When the Patient Voices series recently featured Tourette’s syndrome, an odd and little understood disorder that causes jerking movements and tics, dozens of readers had questions for the Consults blog. Here, one reader wonders whether Tourette’s is related to autism or attention deficit disorders.
Q.
Is Tourette’s syndrome related to autism? Is A.D.D. always a symptom of Tourette’s, or a separate diagnosis? Are Tourette’s children often seen as intellectually advanced? Thank you.
Pat Francek, Shelton, Conn.
A.
Dr. Robert King and Dr. James Leckman of the Yale Child Study Center respond:
As with other neurologically based psychiatric disorders, the genetics of Tourette’s syndrome and autism are proving to be more complex than anticipated, with a large number of different genes probably at work in both disorders. Whether there is any genetic connection or whether the two disorders co-occur more than one would expect by chance is not clear.
The vast majority of individuals with Tourette’s do not have autistic features. Children with autism spectrum disorders may exhibit repetitive behaviors like flapping or make noises, but it is usually possible to distinguish these from true tics or obsessive-compulsive disorder. That said, some children with autism spectrum disorders may also have tics as well.
For individuals with full blown Tourette’s, co-occurring conditions are commonplace. Last year the Centers for Disease Control and Prevention reported the results of a nationwide telephone survey of households in the United States. They found that the prevalence of Tourette’s by parent report was 3 cases per 1,000 children, representing approximately 148,000 children nationwide.
Fully 79 percent of the children with Tourette’s had at least one other condition. Most commonly, in about 60 percent of cases, this was attention-deficit hyperactivity disorder or another disruptive behavior disorder. Also common were anxiety and mood disorders, which parents reported in 30 percent to 40 percent of cases, as well as developmental disorders on the autism spectrum, which occurred in about 20 percent of cases.
Perhaps half of children with Tourette’s have some sort of attentional difficulties or A.D.H.D., but the large majority of children with A.D.H.D. do not have tics or Tourette’s syndrome. Hence, these are considered separate disorders that, at times, warrant separate treatments.
In general, individuals with Tourette’s syndrome show the same range of intellectual ability as the rest of the population. That said, there may be difficulties with specific areas, such as visual-spatial processing and hand-writing, despite good intelligence.
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By THE NEW YORK TIMES