Child Psychiatry & Human Development

, Volume 47, Issue 4, pp 563–573 | Cite as

The Impact of Tic Severity, Comorbidity and Peer Attachment on Quality of Life Outcomes and Functioning in Tourette’s Syndrome: Parental Perspectives

  • Deirdre O’Hare
  • Edward Helmes
  • Valsamma Eapen
  • Rachel Grove
  • Kerry McBain
  • John Reece
Original Article


The aim of this controlled, community-based study based on data from parents of youth (aged 7–16 years) with Tourette’s syndrome (TS; n = 86) and parents of age and gender matched peers (n = 108) was to test several hypotheses involving a range of variables salient to the TS population, including peer attachment, quality of life, severity of tics, comorbidity, and psychological, behavioural and social dysfunction. Multivariate between-group analyses confirmed that TS group youth experienced lower quality of life, increased emotional, behavioural and social difficulties, and elevated rates of insecure peer attachment relative to controls, as reported by their primary caregiver. Results also confirmed the main hypothesis that security of peer attachment would be associated with individual variability in outcomes for youth with TS. As predicted, multivariate within-TS group analyses determined strong relationships among adverse quality of life outcomes and insecure attachment to peers, increased tic severity, and the presence of comorbid disorder. Findings suggest that youth with TS are at increased risk for insecure peer attachment and that this might be an important variable impacting the quality of life outcomes for those diagnosed.


Tourette syndrome Quality of life Peer attachment Comorbidity Tic severity 



We are very grateful to all who participated in the study. We also wish to thank the TSAA, TSAV and volunteers for their support and help with advertising and recruitment. Thanks also to Dr. Douglas Woods and colleagues for permission use the PTQ and Dr. James Varni and associates for permission to the use of the PedsQL.


  1. 1.
    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders—fifth edition (DSM-5). American Psychiatric Publishing, WashingtonGoogle Scholar
  2. 2.
    Robertson MM, Eapen V (2014) Tourette’s: syndrome, disorder or spectrum? Classificatory challenges and an appraisal of the DSM criteria. Asian J Psychiatr 11:106–113CrossRefPubMedGoogle Scholar
  3. 3.
    Cavanna A, Servo S, Monaco F, Robertson M (2009) The behavioral spectrum of Gilles de la Tourette syndrome. J Neuropsychiatry Clin Neurosci 21:13–23CrossRefPubMedGoogle Scholar
  4. 4.
    Robertson MM, Cavanna AE, Eapen V (2015) Gilles de la Tourette syndrome and disruptive behavior disorders: prevalence, associations and explanation of the relationships. J Neuropsychiatry Clin Neurosci 27:33–41CrossRefPubMedGoogle Scholar
  5. 5.
    Robertson MM (2012) The Gilles de la Tourette syndrome: the current status. Arch Dis Child Educ Pract Ed 97:166–175CrossRefPubMedGoogle Scholar
  6. 6.
    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 Dev 28:69–75CrossRefPubMedGoogle Scholar
  7. 7.
    Freeman RD, Fast DK, Burd DL, Kerbashian J, Robertson MM, Sandor P (2000) An international perspective on Tourette syndrome: selected findings from 3500 individuals in 22 countries. Dev Med Child Neurol 42:436–447CrossRefPubMedGoogle Scholar
  8. 8.
    Conelea CA, Woods DW, Zinner SH, Budman C, Murphy T, Scahill LD et al (2011) Exploring the impact of chronic tic disorders on youth: results from the Tourette syndrome impact survey. Child Psychiatry Hum Dev 42:219–242CrossRefPubMedGoogle Scholar
  9. 9.
    Eddy CM, Cavanna AE, Gulisano M, Agodi A, Barchitta M, Calì P et al (2011) Clinical correlates of quality of life in Tourette syndrome. Mov Disord 26:735–738CrossRefPubMedGoogle Scholar
  10. 10.
    Leckman JF, Bloch MH, Scahill L, King RA (2006) Tourette syndrome: the self under Siege. J Child Neurol 21:642–649CrossRefPubMedGoogle Scholar
  11. 11.
    Storch EA, Lack CW, Simons LE, Goodman WK, Murphy TK, Geffken GR (2007) A measure of functional impairment in youth with Tourette’s syndrome. J Pediatr Psychol 32:950–959CrossRefPubMedGoogle Scholar
  12. 12.
    Eddy CM, Rizzo R, Gulisano M, Agodi A, Barchitta M, Calì P et al (2011) Quality of life in young people with Tourette syndrome: a controlled study. J Neurol 258:291–301CrossRefPubMedGoogle Scholar
  13. 13.
    Cutler D, Murphy T, Gilmour J, Heyman I (2009) The quality of life of young people with Tourette syndrome. Child Care Health Dev 35:496–504CrossRefPubMedGoogle Scholar
  14. 14.
    Muller-Vahl K, Dodel I, Müller N, Münchau A, Reese JP, Balzer-Geldsetzer M et al (2010) Health-related quality of life in patients with Gilles de la Tourette’s syndrome. Mov Disord 25:309–314CrossRefPubMedGoogle Scholar
  15. 15.
    Storch EA, Merlo LJ, Lack C, Milsom VA, Geffken GR, Goodman WK et al (2007) Quality of life in youth with Tourette’s syndrome and chronic tic disorder. J Clin Child Adolesc Psychol 36:217–227CrossRefPubMedGoogle Scholar
  16. 16.
    Jalenques I, Galland F, Malet L, Morand D, Legrand G, Auclair C et al (2012) Quality of life in adults with Giles de la Tourette syndrome. BMC Psychiatry 13:109CrossRefGoogle Scholar
  17. 17.
    Eapen V, Črnčec R (2009) Tourette syndrome in children and adolescents: special considerations. J Psychosom Res 67:525–532CrossRefPubMedGoogle Scholar
  18. 18.
    Boudjouk PJ, Woods DW, Miltenberger RG, Long ES (2000) Negative peer evaluation in adolescents: effects of tic disorders and trichotillomania. Child Fam Behav Ther 22:17–28CrossRefGoogle Scholar
  19. 19.
    Achenbach TM, Rescorla LA (2000) Manual for the ASEBA preschool forms and profiles. University of Vermont, Research Center for Children, Youth, & Families, BurlingtonGoogle Scholar
  20. 20.
    Chang S, Himle MB, Tucker BTP, Woods DW, Douglas W, Piacentini JC (2009) Initial psychometric properties of a brief parent-report instrument for assessing tic severity in children with chronic tic disorders. Child Fam Behav Ther 31:181–191CrossRefGoogle Scholar
  21. 21.
    Cooper C, Robertson MM, Livingston G (2003) Psychological morbidity and caregiver burden in parents of children with Tourette’s disorder and psychiatric comorbidity. J Am Acad Child Adolesc Psychiatry 42:1370–1375CrossRefPubMedGoogle Scholar
  22. 22.
    Packer LE (1997) Social and educational resources for patients with Tourette syndrome. Neurol Clin 15:457–473CrossRefPubMedGoogle Scholar
  23. 23.
    Packer LE (2005) Tic-related school problems: Impact on functioning, accommodations, and interventions. Behav Modif 29:876–899CrossRefPubMedGoogle Scholar
  24. 24.
    Wilkinson BJ, Marshall RM, Curtwright B (2008) Impact of Tourette’s disorder on parent reported stress. J Child Fam Stud 17:582–598CrossRefGoogle Scholar
  25. 25.
    Woods DW (2005) Introduction to the special issue on the clinical management of Tourette’s syndrome: a behavioral perspective. Behav Modif 29:711–715CrossRefGoogle Scholar
  26. 26.
    Storch EA, Murphy TK, Chase RM, Keeley M, Goodman WK, Murray M et al (2007) Peer victimization in youth with Tourette’s syndrome and chronic tic disorder: relations with tic severity and internalizing symptoms. J Psychopathol Behav 29:211–219CrossRefGoogle Scholar
  27. 27.
    Carter AS, O’Donnell DA, Schultz RT, Scahill L, Leckman JF, Pauls DL (2000) Social and emotional adjustment in children affected with Gilles de la Tourette’s syndrome: associations with ADHD and family functioning. J Child Psychol Psychiatry 41:215–223CrossRefPubMedGoogle Scholar
  28. 28.
    Silva RR, Munoz DM, Barickman J, Friedhoff AJ (1995) Environmental factors and related fluctuation of symptoms in children and adolescents with Tourette’s disorder. J Child Psychol Psychiatry 36:305–312CrossRefPubMedGoogle Scholar
  29. 29.
    Woods DW, Piacentini JC, Scahill L, Peterson AL, Wilhelm S, Chang S et al (2011) Behavior therapy for tics in children: acute and long-term effects on psychiatric and psychosocial functioning. J Child Neurol 26:858–865CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Woods DW, Koch M, Miltenberger RG (2003) The impact of tic severity on the effects of peer education about Tourette’s syndrome. J Dev Phys Disabil 15:67–78CrossRefGoogle Scholar
  31. 31.
    Stokes A, Bawden HN, Backman JE, Dooley JM, Camfield PR (1991) Peer problems in Tourette’s disorder. Pediatrics 87:936–942PubMedGoogle Scholar
  32. 32.
    Champion LM, Fulton WA, Shady GA (1989) Tourette syndrome and social functioning in a Canadian population. Neurosci Biobehav Rev 12:255–257CrossRefGoogle Scholar
  33. 33.
    Cohen DJ, Leckman JF (1994) Developmental psychopathology and neurobiology of Tourette’s syndrome. J Am Acad Child Adolesc Psychiatry 33:2–15CrossRefPubMedGoogle Scholar
  34. 34.
    Dykens E, Leckman J, Riddle M, Hardin M, Schwartz S, Cohen D (1990) Intellectual, academic, and adaptive functioning of Tourette syndrome children with and without attention deficit disorder. J Abnorm Child Psychol 18:607–615CrossRefPubMedGoogle Scholar
  35. 35.
    Kurlan R, Daragjati C, Como PG, McDermott MP, Trinidad KS, Roddy S et al (1996) Non-obscene complex socially inappropriate behavior in Tourette’s syndrome. J Neuropsych Clin Neurosci 8:311–317CrossRefGoogle Scholar
  36. 36.
    Bowlby J (1982) Attachment and loss: retrospect and prospect. Am J Orthopsychiatry 52:664–678CrossRefPubMedGoogle Scholar
  37. 37.
    Ainsworth MD (1989) Attachments beyond infancy. Am Psychol 44:709–716CrossRefPubMedGoogle Scholar
  38. 38.
    Ainsworth MDS (1982) Attachment: retrospect and prospect. In: Parkes CM, Stevenson-Hinde J (eds) The place of attachment in human behavior. Basic Books, New York, pp 3–30Google Scholar
  39. 39.
    Hazan C, Shaver P (1987) Romantic love conceptualized as an attachment process. J Pers Soc Psychol 52:511–524CrossRefPubMedGoogle Scholar
  40. 40.
    Sroufe LA (2005) Attachment and development: a prospective, longitudinal study from birth to adulthood. Attach Hum Dev 7:349–367CrossRefPubMedGoogle Scholar
  41. 41.
    Seibert AC, Kerns KA (2009) Attachment figures in middle childhood. Int J Behav Dev 33:347–355CrossRefGoogle Scholar
  42. 42.
    Muris P, Maas A (2004) Strengths and difficulties as correlates of attachment style in institutionalized and non-institutionalized children with below-average intellectual abilities. Child Psychiatry Hum Dev 34:317–328CrossRefPubMedGoogle Scholar
  43. 43.
    Laible DJ, Carlo G, Roesch SC (2004) Pathways to self-esteem in late adolescence: the role of parent and peer attachment, empathy, and social behaviours. J Adolesc 27:703–716CrossRefPubMedGoogle Scholar
  44. 44.
    Rubin KH, Dwyer KM, Booth-LaForce C, Kim AH, Burgess KB, Rose-Krasnor L (2004) Attachment, friendship, and psychosocial functioning in early adolescence. J Early Adolesc 24:326–356CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Varni JW, Limbers CA (2009) The pediatric quality of life inventory: measuring pediatric health-related quality of life from the perspective of children and their parents. Pediatr Clin North Am 56:843–863CrossRefPubMedGoogle Scholar
  46. 46.
    Varni JW, Seid M, Kurtin PS (2001) PedsQL 4.0: reliability and validity of the pediatric quality of life inventory version 4.0 generic core scales in healthy and patient populations. Med Care 39:800–812CrossRefPubMedGoogle Scholar
  47. 47.
    Chan KS, Mangione-Smith R, Burwinkle TM, Rosen M, Varni JW (2005) The PedsQL: reliability and validity of the short-form generic core scales and asthma module. Med Care 43:256–265CrossRefPubMedGoogle Scholar
  48. 48.
    Goodman R (1997) The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry 38:581–586CrossRefPubMedGoogle Scholar
  49. 49.
    Mellor D (2005) Normative data for the strengths and difficulties questionnaire in Australia. Aust Psychol 40:215–222CrossRefGoogle Scholar
  50. 50.
    Goodman R, Scott S (1999) Comparing the strengths and difficulties questionnaire and the child behavior checklist: Is small beautiful? J Abnorm Child Psychol 27:17–24CrossRefPubMedGoogle Scholar
  51. 51.
    Muris P, Meesters C, van Melick M, Zwambag L (2001) Self reported attachment style, attachment quality, and symptoms of anxiety and depression in young adolescents. Pers Indiv Differ 30:809–818CrossRefGoogle Scholar
  52. 52.
    Bartholomew K, Shaver P (1998) Methods of assessing adult attachment. Do they converge? In: Simpson JA, Rholes WS (eds) Attachment theory and close relationships. Guilford Press, New York, pp 25–45Google Scholar
  53. 53.
    Muris P, Meesters C (2002) Attachment, behavioral inhibition, and anxiety disorders symptoms in normal adolescents. J Psychopathol Behav 24:97–106CrossRefGoogle Scholar
  54. 54.
    Baron RM, Kenny DA (1986) The moderator–mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations. J Pers Soc Psychol 51:1173–1182CrossRefPubMedGoogle Scholar
  55. 55.
    Bernard BA, Stebbins GT, Siegel S, Schultz TM, Hays C, Morrissey MJ et al (2009) Determinants of quality of life in children with Gilles de la Tourette syndrome. Mov Disord 24:1070–1073CrossRefPubMedGoogle Scholar
  56. 56.
    Robertson MM (2008) The prevalence and epidemiology of Gilles de la Tourette syndrome. Part 1: the epidemiological and prevalence studies. J Psychosom Res 65:461–472CrossRefPubMedGoogle Scholar
  57. 57.
    Robertson MM (2011) Gilles de la Tourette syndrome: the complexities of phenotype and treatment. Br J Hosp Med 72:100–107CrossRefGoogle Scholar
  58. 58.
    Main M, Solomon J (1990) Procedures for identifying infants as disorganized–disoriented during the ainsworth strange situation. In: Greenberg M, Cicchetti D, Cummings EM (eds) Attachment in the preschool years: theory, research and intervention. University of Chicago Press, Chicago, pp 121–160Google Scholar
  59. 59.
    De Lange N, Olivier M (2004) Mothers’ experiences of aggression in their Tourette’s syndrome children. Int J Adv Couns 26:65–77CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Deirdre O’Hare
    • 1
  • Edward Helmes
    • 1
  • Valsamma Eapen
    • 2
    • 4
  • Rachel Grove
    • 2
  • Kerry McBain
    • 1
  • John Reece
    • 3
  1. 1.School of Arts and Social SciencesJames Cook UniversityTownsvilleAustralia
  2. 2.School of PsychiatryUniversity of New South Wales & Ingham InstituteSydneyAustralia
  3. 3.School of Psychological SciencesAustralian College of Applied PsychologyMelbourneAustralia
  4. 4.Academic Unit of Child Psychiatry, South Western Sydney Local Health District (AUCS), Liverpool HospitalMental Health Centre (Level 1: ICAMHS)Liverpool, SydneyAustralia

Personalised recommendations