Objective: The aim of this study is to assess the phenomenology of tics in children with primary tic disorders and investigate how age and sex influence tic phenomenology.

Background: In children with primary tic disorders, tics demonstrate a rostrocaudal progression and evolve from simple to complex. Tic disorders have a marked male predominance, with a 4:1 ratio in Tourette syndrome (TS). There is a need to accumulate information regarding the clinical dimorphism of tic disorders between sexes.

Method: Children with primary tic disorders have been prospectively included in our Registry in Calgary, Canada, since 2017. In this study, we compared age at onset between boys and girls, Yale Global Tic Severity Scale (YGTSS) scores including detailed tic inventory, comorbidities and treatment. We examined the most common body areas affected and types of sounds, differences between males and females, and changes in tic complexity with age.

Results: We studied 180 children with tic disorders (150 with TS, 16 with persistent motor tic disorder, 3 with persistent vocal tic disorder, 11 with provisional tic disorder). Males represented 76.1% of patients. Mean age of onset was 6.5 years (CI 6.1-6.9) and did not differ by sex. The most common tics were simple motor and simple vocal tics, including eye blinking (56.1%), head jerks/movements (51.1%), eye movements (49.4%), mouth movements (45%) and throat clearing (42.2%). Looking at the YGTSS, females had higher intensities of motor tics (3.1 vs 2.6 in males, p=0.006) and higher motor scores (12.7 vs 11.0 in males, p=0.03). Females had more simple nose movements (44.2% vs 20.4%, p=0.003), more simple shoulder shrugs (39.5% vs 20.4%, p=0.013), more simple leg/foot/toe movements (37.2% vs 20.4%, p=0.028) and more grunting tics (14% vs 2.9%, p=0.012). Females had greater impairment scores (19.5 vs 15.6, p>0.05). As children aged, the YGTSS total tic scores were significantly greater (p=0.006). The most common psychiatric comorbidities were attention-deficit/hyperactivity disorder (ADHD) (48.9%), obsessive-compulsive disorder (27.2%) and anxiety (27.2%). Males were more affected by ADHD (55.5%) than females (27.9%) (p=0.002).

Conclusion: Our study suggests that age and sex affect clinical presentation in children with tics. Females had a small but significantly higher motor score on the YGTSS than males. Males were more likely to have ADHD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/an-exploration-of-tic-phenomenology-in-children-with-primary-tic-disorders/