JOURNAL READING

BLOK 15
Muhammad Saad Zaidan 2113010047

Chairun Najwa Lokeswara

2113010101
1. What was the article type?

Original research article

 2. What was the title?

Prevalence of Tourette Syndrome and Chronic Tics in the

Population-Based Avon Longitudinal Study of Parents and
Children Cohort
 3. Who were the authors?

Jeremiah M. Scharf, M.D., Ph.D., et al.

4. What was the main research problem?

Prevalence of TS, CT, and their overlap with OCD and ADHD in the
Avon Longitudinal Study of Parents and Children (ALSPAC) birth
cohort
5. Was there any mention of previous studies on this topic?

This study mentions previous research regarding the prevalence of Tourette's syndrome (TS) and
chronic tic disorder (CT) in school-aged children. prevalence estimates reported by most population
based TS prevalence studies of school-age children over the past decade. (Elstner K.et al.)
Although the researcher is refer to some recent studies reported significantly higher TS rates , these
studies were confounded by small sample size and low participation rates, respectively. The researcher
is refer to some recent studies reported significantly higher TS rates , but acknowledged that this study
had limitations related to case ascertainment and diagnostic criteria. (Burd L,et al)
These references demonstrate that the researchers considered and contextualized their findings within
the existing literature on the prevalence of TS and CT.
6. Why was this study performed (the rationale)?

This study was conducted to provide updated prevalence estimates for Tourette's
syndrome (TS) and chronic tic disorder (CT) in a population-based cohort, as well as to
investigate rates of co-occurring obsessive-compulsive disorder (OCD) and attention
disorders deficit/hyperactivity disorder (ADHD) in individuals with TS and CT.
 7. What were the aims and objectives of the
study?

The study also aimed to identify potential factors associated with attrition and bias in
prevalence estimates, and to compare prevalence rates and co-occurring conditions
between population-based samples and clinically confirmed cases.
 8. What was the study (research) hypothesis?

The hypothesis was that the prevalence estimates for TS and CT in the ALSPAC sample
would be consistent with those reported in previous community-based samples, and that a
high proportion of TS cases would have at least one additional neuropsychiatric condition,
including OCD and ADHD
9. How did the researcher attempt to answer the
research question?
The researchers attempted to answer the research question by determining the prevalence of Tourette
syndrome (TS) and chronic tic disorder (CT), as well as the rates of co-occurring obsessive-
compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) in the Avon
Longitudinal Study of Parents and Children (ALSPAC) sample. They utilized maternal screening
questionnaires at multiple time points throughout childhood to assess tic, OCD, and ADHD symptoms.
The study included an ongoing, prospective, population-based birth cohort, and the researchers
examined the prevalence of TS and CT, as well as the rates of co-occurring OCD and ADHD in this
sample. They also took steps to minimize the impact of potential biases in prevalence estimates
resulting from differential attrition and the reliance on maternal questionnaires rather than direct
clinical assessments. The researchers examined factors related to attrition and used rigorous disease
definitions to minimize potential biases
 10. What were the inclusion criteria?

Inclusion criteria for the study included children who were eligible for analysis at age 13 years and did
not meet any tic case definition, as well as children who were lost to follow-up before age 13 years
due to the absence of a detailed tic questionnaire. data are only available at age 13 years. The study
also included subjects who did not have intellectual disabilities, autism, or an IQ less than 80. These
criteria were used to determine the study's control, and clidren who not have autism,IQ less than 80,
intellectual disabilities.
11. What were the exclusion criteria?
Exclusion criteria for this study included individuals with intellectual disabilities (ID) or autism, as
these conditions have the potential to mimic tics. Autism and ID were defined based on a review of
medical and school records, and subjects with a full-scale IQ less than 80 were also excluded.
Additionally, individuals with possible non-tic movement disorders, such as autism stereotypes or
intellectual disability, were excluded to minimize the potential impact of reliance on maternal
questionnaires.
The study also excluded subjects with chronic tics that subsided before age 13, as well as subjects with
repetitive arm/leg movements that could be better explained by tremor or motor restlessness. These
exclusion criteria were used to ensure the accuracy of prevalence estimates and minimize potential
bias in the study
12. Which variables were measured?
 13. What statistical methods/tests were
employed?
The study employed several statistical methods and tests, including:Calculation of point prevalence
estimates for Tourette syndrome (TS) and chronic tic disorder (CT) using narrow, intermediate, and
broad definitions .
Comparison of gender ratios and rates of co-occurring obsessive-compulsive disorder (OCD) and
attention-deficit/hyperactivity disorder (ADHD) in subjects with TS and CT with unaffected controls
using chi-squared statistics with Yates’ adjustment for small sample sizes and exact confidence
intervals .
Heterogeneity analyses between different TS/CT disease definitions using Cochran’s Q and I2
statistics .Sensitivity analysis by relaxing the tic frequency criterion to include children whose parents
reported the presence of tics "about once a week" in addition to the two higher frequency responses
"daily" and "more than once a week" .
Examination of factors related to attrition and its impact on prevalence estimates .
Assessment of socio-economic factors associated with loss to follow-up before age 13 .
 14. What were the key findings?
• the determination of the prevalence of Tourette syndrome (TS) and chronic tic disorder (CT), as well
as the rates of co-occurring obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity
disorder (ADHD) in the Avon Longitudinal Study of Parents and Children (ALSPAC) sample.
•The study found that the prevalence estimates for TS Narrow and TS Intermediate, as well as CT
Narrow and CT Intermediate, were consistent with those reported in previous community-based
samples.
•Additionally, the study identified that 92% of community-based TS cases had at least one additional
neuropsychiatric condition, including OCD and ADHD.
•The study also found that socio-economic factors such as housing tenure and maternal education were
associated with loss to follow-up before age 13, highlighting potential biases in prevalence estimates.
15. Which results were statistically significant?
16. Which results were statistically
non‑significant?
17. Did the results answer the research question?

Yes, the results of the study answered the research question by providing prevalence estimates for
Tourette syndrome (TS) and chronic tic disorder (CT) in the Avon Longitudinal Study of Parents and
Children (ALSPAC) sample, as well as rates of co-occurring obsessive-compulsive disorder (OCD)
and attention-deficit/hyperactivity disorder (ADHD) in this population-based cohort . The study also
identified potential factors associated with attrition and bias in prevalence estimates, and compared
prevalence rates and co-occurring conditions between population-based samples and clinically
ascertained cases . The statistically significant findings regarding the co-occurrence of OCD and
ADHD in TS and CT cases compared to controls also contributed to answering the research question.
 18. How were these results different/similar when
compared to other studies?
The results of the study were similar to those reported in previous community-based samples, as the
prevalence estimates for Tourette syndrome (TS) and chronic tic disorder (CT) using narrow and
intermediate definitions were consistent with previous findings . Additionally, the study found that
92% of community-based TS cases had at least one additional neuropsychiatric condition, including
OCD and ADHD, which is in line with findings from other studies .
However, the study also identified potential biases in prevalence estimates due to attrition and reliance
on maternal questionnaires, which may have impacted the generalizability of the findings. The study
addressed these limitations by examining factors related to attrition and using rigorous disease
definitions to minimize potential biases .
 19. What were the conclusions?

This study suggests that co-occurring OCD and ADHD is markedly lower in TS cases
derived from population-based samples than has been reported in clinically ascertained TS
cases. Further examination of the range of co-occurring neuropsychiatric disorders in
population-based TS samples may shed new perspective on the underlying shared
pathophysiology of these three neurodevelopmental conditions.
20. Will the results be useful in clinical practice
or for further research?

For further research in understanding the shared pathophysiology of these neurodevelopmental

conditions and for exploring potential factors associated with attrition and bias in prevalence
estimates.

In clinical practice, the study's results may inform clinical practice by enhancing understanding of the
prevalence and characteristics of these disorders in children and adolescents, potentially contributing
to improved diagnosis and management strategies.