTHOR]

The present study examines the influence of diagnostic comorbidity on the demographic, psychiatric, and functional status of youth with a primary diagnosis of obsessive compulsive disorder (OCD). Two hundred and fifteen children (ages 5–17) referred to a university-based OCD specialty clinic were compared based on DSM-IV diagnostic profile: OCD without comorbid anxiety or externalizing disorder, OCD plus anxiety disorder, and OCD plus externalizing disorder. No age or gender differences were found across groups. Higher OCD severity was found for the OCD + ANX group, while the OCD + EXT group reported greater functional impairment than the other two groups. Lower family cohesion was reported by the OCD + EXT group compared to the OCD group and the OCD + ANX group reported higher family conflict compared to the OCD + EXT group. The OCD + ANX group had significantly lower rates of tic disorders while rates of depressive disorders did not differ among the three groups. The presence of comorbid anxiety and externalizing psychopathology are associated with greater symptom severity and functional and family impairment and underscores the importance of a better understanding of the relationship of OCD characteristics and associated disorders. Results and clinical implications are further discussed.

Obsessive-compulsive disorder (OCD) presents heterogeneously and can be difficult to assess in youth. This review focuses on research-supported assessment approaches for OCD in childhood. Content areas include pre-visit screening, diagnostic establishment, differential diagnosis, assessment of comorbid psychiatric conditions, tracking symptom severity, determining psychosocial functioning, and evaluating clinical improvement. Throughout this review, similarities and differences between assessment approaches geared towards clinical and research settings are discussed.

This study examined optimal guidelines to assess treatment response and remission for anxiety in youth with autism spectrum disorders (ASD) using the Pediatric Anxiety Rating Scale (PARS). Data was collected for 108 children aged 7-16 years with comorbid anxiety and ASD before and after receiving cognitive behavior therapy. Optimal cut-offs on the PARS were assessed using signal detection analyses using receiver operating characteristic methods. Maximum agreement with response criteria was achieved at 15% reduction in symptoms on the PARS. Maximum agreement with remission criteria was achieved at 40% reduction in symptoms, or at a score of 10 or below at post-treatment. Results have implications for standardizing criteria used in research trials and clinical practice.

Cognitive-behavioral therapy for anxiety in youth with an autism spectrum disorder appears efficacious; however, maintenance of treatment gains has not yet been studied. Using a sample of 32 youth who had benefited at least minimally from a past trial of cognitive-behavioral therapy for anxiety in autism spectrum disorder, this study assessed anxiety symptoms in youth 10--26 months following treatment completion. Compared to baseline, follow-up scores were associated with large effects for treatment. Relative to post-treatment, a small effect for return in symptoms was present and significantly fewer individuals were rated as responders at follow-up. Future studies should investigate factors associated with poor treatment maintenance and modifications or additions to treatment that may help maintain treatment gains.

High rates of anxiety and depression are reported among youth with autism spectrum disorders. These conditions are generally assessed using measures validated for typically developing youth. Few studies have investigated their validity for autism spectrum disorders, which is crucial for accurate assessment and the provision of proper treatment. The Revised Children's Anxiety and Depression Scale was evaluated with 67 youth with autism spectrum disorders to examine its utility in measuring anxiety and depression in this population. Parents and children (aged 11-15 years) referred to a multisite intervention study completed the Pediatric Anxiety Rating Scale, Multidimensional Anxiety Scale for Children, Anxiety Disorders Interview Schedule, Child Behavior Checklist, and Revised Children's Anxiety and Depression Scale. Results suggest acceptable internal consistency of the Revised Children's Anxiety and Depression Scale. Modest convergent validity was found among the Revised Children's Anxiety and Depression Scale and other standardized measures of anxiety and depression. There were stronger correlations between Revised Children's Anxiety and Depression Scale Total scores and subscales of measures expected to correlate significantly than those not expected to correlate. One exception was a significant association between the Revised Children's Anxiety and Depression Scale and Child Behavior Checklist Attention subscale, calling into question the divergent validity in separating anxiety from attention problems. Overall, results suggest preliminary support for the Revised Children's Anxiety and Depression Scale in youth with high-functioning autism spectrum disorders.