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• Anxiety disorders in children with tics
  Sally J Robinson
  Published on: 9 July 2014

• Published on: 9 July 2014

  Anxiety disorders in children with tics

  • Sally J Robinson, Highly Specialist Clinical Psychologist
  • Other Contributors:
    • Tammy Hedderly, Anya Kushank, Peter Hindley, Martin Woods and Claire Grose

  We read with great interest the recent review article by Creswell, Waite and Cooper on 'Assessment and management of anxiety disorders in children and adolescents'. The article brought to the forefront the importance of accurately identifying and treating anxiety disorders during development, with an encouraging discussion of new treatment strategies and delivery approaches to increase access to psychological therapies fo...

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  We read with great interest the recent review article by Creswell, Waite and Cooper on 'Assessment and management of anxiety disorders in children and adolescents'. The article brought to the forefront the importance of accurately identifying and treating anxiety disorders during development, with an encouraging discussion of new treatment strategies and delivery approaches to increase access to psychological therapies for children with anxiety disorders. We are keen to add to these discussions by raising awareness of the common co-occurrence and interaction between anxiety symptomatology and tics for children with Tourette syndrome or other chronic tic disorders (CTD). Psychiatric diagnoses are commonly reported for children with CTD , with approximately 50% of children meeting criteria for at least one anxiety disorder.[1] Obsessive compulsive disorder (OCD), social phobia and generalised anxiety disorder are most commonly reported, though separation anxiety may also co- occur.[1] Interestingly, for children with CTD, behavioural difficulties (e.g. Attention Deficit Hyperactivity Disorder) are most commonly reported during the primary school years whilst anxiety disorders are more prevalent during the teenage years, thus a reduction in externalising behaviours are associated with an increase in internalising behaviours.[2] Findings from our own clinical population support this trajectory and indicate that for children with CTD quality of life is more closely related to anxiety symptomatology than tic severity.[3] In addition, in our clinical experience, the effective management of anxiety disorders with evidence based cognitive-behavioural strategies (as advocated by Creswell and colleagues) often results in improved in tic control and reduced interference from tics on day to day life. Thus, there is a complex interaction between anxiety and tics during development. This highlights the need for the careful evaluation of anxiety disorders in children with CTD to ensure that their broader mental health needs are not overlooked, as for many children often it is not the tics that need managing but the co-morbid psychiatric conditions.

  References:

  1. Specht, M. W., Woods, D. W., Piacentini, J., Scahill, L., Wilhelm, S., Peterson, A. L., ... & Walkup, J. T. Clinical characteristics of children and adolescents with a primary tic disorder. Journal of Developmental and Physical Disabilities 2011;23(1):15-31.

  2. Rizzo, R., Gulisano, M., Cal?, P. V., & Curatolo, P. (2012). Long term clinical course of Tourette syndrome. Brain and Development 2012;34(8):667-673.

  3. Woods, M., Robinson, S., Brennan, H, Bunton, P., & Hedderly, T. A Comparison of Clinician and Self-Report Measures of Tics, Co-morbid Difficulties and Quality of Life [abstract p48]. European Society Study of Tourette Syndrome, 25-26 April 2014, Pitie-Salpetriere Hospital, Paris

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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