Factors influencing diagnosis delay in children with Tourette syndrome

Abstract

Background Tourette syndrome (TS) is a chronic disorder characterized by motor and vocal tics. Previous studies reported a substantial lag period between disease onset and diagnosis ranging from 3 to 11.9 years. Aims To determine the lag period and factors associated with diagnosis delay of TS. Methods All files of 185 children with TS attending one neuropediatric unit in Jerusalem were reviewed. Lag time between disease onset, according to DSM criteria, and diagnosis was determined and the contributions of the disease course, comorbidities and epidemiological factors were assessed. Results A relatively short lag to diagnosis following the onset of diagnosable TS was documented (mean 13.2±15.9 months, median 6 months). A relatively longer gap was associated with older age at TS onset ( r=0.161, p<0.05) and vocal tics as the first manifestation rather than motor or combined motor and vocal tics (mean=20.3+16.3 months vs 11.9+16.5 and 12.6+15.2, respectively, p<0.05). A relatively shorter gap was associated with tic severity ( r=0.13, p<0.05) and presence of comorbid obsessive–compulsive disorder (OCD) (9.5+14.7 months vs. 14.1+16 without OCD, p<0.05). Conclusions Lag time to diagnosis is relatively short in our population. Factors associated with a shorter lag (early age of TS onset, motor tics as the first manifestation, greater tics severity and the presence of OCD) may be perceived as disruptive, prompting patient and families to seek medical care. Conversely, vocal tics as the first manifestation, associated with a longer lag, may be misdiagnosed as features of common pediatric conditions, thus delaying diagnosis.