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Free AccessOriginalarbeit

The Role of Obsessive-Compulsive Symptoms

in the Psychopathological Profile of Children with Chronic Tic Disorder and Attention-Deficit Hyperactivity Disorder

Published Online:May 02, 2013https://doi.org/10.1024/1422-4917/a000229

Abstract

Objective: The study examines the role of obsessive-compulsive symptoms (OCS) as a part of the psychopathology of children with chronic tic disorders (CTD) and/or attention-deficit hyperactivity disorder (ADHD). Method: We assessed the psychopathology of four large patient groups without further psychiatric disorders: CTD (n = 112), CTD + ADHD (n = 82), ADHD (n = 129), and controls (n = 144)) by implementing the Child Behavior Checklist (CBCL). We compared the main effects for CTD and ADHD with and without including OCS as covariates. Results: Including OCS led to substantially different main effects for CTD on seven out of eight CBCL subscales. Slightly different main effects for ADHD were determined with respect to ADHD, mainly on the subscale withdrawn. Conclusions: OCS are closely related to CTD-associated psychopathology and – to a lesser extent, but nevertheless of importance in daily clinical practice – on ADHD-related symptoms. This information can be helpful in implementing more precise diagnostics and treatment in daily routine care.

Die Rolle von Zwangssymptomen beim psychopathologischen Profil von Kindern mit chronischer Tic-Störung und Aufmerksamkeitsdefizit/Hyperaktivitätsstörung

Fragestellung: Die Studie untersucht die Rolle von Zwangssymptomen (ZS) im Zusammenhang mit dem psychopathologischen Profil von Kindern mit chronischen Tic-Störungen (TS) und/oder Aufmerksamkeitsdefizit/Hyperaktivitätsstörung (ADHS). Methodik: Mit der Child Behavior Checklist (CBCL) erhoben wir die Psychopathologie von vier großen Patientengruppen ohne weitere psychiatrische Störungen: TS (n = 112), TS + ADHS (n = 82), ADHS (n = 129) und Kinder ohne psychiatrische Störung (n = 144). Wir verglichen die Haupteffekte für TS und ADHS mit und ohne ZS als Kovariate. Ergebnisse: Bei Berücksichtigung der Kovariate ZS veränderten sich die Haupteffekte für TS auf sieben von acht Unterskalen. Bei ADHS wurden geringfügig veränderte Haupteffekte vor allem auf der Unterskala Rückzugsverhalten festgestellt. Schlussfolgerungen: Bei der TS-assoziierten Psychopathologie spielen ZS eine wichtige Rolle. Auch wenn diese Rolle bzgl. ADHS-assoziierter Psychopathologie geringer ist, sind sie dennoch von praktischer Relevanz. Diese Informationen sind für eine präzisere Diagnostik und Behandlung der betroffenen Kinder und Jugendlichen hilfreich.

Introduction

Chronic tic disorders (CTD) and attention-deficit-hyperactivity disorder (ADHD) are both chronic disorders with childhood onset which often co-occur (Rothenberger, Roessner, Banaschewski, & Leckman, 2007). Obsessive-compulsive symptoms (OCS) are often associated with both CTD and ADHD (Arnold, Ickowicz, Chen, & Schachar, 2005; Freeman et al., 2000; Gillberg et al., 2004; Lewin, Chang, McCracken, McQueen, & Piacentini, 2010; Riddle et al., 1990). There is an ongoing discussion about the definition and psychopathological placement of OCS (Fullana et al., 2009), partly resulting from the somewhat heterogeneous findings on gender distribution, factor structure, etc., of OCS in the general population, in patients suffering from OCD as well as in relatives classified as belonging to a “high-risk” population (Black & Gaffney, 2008).

In daily clinical care it is of practical value to gain a better understanding of CTD and ADHD and their relationship to OCS, particularly in light of the fact that the latter might influence the disorder specific psychopathological profile and thus diagnostics and treatment as well (Roessner, Schoenefeld, Buse, Wanderer, & Rothenberger, 2012). Unfortunately, studies regarding this issue are scarce.

To the best of our knowledge only one study (Pollak et al., 2009) has investigated how ADHD and OCS may contribute to the Tourette syndrome (TS)-associated psychopathological profile in four groups: TS without ADHD, TS + ADHD, ADHD without TS, and an unaffected control group. Using linear regressions, the authors found that ADHD and OCS differentially influenced the variance of externalizing and internalizing behavioral problems (as measured by implementation of the Child Behavior Checklist, CBCL) in individuals with TS. While tic severity, inattention, and hyperactivity/impulsivity were positively related to externalizing behavior, internalizing behavior was positively related to OCS and inattention (Pollak et al., 2009). However, it has to be taken into account that patients with comorbidities other than TS or ADHD were not excluded (e.g., OCD, anxiety disorders), and there were substantial differences in sample size among groups. In addition, only results for the two wide-band scales (Internalizing and Externalizing Problems) but not for the eight narrow-band subscales of the CBCL were reported.

Hence, it seemed of importance not only to test for replication, but also to extend the investigated psychopathological features of the latter study in order to allow for better daily practical implications. Thus, the present study investigates the association between OCS (based on different OCS CBCL scores) and a detailed psychopathological profile as measured by the subscales of the CBCL in patients suffering from CTD and/or ADHD. We expected a significant psychopathological role of OCS not only in CTD as depicted to a certain extent in Pollack et al. (2009), but also in ADHD as suggested by Moll et al. (2000). The latter study reflects a neglected but practically important issue requiring further and better evidence. In order to better control for confounders, we modified the basic design as proposed by Pollack et al. (2009) by including only children with “pure” CTD, “pure” ADHD, CTD + ADHD, and healthy controls who had already been assessed in our previous study (Roessner, Becker, Banaschewski, & Rothenberger, 2007). This enabled the implementation of a 2 × 2 factorial design to separately analyze the association of OCS with CTD-related as well as ADHD-related psychopathology.

Method

Participants

All participants of this study had been referred to the Outpatient Clinic of the Department of Child and Adolescent Psychiatry at the University of Göttingen (Germany) between January 1997 and January 2005 for routine clinical assessment. The clinic includes a center of excellence for CTD, ADHD, and OCD. Out of the 1,373 patients who were referred to the specialized clinic during that time, 343 showed no symptoms of CTD or ADHD. Another 69 subjects had to be excluded due to missing values (> 20) on the CBCL. In order to avoid confounding with other psychiatric disorders, 593 patients with other psychiatric disorders besides CTD and ADHD (according to ICD-10, World Health Organization, 1996) were excluded. Based on their diagnosis according to DSM-IV and ICD-10 (for a detailed description of the clinical assessment by a board-certified child and adolescent psychiatrist, see Roessner et al., 2007), the participants were allocated to one of the following groups: CTD-only (n = 112, mean age = 11.1 years, SD = 2.6), CTD + ADHD (n = 82, mean age = 10.7 years, SD = 2.3), and ADHD-only (n = 129, mean age = 10.5 years, SD = 2.5). Out of 345 referrals to the general outpatient clinic (43% learning disorder, 57% no diagnosis), 144 children were selected as controls, having nonfulfilled criteria for any axis I diagnosis (according to ICD-10 multiaxial classification system, World Health Organization, 1996), though some of them showed subclinical psychiatric problems or learning disorders. The control group did not differ statistically from the three patients groups in terms of age (mean age = 14.4 years, SD = 2.4) and gender. This chart review was considered by the local Ethics Committee to be exempt from review, and written informed consent was not required.

Assessment of Psychopathology

Psychopathology was assessed by the CBCL (Achenbach, 1991). The CBCL is one of the most established inventories for the evaluation of dimensional psychopathology in children and adolescents. It includes 112 behavioral items rated by a parent on a three-point scale. Each item contributes to the score on one of eight subscales. In addition two wide-band scales (Internalizing and Externalizing Problems) and a total problem score can be composed. Numerous studies have confirmed the stability of the psychometric properties of this instrument, which shows good reliability and validity in both clinical and nonclinical populations (Jensen et al., 1996; Schmeck et al., 2001). The stability of the subscales over a 4-year period was established previously in a clinical sample of youths with ADHD (Biederman et al., 2001). In addition, CBCL scores demonstrate good convergence with structured interviews for psychiatric diagnosis in children with ADHD (Biederman et al., 1993), and its subscale Attention Problems has a highly discriminative power for ADHD (Chen, Faraone, Biederman, & Tsuang, 1994). Furthermore, the CBCL has shown particular usefulness in psychopathological studies on CTD (Cardona, Romano, Bollea, & Chiarotti, 2004; Termine et al., 2006).

Assessment of Obsessive-Compulsive Symptoms (OCS)

Obsessive-compulsive symptomatology forms a continuum ranging from complete absence of symptoms to full-blown OCD with OCS holding the middle position (Black & Gaffney, 2008). Because of time constraints in clinical routine, it is often not feasible to use an extensive diagnostic instrument like the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) (Goodman et al., 1989) to assess OCS. In addition, the Y-BOCS was designed to measure the severity of full-blown OCD. Therefore, a rating scale would prove helpful that can be generated from instruments used in clinical routine and that enables quantification of OCS, e.g., to investigate OCS in patients with CTD and/or ADHD. Three OCS scores based on selected items from the CBCL (see Table 1 ) were developed, one by Moll et al. (2000), one by Nelson et al. (2001), and the most recent one by Storch et al. (2006). Moll et al. identified nine CBCL-items that are related to OCS (Moll et al., 2000). They can be allocated to the syndrome scales Anxious/Depressed, Other Problems, and Thought Problems. The screening tool developed by Nelson et al. (2001) consists of eight items from the CBCL and has shown good validity and reliability. Six of them are identical to the items used by Moll et al. (2000). The items included in Nelson’s scale contribute to the syndrome scales Anxious/Depressed and Thought Problems. Storch et al. (2006) developed the latest version of a CBCL-based scale assessing OCS: By dropping two items from the scale developed by Nelson et al. (2001), they created a 6-item screening tool. We used each of the three scores to estimate OCS in the present study sample of CTD and ADHD patients.

Table 1. Obsessive-compulsive symptoms (OCS) scores derived from Child Behavior Checklist (CBCL) items. N = Nelson et al. (2001); M = Moll et al. (2000), S = Storch et al. (2006)

Statistics

In our previously published study on the same sample (Roessner et al., 2007), we conducted two-way analyses of variance (ANOVA) with the factors CTD (yes, no) and ADHD (yes, no). In the present study, we included the three different scores for obsessive-compulsive symptomatology developed by Moll et al. (2000), Nelson et al. (2001), and Storch et al. (2006) as covariates. Our goal was to compare the results of the ANOVAs with those of the three analyses of covariance (ANCOVA) to evaluate whether parts of the main effects for ADHD and CTD are due to the co-occurrence of OCS. If OCS influenced the psychopathology associated with CTD and ADHD, the main effects revealed by the ANCOVAs would substantially differ from the main effects revealed by the ANOVAs.

Results

Impact of OCS on the Main Effects for CTD

The ANOVA with the factors CTD and ADHD showed main effects for CTD on five of eight CBCL subscales (see Table 2 ). The results of the three ANCOVAs using the OCS scores as covariates differed notably from the results of the ANOVAs (see Table 3 ).

Table 2. Demographic data and CBCL scores of the four groups under investigation (from Roessner et al. 2007). For CBCL means (SD) are given
Table 3. Main effects for CTD: ANOVAs vs. three ANCOVAs (including different OCS scores as covariates: Moll et al., 2000; Nelson et al., 2001; Storch et al., 2006)

Inclusion of the OCS score by Moll et al. (2000) revealed significant main effects on the four subscales Delinquent Behavior, Anxious/Depressed, Somatic Complaints, and Social Problems. By including the OCS score by Nelson et al. (2001) as a covariate, we found significant main effects only on three subscales: Delinquent Behavior, Withdrawn, and Somatic Complaints. The ANCOVA including the OCS score by Storch et al. (2006) as a covariate revealed significant main effects on the four subscales Delinquent Behavior, Anxious/Depressed, Withdrawn, and Somatic Complaints.

On the subscales Attention Problems, Anxious/Depressed, Thought Problems, and Social Problems the main effect for CTD mostly disappeared when ANCOVAs with OCS scores as covariates were conducted. On the subscales Attention Problems and Thought Problems, each of the three OCS scales had this impact, whereas on the Anxious/Depressed scale it was only the OCS score by Nelson et al. (2001). On the Social Problems scale Nelson’s (2001) and Storch’s (2006) OCS score reduced the effect of CTD. On the subscales Delinquent Behavior and Withdrawn, inclusion of the OCS scores had the opposite result: The main effect was not significant when conducting an ANOVA, but was revealed by the ANCOVAs (in terms of Delinquent Behavior by all three ANCOVAs, in terms of Withdrawn by including the scores by Nelson et al., 2001; and Storch et al., 2006).

Impact of OCS on the Main Effects for ADHD

The ANOVA with the factors CTD and ADHD revealed main effects for ADHD on seven out of the eight CBCL subscales. Also, when we included each of the three OCS scores as covariates, main effects for ADHD were present in six of eight subscales. That is, the results of the three ANCOVAs differed only on one of the subscales (see Table 4 ). No main effect for ADHD on Withdrawn was observable when an OCS score was included as covariate.

Table 4. Main effects for ADHD: ANOVAs vs. three ANCOVAs (including different OCS scores as covariates: Moll et al., 2000; Nelson et al., 2001; Storch et al., 2006)

Discussion

In a previous study we examined the role of the main factors CTD and ADHD in the psychopathological profile of children suffering from CTD and/or ADHD. In order to extend and refine these findings for better practical use, we included in the present study an OCS score as covariate in the original ANOVAs in order to specify the role of the often coexisting OCS. Three different OCS scores of the CBCL were discussed in the previous empirical literature. For each single OCS score a separate ANCOVA was conducted.

Overall, we found that OCS plays a significant role in the social competence and psychological problems of children with CTD and/or ADHD. These findings corroborate the results of the study on the interrelatedness of tics, ADHD, and OCD by Peterson, Pine, Cohen, and Brook (2001). The authors suggested that the co-occurrence of tics and ADHD might partially result from a complex sharing of numerous psychopathological risk factors such as OCS as a subclinical form of OCD. Also, Matthews and Grados (2011), after investigating parent-offspring concordance in a large-scale sample of Tourette syndrome (TS)-affected sib-pair families, suggested that “... the observed relation between TS and ADHD may in part be due to a genetic association between OCD and ADHD ...” Furthermore, Banaschewski, Siniatchkin, Uebel, and Rothenberger (2003) assumed a complex psychopathological pattern of tics, obsessive-compulsive behavior, impulsivity, and internalizing symptomatology.

Our results reveal noticeable differences between the relationship of OCS to CTD-related psychopathology versus the relationship of OCS to the psychological profile associated with ADHD. While OCS play an important role in the psychopathological profile of children with CTD, the association to ADHD-related psychopathology is also remarkable, albeit less pronounced. This replicates the findings of Pollak et al. on OCS and TS (2009) but gives a more precise and detailed picture on OCS and ADHD, i.e., withdrawal behavior of children with ADHD may be linked to OCS. This should be considered in routine care (Schmitman Gen Pothmann, Petermann, Petermann, & Zakis, 2011).

Generally speaking, our findings are almost identical for all three OCS scores, although the association between OCS and the psychopathological profile of CTD becomes more evident using Nelson’s (2001) or Storch’s (2006) OCS scores compared to Moll’s (2000) OCS score.

CTD

On seven out of eight CBCL subscales the main effects for CTD differed depending on whether an OCS score was included as a covariate or not. These findings emphasize the importance of OCS regarding the psychopathology in CTD. The direction of influence of OCS is not identical on all subscales of the CBCL. On the subscales Attention Problems and Thought Problems, the main effects for CTD disappeared with the inclusion of each of the three OCS covariates. This leads to the assumption that attention problems are more likely to be associated with sorrows (which are a typical symptom of OCD) than with tics. This is in accordance with previous findings. Kurlan et al. (2002) assumed that subjects with OCD might endorse some of the items scored as thought problems in patients with TS. Additionally, there is evidence for a positive relationship between OCD severity and thought problems in OCD patients (Ivarsson, Melin, & Wallin, 2008). A similar pattern was observed on the subscale Social Problems. Here, main effects were no longer significant when Nelson’s (2001) and Storch’s (2006) scores were included, and the F-value was noticeably reduced when Moll’s (2000) OCS score was included. This might indicate that OCS are more closely associated with social problems than with tics. On the subscales Delinquent Behavior and Withdrawn, there were significant main effects for CTD only when the OCS scores were included (except for the ANCOVA including Moll’s (2000) OCS score on the subscale Withdrawn), likely reflecting that OCS in CTD seems to mask or compensate delinquent tendencies and social withdrawal.

ADHD

In general, including OCS as a covariate showed a diminished association to psychopathology related to ADHD compared to the psychopathology associated with CTD. However, the main effect of ADHD was absent only on the subscale Withdrawn when conducting ANCOVAs. This is an important point for the clinician and indicates that accompanying OCS may result in an increased risk for withdrawal in children affected by ADHD. If we consider that no significant increase of psychopathology was observed by including an OCS covariate in terms of the factor ADHD, we could assume that OCS do not mask, compensate, or alleviate symptoms caused by ADHD to a clinically relevant degree.

This assumption is supported by the findings of Geller et al. (2002, 2004) that “the number, frequency and types of core ADHD symptoms ... as well as ... associated functional indices were identical in all youths ... irrespective of the presence or absence of comorbid OCD.” Thus, the coexistence of OCD and ADHD seems to reflect two principally independent problem areas that often co-exist and show familial cosegregation (Geller et al., 2007; Mathews & Grados, 2011) and even some clinical interaction (as reported above). Thus, the clinician should be aware of this for successful diagnostics and treatment.

The present study has some methodological limitations that have to be addressed. First, the OCS scores included as covariates as well as the psychopathology scales that served as dependent variables all derive from the CBCL. This might be considered to be a problem of circularity. However, the items integrated in the OCS scores stem only from three of the eight subscales, while the influence of the covariate is observable on almost all of the subscales. This shows that the effects of the covariates are at least not solely an artifact caused by circularity. Second, patients presenting any comorbid disorder apart from CTD and ADHD were excluded from the study to avoid confounding. This implies that the OCS assessed in this study are not categorical for OCD. Thus, all conclusions regarding the relation between OCS and the psychopathology of CTD and ADHD cannot readily be transferred to subjects suffering from OCD. Third, because recruitment took place in a tertiary center specialized in CTD, ADHD, and OCD, our findings cannot be generalized to other populations.

In summary, our results show that OCS play an important role in the psychopathological profile of children with CTD. Withdrawn behavior seems to be related to OCS only in ADHD. The assumption that CTD, ADHD, and OCD are interrelated is supported. The psychopathological pattern of children with CTD + ADHD is complex and cannot be explained solely by the core symptoms of the disorders tics, inattention, and hyperactivity/impulsivity. It may be of clinical value to be aware of all symptoms and problems that are present in one patient, and to evaluate which disorder contributes more to that person’s symptoms. Especially when dealing with CTD + comorbidities, the most obvious disorder might not be the most impairing. In this case, treatment of the most prominent disorder may not help the child with the problem causing the greatest subjective impairment. Our findings indicate that OCS should be taken into consideration (for details see Roessner et al., 2012) in planning treatment of CTD (but also ADHD). One of the three scores developed by Moll et al. (2000), Nelson et al. (2001), and Storch et al. (2006) could serve as a feasible method for estimating OCS in day-to-day clinical practice when extensive specialized diagnostic instruments cannot be used. However, cut-off scores still remain to be developed for this purpose.

Conflicts of Interest

Prof. Rothenberger:

Advisory Board and Speakers Bureau: Lilly, Shire, Medice, Novartis Research Support: Shire, German Research Society, Schwaabe Travel Support: Shire Educational Grant: Shire Consultant: UCB/Shire, Lilly

Prof. Roessner:

Lecture Fees: Eli Lilly, Janssen-Cilag, Medice, Novartis. Member of Advisory Boards: Eli Lilly, Novartis, Shire

References

  • Achenbach, T. M. (1991). Manual for the child behavior checklist/4–18 and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry. First citation in articleGoogle Scholar

  • Arnold, P. D. , Ickowicz, A. , Chen, S. , Schachar, R. (2005). Attention-deficit hyperactivity disorder with and without obsessive-compulsive behaviors: Clinical characteristics, cognitive assessment, and risk factors. Canadian Journal of Psychiatry, 50, 59–66. First citation in articleMedline, Google Scholar

  • Banaschewski, T. , Siniatchkin, M. , Uebel, H. , Rothenberger, A. (2003). Zwangsphänomene bei Kindern mit Tic-Störung bzw. Aufmerksamkeitsdefizit-Hyperaktivitätsstörung [Compulsive phenomena in children with tic disorder and attention deficit-hyperactive disorder]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 31, 203–211. First citation in articleLink, Google Scholar

  • Biederman, J. , Faraone, S. V. , Doyle, A. , Lehman, B. K. , Kraus, I. , Perrin, J. et al. (1993). Convergence of the Child Behavior Checklist with structured interview-based psychiatric diagnoses of ADHD children with and without comorbidity. Journal of Child Psychology and Psychiatry, 34, 1241–1251. First citation in articleCrossref Medline, Google Scholar

  • Biederman, J. , Monuteaux, M. C. , Greene, R. W. , Braaten, E. , Doyle, A. E. , Faraone, S. V. (2001). Long-term stability of the Child Behavior Checklist in a clinical sample of youth with attention deficit hyperactivity disorder. Journal of Clinical Child Psychology, 30, 492–502. First citation in articleCrossref Medline, Google Scholar

  • Black, D. W. , Gaffney, G. R. (2008). Subclinical obsessive-compulsive disorder in children and adolescents: Additional results from a “high-risk” study. CNS Spectrum, 13, 54–61. First citation in articleMedline, Google Scholar

  • Cardona, F. , Romano, A. , Bollea, L. , Chiarotti, F. (2004). Psychopathological problems in children affected by tic disorders – Study on a large Italian population. European Child and Adolescent Psychiatry, 13, 166–171. First citation in articleCrossref Medline, Google Scholar

  • Chen, W. J. , Faraone, S. V. , Biederman, J. , Tsuang, M. T. (1994). Diagnostic accuracy of the Child Behavior Checklist scales for attention-deficit hyperactivity disorder: A receiver-operating characteristic analysis. Journal of Consulting and Clinical Psychology, 62, 1017–1025. First citation in articleCrossref Medline, Google Scholar

  • Freeman, R. D. , Fast, D. K. , Burd, L. , Kerbeshian, J. , Robertson, M. M. , Sandor, P. (2000). An international perspective on Tourette syndrome: Selected findings from 3,500 individuals in 22 countries. Developmental Medicine and Child Neurology, 42, 436–447. First citation in articleCrossref Medline, Google Scholar

  • Fullana, M. A. , Mataix-Cols, D. , Caspi, A. , Harrington, H. , Grisham, J. R. , Moffitt, T. E. et al. (2009). Obsessions and compulsions in the community: Prevalence, interference, help-seeking, developmental stability, and co-occurring psychiatric conditions. The American Journal of Psychiatry, 166, 329–336. First citation in articleCrossref Medline, Google Scholar

  • Geller, D. A. , Biederman, J. , Faraone, S. V. , Cradock, K. , Hagermoser, L. , Zaman, N. et al. (2002). Attention-deficit/hyperactivity disorder in children and adolescents with obsessive-compulsive disorder: Fact or artifact? Journal of the American Academy of Child and Adolescent Psychiatry, 41, 52–58. First citation in articleCrossref Medline, Google Scholar

  • Geller, D. A. , Biederman, J. , Faraone, S. V. , Spencer, T. , Doyle, R. , Mullin, B. et al. (2004). Re-examining comorbidity of obsessive compulsive and attention-deficit hyperactivity disorder using an empirically derived taxonomy. European Child and Adolescent Psychiatry, 13, 83–91. First citation in articleCrossref Medline, Google Scholar

  • Geller, D. A. , Petty, C. , Vivas, F. , Johnson, J. , Pauls, D. , Biederman, J. (2007). Examining the relationship between obsessive-compulsive disorder and attention-deficit/hyperactivity disorder in children and adolescents: A familial risk analysis. Biological Psychiatry, 61, 316–321. First citation in articleCrossref Medline, Google Scholar

  • Gillberg, C. , Gillberg, I. C. , Rasmussen, P. , Kadesjo, B. , Soderstrom, H. , Rastam, M. et al. (2004). Co-existing disorders in ADHD: Implications for diagnosis and intervention. European Child and Adolescent Psychiatry, 13(Suppl. 1), I80–92. First citation in articleGoogle Scholar

  • Goodman, W. K. , Price, L. H. , Rasmussen, S. A. , Mazure, C. , Fleischmann, R. L. , Hill, C. L. et al. (1989). The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry, 46, 1006–1011. First citation in articleCrossref Medline, Google Scholar

  • Ivarsson, T. , Melin, K. , Wallin, L. (2008). Categorical and dimensional aspects of co-morbidity in obsessive-compulsive disorder (OCD). European Child and Adolescent Psychiatry, 17, 20–31. First citation in articleCrossref Medline, Google Scholar

  • Jensen, P. S. , Watanabe, H. K. , Richters, J. E. , Roper, M. , Hibbs, E. D. , Salzberg, A. D. et al. (1996). Scales, diagnoses, and child psychopathology: II. Comparing the CBCL and the DISC against external validators. Journal of Abnormal Child Psychology, 24, 151–168. First citation in articleCrossref Medline, Google Scholar

  • Kurlan, R. , Como, P. G. , Miller, B. , Palumbo, D. , Deeley, C. , Andresen, E. M. et al. (2002). The behavioral spectrum of tic disorders: A community-based study. Neurology, 59, 414–420. First citation in articleCrossref Medline, Google Scholar

  • Lewin, A. B. , Chang, S. , McCracken, J. , McQueen, M. , Piacentini, J. (2010). Comparison of clinical features among youth with tic disorders, obsessive-compulsive disorder (OCD), and both conditions. Psychiatry Research, 178, 317–322. First citation in articleCrossref Medline, Google Scholar

  • Mathews, C. A. , Grados, M. A. (2011). Familiality of Tourette syndrome, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder: Heritability analysis in a large sib-pair sample. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 46–54. First citation in articleCrossref Medline, Google Scholar

  • Moll, G. H. , Eysenbach, K. , Woerner, W. , Banaschewski, T. , Schmidt, M. H. , Rothenberger, A. (2000). Quantitative and qualitative aspects of obsessive-compulsive behavior in children with attention-deficit hyperactivity disorder compared with tic disorder. Acta Psychiatrica Scandinavica, 101, 389–394. First citation in articleCrossref Medline, Google Scholar

  • Nelson, E. C. , Hanna, G. L. , Hudziak, J. J. , Botteron, K. N. , Heath, A. C. , Todd, R. D. (2001). Obsessive-compulsive scale of the child behavior checklist: Specificity, sensitivity, and predictive power. Pediatrics, 108, E14. First citation in articleCrossref Medline, Google Scholar

  • Peterson, B. S. , Pine, D. S. , Cohen, P. , Brook, J. S. (2001). Prospective, longitudinal study of tic, obsessive-compulsive, and attention-deficit/hyperactivity disorders in an epidemiological sample. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 685–695. First citation in articleCrossref Medline, Google Scholar

  • Pollak, Y. , Benarroch, F. , Kanengisser, L. , Shilon, Y. , Benpazi, H. , Shalev, R. S. et al. (2009). Tourette syndrome-associated psychopathology: Roles of comorbid attention-deficit hyperactivity disorder and obsessive-compulsive disorder. Journal of Developmental and Behavioral Pediatrics, 30, 413–419. First citation in articleCrossref Medline, Google Scholar

  • Riddle, M. A. , Scahill, L. , King, R. , Hardin, M. T. , Towbin, K. E. , Ort, S. I. et al. (1990). Obsessive compulsive disorder in children and adolescents: phenomenology and family history. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 766–772. First citation in articleCrossref Medline, Google Scholar

  • Roessner, V. , Becker, A. , Banaschewski, T. , Rothenberger, A. (2007). Psychopathological profile in children with chronic tic disorder and co-existing ADHD: Additive effects. Journal of Abnormal Child Psychology, 35, 79–85. First citation in articleCrossref Medline, Google Scholar

  • Roessner, V. , Schoenefeld, K. , Buse, J. , Wanderer, S. , Rothenberger, A. (2012). Therapie der Tic-Störungen [Therapy of tic disorders]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 40, 217–237. First citation in articleLink, Google Scholar

  • Rothenberger, A. , Roessner, V. , Banaschewski, T. , Leckman, J. F. (2007). Co-existence of tic disorders and attention-deficit/hyperactivity disorder: Recent advances in understanding and treatment. European Child and Adolescent Psychiatry, 16(Suppl. 1), 1–4. First citation in articleCrossref Medline, Google Scholar

  • Schmeck, K. , Poustka, F. , Dopfner, M. , Pluck, J. , Berner, W. , Lehmkuhl, G. et al. (2001). Discriminant validity of the Child Behavior Checklist CBCL-4/18 in German samples. European Child and Adolescent Psychiatry, 10, 240–247. First citation in articleCrossref Medline, Google Scholar

  • Schmitman Gen Pothmann, M. , Petermann, U. , Petermann, F. , Zakis, D. (2011). Training sozialer Fertigkeiten für Kinder mit ADHS [The training of social skills in children with ADHD: Results of a pilot study]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 39, 277–285. First citation in articleLink, Google Scholar

  • Storch, E. A. , Murphy, T. K. , Bagner, D. M. , Johns, N. B. , Baumeister, A. L. , Goodman, W. K. et al. (2006). Reliability and validity of the Child Behavior Checklist Obsessive-Compulsive Scale. Journal of Anxiety Disorders, 20, 473–485. First citation in articleCrossref Medline, Google Scholar

  • Termine, C. , Balottin, U. , Rossi, G. , Maisano, F. , Salini, S. , Di Nardo, R. et al. (2006). Psychopathology in children and adolescents with Tourette’s syndrome: A controlled study. Brain and Development, 28, 69–75. First citation in articleCrossref Medline, Google Scholar

  • World Health Organization . (1996). Multiaxial classification of child and adolescent psychiatric disorders: The ICD-10 classification of mental and behavioral disorders in children and adolescents. Cambridge, MA: Cambridge University Press. First citation in articleCrossref, Google Scholar

CME-Fragen

  1. 1.
    Welche Aussage ist richtig: Es wird vermutet, dass das gemeinsame Auftreten von Tics und ADHS
    1. 1.
      durch viele gemeinsame psychopathologische Risikofaktoren entsteht
    2. 2.
      rein auf Umweltfaktoren zurückzuführen ist
    3. 3.
      durch den zeitlichen Ablauf der Störungen bedingt ist
    4. 4.
      nur sehr selten zu beobachten ist
    5. 5.
      auf eine zurückliegende oder verdeckte Zwangsstörung zurückzuführen ist
  2. 2.
    Welche Aussage zur CBCL treffen nicht zu
    1. 1.
      die CBCL erlaubt es, Psychopathologie von Kindern und Jugendlichen dimensional zu erheben
    2. 2.
      es werden insgesamt 112 Items abgefragt
    3. 3.
      es werden 8 Subskalen unterschieden
    4. 4.
      die Beurteilung erfolgt auf einer 3-Punkte-Skala
    5. 5.
      die CBCL wird typischerweise von den Kindern und Jugendlichen selbst ausgefüllt
  3. 3.
    Welche Aussage trifft nicht zu:
    1. 1.
      Zwangssymptome spielen eine wichtige Rolle im psychopathologischen Profil von Kindern mit chronischer Tic-Störung
    2. 2.
      die chronisch-motorische Tic-Störung, ADHS und Zwangsstörungen sind miteinander assoziiert
    3. 3.
      der psychopathologische Befund von Kindern mit chronischer Tic-Störung und ADHS kann nicht allein aus der Kernsymptomatik der Störungen (Tics, Unaufmerksamkeit, Hyperaktivität und Impulsivität) erklärt werden
    4. 4.
      es ist klinisch bedeutsam, diese Symptome eines betroffenen Patienten umfassend zu erheben
    5. 5.
      besonders beim Auftreten von chronischer Tic-Störung und komorbiden Störungen ist die am deutlichsten hervortretende Störung immer auch die Störung, die am meisten Einschränkungen bei den Patienten verursacht.
  4. 4.
    Welche Aussage trifft zu:
    1. 1.
      Die chronische Ticstörung und die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) sind Störungen, die in der Kindheit beginnen und häufig gemeinsam vorkommen
    2. 2.
      Zwangserkrankungen treten selten gemeinsam mit Ticstörungen und ADHS auf
    3. 3.
      Aufmerksamkeitsstörungen betreffen hauptsächlich Mädchen
    4. 4.
      Ticstörungen, ADHS und Zwangsstörungen haben keine gemeinsame neurobiologische Grundlage
    5. 5.
      das Auftreten einer Aufmerksamkeitsstörung macht das zusätzliche Auftreten von chronischen Ticstörungen unwahrscheinlich.
  5. 5.
    Welche Aussage zur Zwangsstörung trifft zu:
    1. 1.
      Zwangsstörungen treten nur in Kindheit und Adoleszenz auf.
    2. 2.
      Ein Standardinstrument zur Erfassung von Zwangsstörungen ist die Yale Brown Obsessive Compulsive Scale (Y-BOCS).
    3. 3.
      Die Ausprägung von Zwangsstörungen variiert nur selten im Krankheitsverlauf.
    4. 4.
      Die Prävalenz von Zwangsstörungen im Kindesalter liegt bei über 30%.
    5. 5.
      Zwangserkrankungen werden generell nur nicht-medikamentös behandelt.

Fortbildungszertifikat

Fortbildungszertifikat

Prof. Dr. Veit Roessner, Departement of Child and Adolescent Psychiatry, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstraße 74, Haus 12, 01307 Dresden, Germany