Cristiano Termine1, Enzo Grossi2, Valentina Anelli1, Ledina Derhemi1, Andrea E Cavanna3,4,5,6. 1. Child Neuropsychiatry Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy. 2. Department of Autism Research, "Villa Santa Maria" Child and Adolescent Neuropsychiatry Rehabilitation Unit, Tavernerio, CO, Italy. 3. Michael Trimble Neuropsychiatry Research Group, University of Birmingham & BSMHFT, Birmingham, UK. a.e.cavanna@bham.ac.uk. 4. School of Life & Health Sciences, Aston University, Birmingham, UK. a.e.cavanna@bham.ac.uk. 5. Sobell Department of Motor Neuroscience & Movement Disorders, Institute of Neurology & University College London, London, UK. a.e.cavanna@bham.ac.uk. 6. Department of Neuropsychiatry, National Centre for Mental Health, 25 Vincent Drive, Birmingham, B15 2FG, UK. a.e.cavanna@bham.ac.uk.
Abstract
BACKGROUND: The association of stereotypies and tics is not rare in children with severe autism spectrum disorder (ASD). The differential diagnosis between stereotypies and tics in this patient population can be difficult; however, it could be clinically relevant because of treatment implications. METHODS: A total of 108 video recordings of repetitive behaviors in young patients with stereotypies in the context of ASD were reviewed by a movement disorders expert and a trainee, in order to assess the prevalence of possible co-morbid tics. The Modified Rush Videotape Rating Scale (MRVS) was used to rate tic frequency and severity. RESULTS: Out of 27 patients with stereotypies (24 males; mean age 14 years), 18 (67%) reported possible tics. The most frequently observed tics were eye blinking, shoulder shrugging, neck bending, staring, and throat clearing. The mean MRVS score was 5, indicating mild tic severity. The only significant difference between patients with tics and patients without tics was the total number of stereotypies, which was higher in the subgroup of patients without tics (p = 0.01). CONCLUSIONS: Expert review of video-recordings of repetitive behaviors in young patients with ASD and stereotypies suggests the possibility of a relatively high rate of co-morbid tics. These findings need to be integrated with a comprehensive clinical assessment focusing on the diagnostic re-evaluation of heterogeneous motor manifestations.
BACKGROUND: The association of stereotypies and tics is not rare in children with severe autism spectrum disorder (ASD). The differential diagnosis between stereotypies and tics in this patient population can be difficult; however, it could be clinically relevant because of treatment implications. METHODS: A total of 108 video recordings of repetitive behaviors in young patients with stereotypies in the context of ASD were reviewed by a movement disorders expert and a trainee, in order to assess the prevalence of possible co-morbid tics. The Modified Rush Videotape Rating Scale (MRVS) was used to rate tic frequency and severity. RESULTS: Out of 27 patients with stereotypies (24 males; mean age 14 years), 18 (67%) reported possible tics. The most frequently observed tics were eye blinking, shoulder shrugging, neck bending, staring, and throat clearing. The mean MRVS score was 5, indicating mild tic severity. The only significant difference between patients with tics and patients without tics was the total number of stereotypies, which was higher in the subgroup of patients without tics (p = 0.01). CONCLUSIONS: Expert review of video-recordings of repetitive behaviors in young patients with ASD and stereotypies suggests the possibility of a relatively high rate of co-morbid tics. These findings need to be integrated with a comprehensive clinical assessment focusing on the diagnostic re-evaluation of heterogeneous motor manifestations.
Entities:
Keywords:
Autism spectrum disorder; Stereotypies; Tics; Tourette syndrome; Video recording