Anxiety Disorders Are Associated With Greater Tic Severity in Youth With Chronic Tic Disorder

Abstract

Background

Anxiety disorders are common in and may affect the severity of chronic tic disorder (CTD). We assessed anxiety phenotype in youth with CTD and evaluated for relationships among anxiety, tics, and related symptoms.

Methods

Participants ages 6-17 years with a diagnosis of CTD were enrolled from clinic into a cross-sectional study. Participants and one parent were interviewed by a psychology study team member and a neurology study team member at separate visits. Anxiety disorder presence was determined by the Anxiety Disorders Interview Schedule Child/Parent Version (ADIS-IV). Anxiety symptom severity and specific anxiety symptom types were determined by the Pediatric Anxiety Rating Scale. Tic and premonitory urge severities were determined by clinician-administered instruments.

Results

We enrolled 42 participants with CTD. Most participants had at least one anxiety disorder based on the ADIS-IV (n = 33, 79%). Generalized anxiety disorder was the most common anxiety diagnosis (n = 26, 62%). However, specific anxiety symptoms were often not isolated to specific diagnostic domains. Clinically significant anxiety as measured by the Pediatric Anxiety Rating Scale was present in most participants (n = 25, 60%). Presence of an anxiety disorder was associated with worse severity of tics (z = −3.58, p = 0.0003) and premonitory urge (z = 2.17, p = 0.03).

Conclusions

Assessing anxiety dimensionally rather than categorically is important. Worse anxiety severity is associated with worse severity of tics and premonitory urge. Understanding how anxiety impacts tics and urge in CTD may provide important insights into factors perpetuating tics and guide the approach managing symptoms in anxious youth with CTD.