Clinical Study Of Sustain Attention In Children With Tic Disorders

Objective:Tic disorders(TD)is a neurodevelopmental disorder that begins in childhood and is characterized by twitch.According to the American Psychiatric Association Manual of Psychiatric Diseases,5th edition(DSM-V),tic disorders is classified into three types:Transient tic disorders(TTD),Chronic motor or vocal tic disorders(CTD)and Tourette syndrome(TS).The clinical manifestations of Tic disorders is diverse,and it often suffers from other mental disorders.Attention deficit hyperactivity disorder(ADHD)is the most common comorbidity of TD.Relevant studies have shown that attention persistence and stability of children with ADHD are worse than that of normal development children.Few studies have found that sustained attention deficit in children with TD may be related to co-existing ADHD or the sedative effects of drugs.This study takes children with TD as the subjects in order to explore whether TD itself has sustained attention impairment and which are the affecting factors.Methods:Subjects were the children with TD in the pediatric neurology outpatient department of our hospital from June 2018 to November 2018.They were conformed to the diagnoses of DMS-V,ranging from 6 to 18 years old and excluding the cases of other comorbidities except ADHD.36 cases with TD only and 19 cases with TD puls ADHD have been collected.In the control group,36 healthy children of the same age and gender were selected from community.All children completed the general condition questionnaire,mental illness related assessment scale and the children with TD or TD puls ADHD aslo completed the Yale Global Tic Severity Scale(YGTSS).All children completed the Eriksen Flanker Task(EFT)in 8 minutes.The study compared the differences of mean reaction time(MRT),reaction time standard deviation(RTSD),coefficient of variation(CV=RTSD/MRT)and errors(comission+ommision)among the three groups.The TD only group were divided into groups according to age,gender,clinical course,typology,severity of YGTSS score,and the results of EFT were analyzed to find the possible affecting factors.SPSS 22.0 software was used to make analyses.Chi-square test was used to analyze count date.Non-parametric test and Kruskal-waillis test was used to analyze some measurement date.Mean values of MRT,RTSD,CV and errors among the three groups were compared.One-way analysis of variance and Least-significant difference(LSD)test were used for homogeneity of variance,while non-parametric test and Kruskal-waillis test were used for heterogeneity of variance.Multiple linear regression analysis was used to analyze the affecting factors of the EFT results in TD only group.Alpha=0.05,bilateral,as the significance standard.Results:There was no significant difference in MRT and errors among the three groups(H=4.415,p=0.110;H=4.259,p=0.119,respectively).There were statistically significant differences in RTSD and CV among groups(H=15.091,p=0.001;F=11.685,p=0.000,respectively).After pair comparison,there was no statistically significant difference in RTSD and CV between TD only group and control group(corrected p=0.239;p=0.227,respectively).There were statistically significant differences in RTSD and CV between TD puls ADHD group and control group(corrected p=0.000;p=0.000,respectively).There were statistically significant differences in RTSD and CV between TD only group and TD puls ADHD group(corrected p=0.046;p=0.000,respectively).Possible affecting factors of EFT results including age,gender,clinical course,typology,severity of YGTSS score were analyzed in the multiple regression model.It was found that the effect of age on MRT was statistically significant(T=-2.373,p=0.024),indicating that the MRT of older children was smaller than that of younger children.The effect of clinical course on RTSD was statistically significant(T=-2.184,p=0.037),indicating that the RTSD in children with TD only is increased with the disease duration.The effects of factors above on CV and errors were not statistically significant.Conclusion:Children with TD only have no sustained attention deficit and ADHD may be the cause of sustained attention impairment.Age,gender,typology,and severity of YGTSS score have no significant influence on the sustained attention of children with TD only.But with the prolongation of the disease course,the sustained attention of children with TD only may be affected.Therefore,it is necessary to intervene and treat TD as early as possible.