Psychometic Standardization of the Tourette Syndrome Unified Rating Scale (TSURS)

Grant Type
Grant Year
Institution Location
Institution Organization Name
University of Rochester
Investigators Name
Como, Peter, PhD

The formulation of a standardized rating scale for Tourette Syndrome (TS) was initiated in May 1988 at a Tourette Syndrome Association (TSA) sponsored workshop chaired by Stanley Fahn, M.D. at which Drs. Como (Principal Investigator-PI) and Kurlan (co-PI) were participants. Other participants included nationally-recognized authorities on TS who were in general agreement that both clinicians and researchers have utilized widely varying rating techniques and scales to quantify the clinical features of TS. Those features include motor and vocal tics and commonly associated behavioral disturbances such as attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive symptoms (OCS). Consequently, the need to develop a unified rating scale for TS became a major focus of this TSA funded consensus workshop. Following that meeting, a sub-committee was formed to develop a unified rating scale for TS to include rating sections for motor and vocal tics, attention deficit disorder, and obsessive-compulsive disorder. An initial draft of the Tourette Syndrome Unified Rating Scale (TSURS) was completed in September 1988. This draft was distributed for review to workshop participants along with position papers by the sub-committee. A finalized version of the TSURS is being prepared following a second meeting of several workshop participants in September 1989. Essentially, the TSURS is divided into four main sections and includes: 1) ratings for motor and phonic tics (both by history and examination), 2) screening questions and global clinical impression ratings for ADHD, 3) screening questions and global clinical impression rates for OCS, and 4) rating scales for overall impairment. Prior to widespread implementation of the TSURS, however, it is imperative that careful psychometric standardization studies take place in the form of assessing inter-rater reliability and instrument validity. Therefore, the specific aims of this research project are to: (1) establish statistically-derived measures of inter-rater reliability among the four sections of the TSURS, and (2) conduct a comparative specificity/sensitivity study of the ADHD and OCS screening questions from the TSURS and other psychometrically accepted measures of these behavioral disturbances. For the inter-rater reliability portion of this project, we plan to make videotaped vignettes of a standard interview and examination of 10 patients with TS. Experts in TS will view these vignettes and complete the TSURS. For the sensitivity/specificity portion of this project, we will be comparing several different techniques for assessing attention deficit disorder and obsessive-compulsive disorder to determine which set of techniques best differentiates TS patients who have these conditions. This project will develop a psychometrically-based level of confidence that the TSURS is indeed a useful rating scale for TS. Hopefully, the TSURS can be adapted universally and become a key instrument both in clinical practice and in future research endeavors such as drug trials and genetic studies. Peter G. Como, Ph.D., Roger Kurlan, M.D. University of Rochester School of Medicine and Dentistry, Rochester, NY Award: $25,000 Tourette Association of America Inc. – Research Grant Award 1989