Mediating role of premonitory urge on the impact of comorbidity with attention-deficit/hyperactivity disorder on tic severity in children with tic disorder
Objective To examine the effect of comorbidity with attention-deficit/hyperactivity disorder(ADHD)on tic severity in children with tic disorder(TD),and to explore the mediating role of premonitory urge in the association.Methods A total of 68 TD children comorbid with ADHD(TD+ADHD)and 150 children with TD were recruited from the Child Health Care/Developmental Behavior Outpatient Department of Fujian Children's Hospital between November 2022 and October 2023.The Premonitory Urge for Tics Scale(PUTS)and the Yale Global Tic Severity Scale(YGTSS)were administered to assess premonitory urges and tic severity,respectively.Pearson correlation analysis was used to examine the associations among variables,and the PROCESS software was used to test the mediation effect.Results The TD+ADHD group scored significantly higher on the PUTS compared to the TD group(t=2.22,P＜0.05).Statistically significant differences were also found between the two groups in terms of frequency(t=2.20)and complexity(t=2.05)of motor tics,as well as intensity(t=2.19)and complexity(t=2.64)of vocal tics(P＜0.05).2)Positive correlations were found between total PUTS scores and motor tics(including number,complexity,disruptiveness,and severity of total motor tics),vocal tics,total impairment rate,and total severity of the YGTSS(r=0.170-0.354,P＜0.05).3)After controlling the confounding factors such as children's age and gender,it was found that the total PUTS score mediated 25.70％of the association between comorbid ADHD and TD vocal intensity and 14.32％of the association between comorbid ADHD and TD vocal complexity.Conclusion Premonitory urge is evident in children comorbid TD and ADHD,and premonitory urge is a mediator of the effect of comorbidity with ADHD on the strength and complexity of TD vocalizations.
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