Qualitative Analysis of Approaches to Diagnosis and Management of Tourette Syndrome and Comorbid Disorders among General Pediatric Practitioners

Grant Type
Clinical
Grant Year
1999-2000
Institution Location
MO
Institution Organization Name
Cardinal Glennon Children’s Hospital
Investigators Name
Zinner, Samuel, MD

Tourette Syndrome (TS) is a neurological condition of childhood onset characterized by multiple motor and vocal tics and is frequently associated with comorbid disorders such as Attention Deficit Hyperactivity Disorder, Obsessive Compulsive Disorder, anxiety disorders, learning disorders and mood disorders. These comorbid conditions often cause more functional or emotional distress or impairment to the individual with TS than do the tics. Estimates of the prevalence of TS may reach 1% or more. By definition, the disorder must begin during childhood, therefore TS is of clinical importance to the general pediatrician. Generally, there is a gap of several years between onset of symptoms and diagnosis. Although this gap has been narrowing due to greater awareness of TS, evidence persists that children as well as adults with TS are being under-identified or misdiagnosed, particularly if they present with a comorbid condition. This study will identify those features that lead general pediatricians to consider TS in the evaluation of a patient. Specifically, the study will delineate the ability of the general pediatrician to consider TS when presented in the context of a comorbid condition. The setting will be in eight separate focus groups across the United States, each comprised of pediatricians and one child psychiatrist. Participants will receive a case vignette of a patient with TS presenting with a comorbid condition. They will be asked to formulate a differential diagnosis, and then asked to generate thoughts on further steps to be taken. Following collection of these written forms, a group discussion will take place, guided with open-ended questions as necessary. Topics to be addressed will include familiarity with the diagnostic criteria of TS, comorbid conditions, management approaches and elucidation of what constitutes a tic. We seek to understand the variability among practitioners in the practical applications of TS criteria. Discussions will be audiotaped and transcribed. Data will be analyzed by both qualitative and quantitative methods. This study has significant public health relevance. Given the prevalence of TS and the debilitating and costly comorbid conditions that affect more than half of individuals with TS, the potential benefit to the general public health of earlier recognition and thus improved treatment is great. Also, our findings can help to develop clinical instruments for practitioners’ use to screen for TS and comorbidity. Samuel H. Zinner, M.D., Cardinal Glennon Children’s Hospital, St. Louis, MO Barbara J. Coffey, M.D., McLean Hospital/Harvard Medical School, Belmont, MA Award $5,605 DR. JOHN B. PENNEY, JR. MEMORIAL AWARD Tourette Association of America Inc. – Research Grant Award 1999-2000