Influence of Stress and Psychiatric Symptoms on Children With Tourette Syndrome

Study Overview
=================
Brief Summary
-----------------
Investigators propose a cross-sectional, observational pilot study to examine the contribution of stress, family dynamics, and peer relationships to quality of life (QOL) in adolescents with Tourette syndrome (TS). Investigators will recruit two groups of participants: 1) adolescents aged 13-17 years of age with TS and 2) adolescents aged 13-17 without any neurologic or psychiatric diagnoses. Participants and one of their parents/caregivers will complete a series of questionnaires screening for and quantifying the extent of stress and mental health symptoms, including anxiety, depression, obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD). Participants will also complete instruments characterizing family interactions and peer relationships. Adolescents with TS will also undergo a semi-structured interview assessing the severity of their tics.

Detailed Description
-----------------
Tourette syndrome (TS) is a multi-faceted neurodevelopmental disorder with wide-ranging impact on adolescent quality of life (QOL). Comorbid psychiatric and psychological factors exert greater influence on QOL than tics in TS, but the specific role of stress, family dynamics, and peer relationships has been largely overlooked, despite the fact that these factors are known to impact QOL in those with chronic disease. Investigators propose a cross-sectional, observational pilot study to examine the contribution of stress, family dynamics, and peer relationships to QOL in adolescents with TS. The primary goal of this study is to collect sufficient data for hypothesis-generation and power analysis refinement in planning of a larger scale study. Investigators will recruit adolescents aged 13-17 years of age with TS presenting for regular care at the Vanderbilt Pediatric Neurology Clinic. Adolescents without any neurologic or psychiatric diagnoses will be recruited as a control population. Participants and one of their parents/caregivers will complete a series of questionnaires screening for and quantifying the extent of stress and mental health symptoms, including anxiety, depression, obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD). Participants will also complete instruments characterizing family interactions and peer relationships. The scale battery can be completed by the adolescent and caregiver in parallel and is anticipated to take 60-75 minutes total to complete. Adolescents with TS will also undergo a semi-structured interview assessing the severity of their tics. The study plans to enroll subjects over a 12-month time frame.

Official Title
-----------------
Influence of Stress and Psychiatric Symptoms on Children With Tourette Syndrome

Conditions
-----------------
Tourette Syndrome in Adolescence, Tourette Syndrome, Tourette Syndrome in Children

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria for adolescents with TS: adolescent age 13-17 years of age adolescent diagnosis of Tourette syndrome (TS) English-speaking adolescent and caregiver (as validated questionnaires are in English) adolescent and caregiver willingness and ability to complete relevant questionnaires Exclusion Criteria for adolescents with TS: cognitive or attentional impairment precluding ability of adolescent or caregiver to complete self-report questionnaires adolescent diagnosis of genetic conditions besides TS and its known comorbidities adolescent with severe medical conditions unrelated to TS (e.g. uncontrolled seizures, prominent heart conditions) Inclusion Criteria for adolescents without any neurologic or psychiatric diagnoses: adolescent age 13-17 years of age no history of tics English-speaking adolescent and caregiver adolescent and caregiver willingness and ability to complete relevant questionnaires Exclusion Criteria for adolescents without any neurologic or psychiatric diagnoses: cognitive or attentional impairment precluding ability of adolescent or caregiver to complete self-report questionnaires adolescent with severe medical conditions

Ages Eligible for Study
-----------------
Minimum Age: 13 Years
Maximum Age: 17 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Adolescents with Tourette Syndrome<br>Adolescents (aged 13-17 years) with Tourette Syndrome | |
| Adolescents without any neurologic or psychiatric diagnoses<br>Adolescents (aged 13-17 years) without any history of tics | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Youth Quality of Life Research Version (YQOL-R) | Self-report quality of life scale comprised of 42 items with 10-point Likert scale (raw total score 0-420) and 15 additional items with open-ended and demographic questions. Higher scores indicate better overall quality of life. | Baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cohen's Perceived Stress Scale | Self-report stress scale comprised of 10 items (total score range 0-40). Higher scores indicate greater perceived stress. | Baseline | 
| PedsQL - Family Impact Module | Caregiver-report scale comprised of 36 items (total score range 0-100) assessing impact of health condition(s) on family. Higher scores indicate better family functioning in context of health-related condition(s). | Baseline | 
| Conners-3 Parent Short QuikScore Forms | Caregiver-report scale comprised of 45 items assessing inattention, hyperactivity, and executive functioning of child. T-scores are generated, with higher scores indicating greater deviation from norms. | Baseline | 
| Revised Children's Anxiety and Depression Scale (RCADS) - Parent Report | Caregiver-report scale comprised of 47 items assessing mood symptoms. T-scores are generated, with higher scores indicating greater deviation from norms. | Baseline | 
| Revised Children's Anxiety and Depression Scale (RCADS) - Self-Report | Self-report scale comprised of 47 items assessing mood symptoms. T-scores are generated, with higher scores indicating greater deviation from norms. | Baseline | 
| Yale Global Tic Severity Scale (YGTSS) | Semi-structured clinician-administered interview assessing tic severity, with total tic score range of 0-50 and functional impairment scale range of 0-50. Higher scores indicate greater tic severity and functional impairment, respectively. This measure will only be administered to adolescents with TS. | Baseline | 
| School and Mental Health Services Inventory | Questionnaire assessing educational and functional status of child. No total score generated. | Baseline | 
| Rosenberg Self Esteem Scale | Self-report self-esteem scale comprised of 10 items (total score range 10-40). Higher scores indicate higher self-esteem. | Baseline | 
| Kearney's Daily Life Stressors Scale | Self-report scale consisting of 30 items (total score range 0-120) assessing degree of stress caused by daily activities. Higher scores indicate greater burden from daily stressors. | Baseline | 
| McMaster Family Assessment Device | Self-report scale consisting of 60 items (total score range 0-180) assessing structural, organizational, and interactional aspects of family environment. The scale contains subscales, the scores of which are added to create a composite overall score, with higher scores indicative of more supportive family environment. | Baseline | 
| PROMIS Peer Relationships Short Form 8a - Self Report | Self-report scale consisting of 8 items (total score is composite of individual item scores, ranked on Likert scale from 1-5) assessing quality of peer relationships. Total raw scores are converted to a T-score. Higher scores indicate more positive perception of peer relationships. | Baseline | 
| PROMIS Peer Relationships Short Form 8a - Proxy-Report | Proxy-report scale consisting of 8 items (total score is composite of individual item scores, ranked on Likert scale from 1-5) assessing quality of child's peer relationships. Total raw scores are converted to a T-score. Higher scores indicate more positive perception of child peer relationships. | Baseline | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Stress, Self-esteem, Quality of life