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Using the CBCL to Evaluate Children with Tourette’s Syndrome and ADHD

Gilles de la Tourette’s syndrome is characterized by multiple motor and phonictics. Because the phonic tics often include obscenities, Tourette’s symptoms can severely embarrass children and their families. The adaptational challenges faced by children with Tourette’s syndrome may be further exacerbated by other problems, such as Attention-Deficit/Hyperactivity Disorder (ADHD). Alice Carter of the University of Massachusetts and her colleagues at Yale (O’Donnell, Scahill, Schultz, Leckman, & Pauls) used the CBCL/4-18 and several other measures to evaluate the social-emotional adjustment of Tourette’s children with and without ADHD. Children with both Tourette’s syndrome and ADHD obtained significantly higher problem scores and lower competence scores than nonreferred children on nearly all CBCL scales. Children who had Tourette’s syndrome but not ADHD were intermediate between Tourette’s children with ADHD and nonreferred children on all CBCL scales. Regression analyses showed that ADHD significantly contributed to higher CBCL Externalizing scores but not to Internalizing scores. In addition, the CBCL Attention Problems scale correlated significantly with a continuous performance test (CPT), which did not correlate significantly with other measures, such as the Vineland Adaptive Behavior Scales. The authors concluded that Tourette’s syndrome alone is associated with elevated rates of Internalizing problems, but that the combination of ADHD with Tourette’s syndrome produces profiles that differ from those of Tourette's children without ADHD, especially with respect to much higher Externalizing scores and lower scores on the CBCL School and Social scales. Rather than assuming that the diverse problems often ascribed to Tourette’s syndrome are present in all cases, practitioners should therefore carefully assess each child with respect to multiple kinds of problems and competencies.

Reference: Carter, A.S., O’Donnell, D.A., Scahill, L., Schultz, R.T., Leckman, J.F., & Pauls, D.L. (2000). Social and emotional adjustment in children affected with Gilles de la Tourette's syndrome: Associations with ADHD and family functioning. Journal of Child Psychology & Psychiatry, 41, 215-223.

Copyright © 2018 by Thomas Achenbach