Cross-sectional Survey And Clinical Efficacy Study Of Tic Disorder Comorbid Attention Deficit Hyperactivity Disorder

Research 1:A Cross-Sectional Study of Tic Disorders with Attention Deficit Hyperactivity DisorderObjective:To investigate the differences in the incidence and disease severity of Tic Disorders(TD)with and without Attention Deficit Hyperactivity Disorder(ADHD),and to explore the clinical characteristics of TD+ADHD in order to guide the clinical treatment.Methods:1 Comparative Analysis of the Clinical Condition of Children in TD Group and TD+ADHD GroupBased on the TD and ADHD in the Diagnostic and Statistical Manual of Mental Disorders,5th Edition(DSM-5),cases were selected from 2018.8-2019.11 in the TD children's outpatient clinic of the department of Pediatrics,Guang'anmen hospital of China Academy of Chinese Medical Science,and finally 408 children at the age of 6-12 years old with TD or TD+ADHD were targeted as research objects,including 296 children in the TD group and 112 children in the TD+ADHD group.To explore the differences in gender,ages,scores of the YGTSS,severity distribution of TD,age distribution at the time of onset of TD,symptoms distribution of onset of TD,course distribution of TD,and subtype distribution of TD.To describe the linear correlation between the SNAP-?score and YGTSS score,and to analyze the severity of TD and ADHD.2 General Situation Analysis of C hildren in TD+ADHD GroupAccording to different types of ADHD,children with TD+ADHD were divided into three subtypes:TD with attention deficit ADHD(TD+ADHD-1),TD with hyperactivity/impulsivity ADHD(TD+ADHD-HI),and TD with attention deficit hyperactivity disorder(TD+ADHD-C).The study was divided into the following four parts:(1)Analyses of the general conditions of the three groups of children;(2)To analyze the differences in the age distribution with initial tics,YGTSS scores,symptoms of the various subtypes of tic among the three groups of children.(3)In view of the three groups of children with the SNAP-? rating scale,to analyze the different condition of various subtypes of ADHD;(4)to explore whether TD+ADHD children have TD or ADHD first,or both.Results:1 Comparative Analysis of the Clinical Condition of Children in TD Group and TD+ADHD Group1.1 TD are mostly in the form of single rather than comorbidity,and the prevalence rate of male children is higher than that of female children.1.2 In terms of age distribution,initial symptom distribution,disease course distribution and subtype distribution of TD,there was no statistical difference between the TD group and the TD+ADHD group(P>0.05).1.3 In terms of YGTSS scores and severity distribution of TD,there were statistically significant differences between the two groups(P<0.001).There was no statistically significant difference between the two groups in the scores of total motor tics and total vocal tics(P>0.05).However,there were significant differences in ratio of psychological,life,learning and social impairment damage in the children(P<0.001).1.4 The correlation coefficient "r" of the YGTSS score and the SNAP-?score was 0.16(P>0.05).So,there was no linear relationship between the YGTSS score and SNAP-? score2 General Situation Analysis of Children in TD+ADHD Group2.1 There was no statistical difference in the gender distribution in TD+ADHD-I group,TD+ADHD-HI group and TD+ADHD-C group(P>0.05).The age distributions of the three groups were statistically different(P<0.05).Their age ranking:TD+ADHD-1 group>TD+ADHD-C group=TD+ADHD-HI group.Thus,it can be concluded that the age of TD+ADHD-HI group and TD+ADHD-C group is relatively small compared with TD+ADHD-I group.2.2 There was no statistical difference in the age of children with initial TD and YGTSS score among the three groups(P>0.05).2.3 In the SNAP-? scale of the sub-project of the Attention Deficit score,there was no significant difference in scores between TD+ADHD-1group and TD+ADHD-C group(P>0.05)But,the two groups' data has obvious statistical difference compared with the TD+ADHD-HI group(P<0.001).Their age ranking:TD+ADHD-I group=TD+ADHD-C group>TD+ADHD-HI group.In the SNAP-? scale of the sub-project of the Hyperactivity/Impulsiveness score,there was no significant difference in scores between TD+ADHD-HI group and TD+ADHD-C group(P>0.05).But the two groups'data has obvious statistical difference compared with the TD+ADHD-1 group(P<0.001).Age ranking:TD+ADHD-HI group=TD+ADHD-Cgroup>TD+ADHD-I group.2.4 In the retrospective investigation of the onset of TD+ADHD group in this study,due to the influence of objective conditions,such as time,and subjective conditions,such as the memory of parents(legal guardians),the onset of disease could not be investigated in TD+ADHD group.So,we could not draw any conclusions about itConclusion:1 Most of the TD are in the form of single rather than the comorbidity,and the proportion of male children is greater than that of female children2 The severity of TD:Compared with the TD group,children with TD+ADHD have higher scores in terms of the total YGTSS score and the rate of damage describing the psychological state.And the disease of TD is more serious in the TD+ADHD group.However,their age of onset and severity of TD are not affected by the ADHD subtype.Among them,the factors affecting the severity of TD are probably related to the more serious psychological and behavioral problems after suffering from ADHD.3 Admission time:Among the TD+ADHD group,the age of the TD+ADHD-H1 group and TD+ADHD-C group were significantly lower than that TD+ADHD-? group.It can be inferred that children with TD+ADHD-HI and TD+ADHD-C have more obvious extraverted psychological behavior problems in clinical practice,so they come to the hospital earlier.4 Although there is no linear relationship between the YGTSS score and the SNAP-?score.But from a further scatter diagram describing the general trend,it seemed to be an increase between them.It can be established other relevant models to future explore YGTSS score and SNAP-? score and their clinical significanceResearch 2:A Study on the Clinical Effect of the "Jingxinzhidong prescribtion" in the Treatment with "Hot heart-liver fire flourishing type"Syndromes of TD with ADHDObjective:Under the guidance of the "mainly treating from the heart",to analyze the "Jingxinzhidong prescription" in the treatment of tics of TD and TD+ADHD children with "hot heart-liver fire flourishing type" syndromes in the clinical practice;To further analyze the therapeutic effect of"Jingxinzhidong prescription" on TD children with the comorbidity of ADHD in order to provide some clinical ideas in treating with them.Methods:The TD group and the TD+ADHD group were compared before and after treating by"Jingxinzhidong prescribtion",to analyze the changes of TD between the two groups with "hot heart-liver fire flourishing type" syndromes.Results:1 After treating by the "Jingxinzhidong prescribtion" in the TD group and TD+ADHD group with "hot heart-liver fire flourishing type" syndromes,there was certain clinical efficacy both in the TD group and the TD+ADHD group.But the efficacy in the TD group was more significant(P<0.05).2 The "Jingxinzhidong prescribtion" can significantly relieve children's irritable disposition,chest tightness/shortness of breath,oral ulcer,sleep problems,thirsty problems,pharyngeal red,abnormal pharyngeal feeling,dry stools and other symptoms of Traditional Chinese Medicine(TCM)(P<0.01).3 While mainly treating TD with "hot heart-liver fire flourishing type" syndromes,the SNAP-? score was decreased as a whole in the TD+ADHD group after treatment,and the difference was statistically significant(P<0.001).Conclnsion:1 There was certain clinical efficacy both in the TD group and the TD+ADHD group with"hot heart-liver fire flourishing type" syndromes after the treatment of the "Jingxinzhidong prescribtion".But,it seemed to be higher in the TD group.In addition,it has a good therapeutic effect on the symptoms of TCM in the two groups2 In this study,for the majority of children with TD+ADHD with "hot heart-liver fire flourishing type" syndromes,the "Jingxinzhidong prescribtion" can not only effectively treat the clinical symptoms of their TD,but also will not aggravate the symptoms of ADHD during the treatment.The symptoms of ADHD can be further intervened after the clinical symptoms of the TD being relieved.It could provide a good clinical idea for the treatment of TD with ADHD.