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Objective Gilles de la Tourette syndrome (GTS) is a neuropsychiatric disorder characterized by multiple motor and vocal tics and commonly associated with co-morbid conditions. Despite early reports of increased prevalence of headache in both children and adults with GTS, little is known about the nature of this co-morbidity. We conducted a collaborative study based in specialist clinics to compare the prevalence and characteristics of headache in paediatric and adult patients with GTS. Methods We assessed a total of 140 patients with GTS for the presence and characteristics of headache: 109 children and adolescents (age range 6-17 years) and 31 adults (age range 18-55, randomly selected from a clinical sample of 200 patients) seen at specialist clinics. A further comparison was performed between the group of adults with headache (n =15) and a subgroup of gender-matched children with headache (n =16). Results In our study, the prevalence of headache was 48.4% in adults with GTS and 22.9% in children with GTS (p = 0.01). Adults with GTS presented with higher tic severity and poorer quality of life compared to younger patients (p = 0.01). There was a significant difference in the headache types: tension type headache was significantly more commonly reported by adults with GTS, whereas migraine was significantly more commonly reported by children with GTS (p = 0.02). Adults with GTS and co-morbid headache consistently presented with higher tic severity and poorer quality of life compared to children with GTS and co-morbid headache (p = 0.01). Conclusions Headache is confirmed as a relatively common co-morbidity of GTS, particularly in adult patients seen at specialist clinics. The higher prevalence of headache in adults with GTS (especially tension-type headache) compared to younger patients could be related to higher tic severity and poorer quality of life in our adult clinical sample. If replicated, these findings can inform clinical practice in guiding targeted scree

Tourette syndrome is a neurodevelopmental disorder characterized by multiple tics and commonly associated with behavioral problems, especially obsessive-compulsive disorder and attention-deficit hyperactivity disorder (ADHD). The presence of specific personality traits has been documented in adult clinical populations with Tourette syndrome but has been underresearched in younger patients. We assessed the personality profiles of 17 male adolescents with Tourette syndrome and 51 age- and gender-matched healthy controls using the Minnesota Multiphasic Personality Inventory-Adolescent version, along with a standardized psychometric battery. All participants scored within the normal range across all Minnesota Multiphasic Personality Inventory-Adolescent version scales. Patients with Tourette syndrome scored significantly higher than healthy controls on the Obsessiveness Content Scale only (P =.046). Our findings indicate that younger male patients with Tourette syndrome do not report abnormal personality traits and have similar personality profiles to healthy peers, with the exception of obsessionality traits, which are likely to be related to the presence of comorbid obsessive compulsive symptoms rather than tics.

Tourette syndrome (TS) and attention-deficit and hyperactivity disorder (ADHD) are co-morbid neurodevelopmental conditions affecting more commonly male patients. We set out to determine the impact of co-morbid ADHD on cognitive function in male children with TS by conducting a controlled study. Participants included four matched groups of unmedicated children (age range 6–15 years): TS (n=13), TS+ADHD (n=8), ADHD (n=39), healthy controls (n=66). Following clinical assessment, each participant completed a battery of tests from the Wechsler Intelligence Scale for Children-III, the Italian Battery for ADHD, the Tower of London test, the Corsi test, and the Digit Span test. All patient groups reported significantly lower scores than healthy controls across the neuropsychological tests involving executive functions. The TS+ADHD group was the most severely affected, followed by the ADHD group and the TS group, particularly in the tests assessing planning ability, inhibitory function, working memory and visual attention, but not auditory attention. Problems in executive functions are more common in patients with neurodevelopmental disorders than controls. Deficits in planning ability, inhibitory function, working memory and visual attention reported by children with TS appear to be more strongly related to the presence of co-morbid ADHD symptoms than core TS symptoms.

Objective: We aimed to define the sociodemographic, clinical, and prescription profiles of the participants enrolled in the Italian Lombardy ADHD Register. Method: Data on patients evaluated by the 18 regional ADHD reference centers in the 2012 to 2013 period were analyzed. Results: Seven hundred fifty-three of 1,150 (65%) suspected patients received a diagnosis of ADHD. In 24% of cases, there was a family history of ADHD. Four hundred eighty-three (64%) patients had at least one psychopathological disorder, the more common of which were learning disorders (35%). Eighty-four percent of patients received a prescription for psychoeducational interventions, 2% received only pharmacological treatment, and 14% a combination of both. Compared with patients treated with psychoeducational intervention alone, patients with drug prescriptions more commonly presented values of Clinical Global Impressions - Severity scale (CGI-S) of 5 or higher (p <.0001). Conclusion: A continuous and systematic monitoring of patterns of care is essential in promoting significant improvements in clinical practice and ensuring an efficient and homogeneous quality of care.

Young patients with Tourette Syndrome (TS) can exhibit poor emotional control and aggression. We explored anger in young patients with TS. Twenty-five patients diagnosed with TS and 41 healthy controls completed the State-Trait Anger Expression Inventory (STAXI). Parents and teachers completed the child behavior checklist and Conners Parent/Teacher Rating Scales-Revised. STAXI scores were not significantly different between patients with TS and controls. However, many proxy-rated measures linked to anger and externalizing problems were significantly higher in TS. As proxy-rated instruments revealed more oppositional and aggressive behaviors in young patients with TS, they are important in the multidimensional assessment of TS. These findings offer useful insights into the nature of anger symptoms in young patients with TS and provide a basis for more effective diagnosis and management.

In Tourette syndrome, motor and phonic tics are associated with a spectrum of psychiatric disorders. As proxy report instruments are commonly used to assess children with Tourette syndrome, we investigated the relationship between child and mother ratings of behavioral problems. We enrolled 28 children with Tourette syndrome (25 males; mean age, 13.9 years) and 61 gender- and age-matched healthy controls (55 males; mean age, 14.7 years). Clinicians completed measures of tic severity, and all children completed the Youth Self-Report version of the Child Behavior Checklist, while their mothers completed the Child Behavior Checklist. In the clinical group, Youth Self-Report scores were significantly lower than mothers' Child Behavior Checklist scores across the majority of subscales (especially affect and somatization). In contrast, for the control group, mother and child ratings only differed for the externalizing behavior subscales. Clinicians should be aware of these differences between self and mother ratings for specific behavioral problems in Tourette syndrome.

The main aim of this study was to estimate the costs associated with diagnostic assessment and 1-year therapy in children and adolescents enrolled in 18 ADHD reference centres. Data concerning 1887 children and adolescents from the mandatory ADHD registry database during the 2012-2014 period were analysed. The overall diagnostic and treatment costs per patient amounts to €574 and €830, respectively. The ADHD centre, the school as sender, and the time to diagnosis constitute cost drivers. Non-pharmacological therapy resulted as being more expensive for patients concomitantly treated with drugs (€929) compared to those treated with psychological interventions alone (€590; p=0.006). This study gives the first and reliable estimate of the costs associated with both diagnosis and treatment of ADHD in Italy. Although costs associated with mental disorders are difficult to estimate, continuing efforts are need to define costs and resources to guarantee appropriate care, also for ADHD.

Although ADHD comorbidity has been widely studied, some issues remain unsolved. This multicenter observational study aims to examine comorbid psychiatric disorders in a clinical sample of newly diagnosed, treatment naïve children and adolescents with and without ADHD and, to compare treatment efficacy based on the type of comorbidity. We performed an analysis of the medical records of patients identified from the Regional ADHD Registry database, enrolled in 18 ADHD centers in the 2011–2016 period. 1919 of 2861 subjects evaluated (67%) met the diagnostic criteria for ADHD: 650 (34%) had only ADHD, while 1269 (66%) had at least one comorbid psychiatric disorder (learning disorders, 56%; sleep disorders, 23%; oppositional defiant disorder, 20%; anxiety disorders, 12%). Patients with ADHD of combined type and with severe impairment (CGI-S ≥5) were more likely to present comorbidity. 382 of 724 (53%) followed up patients improved after 1 year of treatment. ADHD with comorbidity showed greater improvement when treated with combined interventions or methylphenidate alone. Specifically, combined treatment showed significant superiority for ADHD with learning disorders (ES 0.66) and ODD (ES 0.98), lower for ADHD with sleep or anxiety disorders. Training intervention alone showed only medium efficacy (ES 0.50) for ADHD and learning disorders. This study was the first describing comorbidity patterns of ADHD in Italy, confirming, in a multicenter clinical setting, that ADHD is more often a complex disorder. Findings highlight important diagnostic, therapeutic, and service organization aspects that should be broadly extended to ensure an appropriate and homogenous ADHD management.

Tourette syndrome is a neurodevelopmental disorder characterized by tics and comorbid behavioral problems. This study compared child- and parent-reported quality of life and everyday functioning. We assessed 75 children with Tourette syndrome, of which 42 (56%) had comorbid conditions (obsessive-compulsive disorder = 25; attention-deficit hyperactivity disorder = 6; both comorbidities = 4). All patients completed psychometric instruments, including the Gilles de la Tourette Syndrome-Quality of Life Scale for Children and Adolescents (child report) and the Child Tourette's Syndrome Impairment Scale (parent report). Data were compared for patients with pure Tourette syndrome, Tourette syndrome + obsessive-compulsive disorder, Tourette syndrome + attention-deficit hyperactivity disorder, and Tourette syndrome + both comorbidities. There were no group differences in quality of life. However, there were differences for total, school, and home activities impairment scores. Children and parents may not share similar views about the impact of Tourette syndrome on functioning. The measurement of health-related quality of life in Tourette syndrome is more complex in children than adults.

Tourette syndrome is a neurodevelopmental disorder characterized by multiple tics and is often associated with comorbid behavioral problems. Research with generic instruments in child populations showed that comorbid disorders can have a greater impact on health-related quality of life than tic severity. This study investigated the usefulness of a newly developed disease-specific instrument, the Gilles de la Tourette Syndrome-Quality of Life Scale for Children and Adolescents (GTS-QOL-C&A), in assessing health-related quality of life in young patients with Tourette syndrome with and without behavioral comorbidity. We recruited 75 patients with Tourette syndrome (60 males; age 12.4 ± 3.2 years). All participants were evaluated by a neuropsychiatrist and completed a standardized psychometric battery, including the GTS-QOL-C&A, Child Depression Inventory, and Multidimensional Anxiety Scale for Children. Forty-two patients (56%) fulfilled diagnostic criteria for at least one comorbidity: obsessive-compulsive disorder (n = 25 patients [33.3%]); attention deficit/hyperactivity disorder (n = 6 patients [8%]); both (n = 11 patients [14.7%]). The GTS-QOL-C&A demonstrated usefulness in differentiating "pure" Tourette syndrome from Tourette syndrome "plus" behavioral problems with regard to health-related quality of life scores for the obsessive-compulsive subscale. In addition to focusing on core tic symptoms, the GTS-QOL-C&A showed sensitivity to the impact of behavioral comorbidities on health-related quality of life and can usefully complement existing nonspecific instruments.

BACKGROUND: Gilles de la Tourette syndrome (GTS) is a chronic childhood-onset neuropsychiatric disorder with a significant impact on patients' health-related quality of life (HR-QOL). Cavanna et al. (Neurology 2008; 71: 1410-1416) developed and validated the first disease-specific HR-QOL assessment tool for adults with GTS (Gilles de la Tourette Syndrome-Quality of Life Scale, GTS-QOL). This paper presents the translation, adaptation and validation of the GTS-QOL for young Italian patients with GTS. METHODS: A three-stage process involving 75 patients with GTS recruited through three Departments of Child and Adolescent Neuropsychiatry in Italy led to the development of a 27-item instrument (Gilles de la Tourette Syndrome-Quality of Life Scale in children and adolescents, C&A-GTS-QOL) for the assessment of HR-QOL through a clinician-rated interview for 6-12 year-olds and a self-report questionnaire for 13-18 year-olds. RESULTS: The C&A-GTS-QOL demonstrated satisfactory scaling assumptions and acceptability. Internal consistency reliability was high (Cronbach's alpha > 0.7) and validity was supported by interscale correlations (range 0.4-0.7), principal-component factor analysis and correlations with other rating scales and clinical variables. CONCLUSIONS: The present version of the C&A-GTS-QOL is the first disease-specific HR-QOL tool for Italian young patients with GTS, satisfying criteria for acceptability, reliability and validity.

Over the last few years, aripiprazole has been proposed as a potentially useful medication for tics in patients with Tourette syndrome (TS). Aripiprazole has been associated with fewer adverse effects compared with other atypicals; however, little is known about its tolerability profile in the TS population. This study assessed the prevalence and characteristics of adverse effects resulting from the use of aripiprazole in a retrospective chart review of 29 patients with TS. Six patients (20.7%) discontinued aripiprazole because of the severity of specific adverse effects. The most commonly reported adverse effects were sedation (n=9, 30%) and sleep problems (n=5, 17%). In the majority of cases, adverse effects were not severe. There were no differences in demographic or clinical variables between the patients who did or did not experience adverse effects. The discontinuation rate of 20.7% suggests that aripiprazole is safe and reasonably well tolerated for use in TS. The prevalence of adverse effects appears to increase with treatment duration.

Aims: Tourette syndrome (TS) is a neurodevelopmental disorder characterized by multiple tics and associated with co-morbid behavioral problems (TS-plus). We investigated the usefulness of self-report versus parent- and teacher-report instruments in assisting the specialist assessment of TS-plus in a child/adolescent population. Methods: Twenty-three patients diagnosed with TS (19 males; age 13.9 ± 3.7 years) and 69 matched healthy controls participated in this study. All recruited participants completed a standardized psychometric battery, including the Children's Depression Inventory (CDI), the Self Administrated Psychiatric Scales for Children and Adolescents (SAFA) and the State-Trait Anger Expression Inventory (STAXI). Parents completed the Child Behavior Checklist (CBCL) and Conners' Parent Rating Scales-Revised (CPRS-R). Participants' teachers completed the Conners' Teacher Rating Scales-Revised (CTRS-R). Results were compared with similar data obtained from controls. Results: Nineteen patients (82.6%) fulfilled DSM-IV-TR criteria for at least one co-morbid condition: obsessive-compulsive disorder (OCD, n = 8; 34.8%); attention deficit-hyperactivity disorder (ADHD, n = 6; 26.1%); OCD + ADHD (n = 5; 21.7%). Scores on self-report instruments failed to show any significant differences between TS and controls. Most subscores of the CPRS-R, CTRS-R, and CBCL were significantly higher for the TS group than controls. The TS + OCD subgroup scored significantly higher than the TS-OCD subgroup on the CBCL-Externalizing, Anxious/Depressed and Obsessive-Compulsive subscales. Conclusions: Self-report instruments appear to have limited usefulness in assisting the assessment of the behavioral spectrum of young patients with TS. However, proxy-rated instruments differentiate TS populations from healthy subjects, and the CBCL can add relevant information to the clinical diagnosis of co-morbid OCD.

Aims Tourette syndrome (TS) is increasingly recognised as a neurodevelopmental disorder associated with a spectrum of behavioural problems. We conducted a case-control study to compare children's self-report measures of behavioural symptoms with their parents' ratings. Methods Our sample consisted of 28 patients (25 males; mean age 14.1 years; range 12.0–18.1 years) diagnosed with TS according to DSM-IV criteria, and a control group of 61 subjects randomly chosen among sex- and age-matched school peers. All parents completed the Child Behaviour Checklist (CBCL) and the Conners' Parents Rating Scales-R (CPRS-R) for ADHD; all children completed the Youth Self Report (the self assessment version of CBCL). We carried out the following comparisons: TS parents vs controls' parents (CBCL and CPRS-R); TS children vs control children (YSR); TS parents vs TS children (CBCL vs YSR), and controls’ parents vs control children (CBCL vs YSR). Results Children with TS show higher scores on various subscales of the CBCL compared with control subjects (eg, Total Problems: 70.0±8.6 vs 49.1±8.9, p<0.001; Internalising Scale: 58.1±9.7 vs 51.9±9.4, p=0.005; Externalising Scale: 56.5±9.1 vs 47.2±8.1, p<0.001) and consider themselves more symptomatic than sex- and age-matched school peers on the YSR Problems and Competences Scales (eg, Problem Scales: Tought 53.0±4.6 vs 52.2±6.2, p=0.027; Attention 61.2±10.1 vs 54.0±6.2, p=0.001; Competence Scales: Total 42.9±10.2 vs 49.9±9.3, p=0.002; Social 46.0±7.2 vs 48.8±7.2, p=0.033; 2.3±0.6 vs 2.6±0.4, p=0.002). However, their own reports of behavioural problems are significantly lower than their parents' reports (eg, CBCL/YSR total scores: 53.4±11.2 vs 61.0±8.6, p=0.001). Conclusions Parents' ratings (CBCL) identify more behavioural symptoms than children's self-report measures (YSR). However, self-report measures such as the YSR are useful in highlighting the areas where children with TS feel more problematic than controls, including social

Aims Tourette syndrome (TS) is a neurodevelopmental disorder characterised by multiple tics and associated with co-morbid behavioural problems (TS-plus). We investigated the usefulness of self-report vs parent- and teacher-report instruments in assisting the specialist assessment of TS-plus in a child/adolescent population. Methods Twenty-three patients diagnosed with TS (19 males; age 13.9±3.7 years) and 69 matched healthy controls participated in this study. All recruited participants completed a standardised psychometric battery, including the Children's Depression Inventory (CDI), the Self Administrated Psychiatric Scales for Children and Adolescents (SAFA) and the State–Trait Anger Expression Inventory (STAXI). Parents completed the Child Behavior Checklist (CBCL) and Conners' Parent Rating Scales–Revised (CPRS-R). Participants' teachers completed the Conners' Teacher Rating Scales–Revised (CTRS-R). Results were compared with similar data obtained from controls. Results Nineteen patients (82.6%) fulfilled DSM-IV-TR criteria for at least one co-morbid condition: obsessive-compulsive disorder (OCD, n=8; 34.8%); attention deficit-hyperactivity disorder (ADHD, n=6; 26.1%); OCD+ADHD (n=5; 21.7%). Scores on self-report instruments failed to show any significant differences between TS and controls. Most subscores of the CPRS-R, CTRS-R, and CBCL were significantly higher for the TS group than controls. The TS+OCD subgroup scored significantly higher than the TS-OCD subgroup on the CBCL-Externalising, Anxious/Depressed and Obsessive-Compulsive subscales. Conclusions Self-report instruments appear to have limited usefulness in assisting the assessment of the behavioural spectrum of young patients with TS. However, proxy-rated instruments differentiate TS populations from healthy subjects, and the CBCL can add relevant information to the clinical diagnosis of co-morbid OCD.

Aims Little is known about the tolerability profile of Aripiprazole in the TS population. We set out to evaluate the prevalence of psychiatric and non-psychiatric adverse events (PAE and nPAE) of Aripiprazole through a retrospective chart review of adult patients seen at a specialist TS clinic. Methods We reviewed the clinical files of 29 patients (22 males; mean age 29.7±13.0) who had been started on Aripiprazole (median starting dose: 5.0 mg; median maintenance dose: 10.0 mg). Results Twenty-one patients (72.4%) developed adverse effects: 6 (20.7%) PAE (most common: anxiety); 17 (58.6%) nPAE (most common: sedation). Thirteen patients (44.8%) discontinued the Aripiprazole, 6 (20.7%) solely because of the severity of specific adverse effects (sedation, sleep problems, weight gain, nausea, lost appetite, tic worsening, hot flushes). When comparing patients with and without adverse effects, we found no differences in socio-demographic or clinical variables. However, there was a trend towards a statistically significant difference in Aripiprazole starting dose (p=0.07). Conclusions The most commonly reported adverse effects of Aripiprazole treatment in TS were sedation and sleep problems. In the majority of cases, adverse effects were not severe. In our clinical sample there were no predictors for poor tolerability. Slow titration is recommended in order to minimise the occurrence of adverse effects.