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Background: Tic disorders are common neurodevelopmental disorders during childhood. Whether prenatal and postnatal exposure to particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5) plays a role in the development of tic disorders remains unexplored. Objectives: To investigate the association of exposure between PM2.5 during the pregnancy and infancy periods and the risk of tic disorders. Methods: This birth cohort study recruited singleton live births at term gestations in central Taiwan from the Taiwan Maternal and Child Health Database between 2004 and 2012 and followed up to the end of 2017. New cases of tic disorders were defined using the ICD‐9‐CM (307.2) and ICD‐10‐CM (F95), which include all tic spectrum disorders. We assigned daily PM2.5 concentrations derived from a satellite‐based model to individuals based on maternal residential addresses at delivery. We fit Cox proportional hazard model and distributed lag non‐linear model to estimate the associations between PM2.5 and tic disorders, with hazard ratio (HR) with 95% confidence interval (CI) as the effect measure. Results: Of the 309,376 singleton live births at term gestations, we identified 5902 (1.9%) tic disorder cases. The HR of tic disorders was positively associated with a 10 μg/m3 increase in PM2.5: during pregnancy HR 1.09, 95% CI 1.04, 1.15 and during infancy HR 1.12, 95% CI 1.06, 1.18. The vulnerable time window for infants with increased risk of tic disorders was 6–52 weeks after birth. We observed a nonlinear relationship between PM2.5 and the risk of tic disorders, with exposure to PM2.5 between 16 and 64 μg/m3 being associated with the risk of tic disorders. The association was restricted to Tourette's disorder group. Infant sex did not modify these associations. Conclusions: Infants delivered at term and exposed to PM2.5 are associated with an increased risk of tic disorders (6–52 weeks). Further studies are needed to confirm these associations. [ABSTRACT FROM AUTHOR]

Purpose: The incidence of Tourette syndrome and chronic tic disorders has seldom been evaluated in Asia. Methods: Using the National Taiwan Insurance Research Database, the annual standardized incidence and prevalence of Tourette syndrome (TS) and chronic tic disorders were estimated from 2007 to 2015. The pre-existing comorbidity at disease diagnosis was also evaluated. Results: From 2007 to 2015, the age- and sex-standardized incidence increased from 5.34 (95% confidence interval [CI] 5.06–5.62) per 100,000 person-years to 6.87 (95% CI 6.53–7.21) per 100,000 person-years. In children and adolescents, the age- and sex-standardized incidence increased from 19.58 (95% CI 18.42–20.75) per 100,000 person-years to 31.79 (95% CI 30.09–33.49) per 100,000 person-years. In adults, the age- and sex-standardized incidence decreased from 2.01 (95% CI 1.79–2.23) per 100,000 person-years to 1.24 (95% CI 1.07–1.42) per 100,000 person-years. The incidence rate ratio (IRR) between males and females was 3.74 (95% CI 3.32–4.22). The age- and sex-standardized prevalence increased from 37.51 (95% CI 36.75–38.27) per 100,000 people in 2007 to 84.18 (95% CI 83.02–85.35) per 100,000 people in 2015. The rate risk (RR) between males and females was 3.65 (95% CI 3.53–3.78). Conclusion: The annual incidence rates of TS and chronic tic disorders increased in childhood and adolescence but decreased in adulthood from 2007 to 2015. The prevalence rates increased over the same period. [ABSTRACT FROM AUTHOR]

Tourette syndrome (TS) is often comorbid with attention deficit hyperactivity disorder, obsessive–compulsive disorder, and depression. Medications are the main treatment for TS. Relationships between TS medication therapy and psychiatric comorbidities remain unclear. This study explored the impacts of TS medication on the risk of psychiatric comorbidities using a nationally representative sample of TS in Taiwan. Data from National Health Insurance Research Database in Taiwan was used to identify 997,213 children and adolescents aged 6–18 years who had received a diagnosis of TS based on ICD-9-CM codes in 2000–2010. Cox's proportional hazard regression analysis was conducted to estimate the risk of comorbidities among subjects with and without tic medication therapy. We found that in TS patients, a lower risk of psychiatric comorbidities occurred in the tic medication therapy group (p = 0.012) and the crude hazard ratio (HR) was 0.6 (95% confidence interval (CI) = 0.4–0.8, p < 0.001). After adjusting for potential confounders of gender, age, income, level of care, department visited, brain injury, and the number of suicide attempts, the risk of comorbidities was still significantly lower in the tic medication therapy group (adjusted HR = 0.5, 95% CI = 0.3–0.6, p < 0.001). One limitation was that we did not include all mediations used to treat psychiatric comorbidities among TS patients. This study found the effectiveness of TS medications on improving psychiatric comorbidities. Compared to those without medication, medication therapy appears to have a benefit of decreasing the risk of psychiatric comorbidities. Strategies to improve medication regimens should be considered in clinical settings. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of a modified four‐session Comprehensive Behavioral Intervention for Tics programme for decreasing tics in children and adolescents with Tourette's syndrome. Background: Comprehensive Behavioral Intervention for Tics programme has been shown to decrease tic severity. However, the lack of behaviour therapists in countries, such as in Taiwan, may preclude application of the standard eight‐session, 10‐week programme. Design: Randomized controlled study. Methods: Participants aged 6–18 years diagnosed with Tourette's syndrome or chronic tic disorder were recruited from February 2015 through September 2016. Participants in the control and intervention groups (N = 23 each) received the routine care (daily pyridoxine [50 mg] and psychoeducation). The intervention group received additional four behavioural intervention sessions over a 3‐month period that included psychoeducation, habit reversal training, relaxation training, and education on tic relapse prevention. The outcome measures, Yale Global Tic Severity Scale scores, were assessed at before and after the completion of programme for both groups and again at 3 months follow‐up for the intervention group. The effect of the intervention on severity scores was assessed using a generalized estimated equation. Results: Comparison of scores before and after intervention showed that the intervention significantly decreased the severity of total motor tics (B = −3.28, p <.01) and total tics (B = −5.86, p <.01) as compared with control treatment. YGTSS scores for the intervention group were lower at 3‐month follow‐up as compared with before treatment or immediately after treatment completion (total tics, p <.001). Conclusion: The modified four‐session Comprehensive Behavioral Intervention for Tics programme was more effective than routine care for decreasing tic severity in our cohort of 6‐ to 18‐year olds. This improvement was maintained 3 months after intervention. Impact: Healthcare providers, including nurses, in countries currently not adopting Comprehensive Behavioral Intervention for Tics programme should be made aware of the positive effects of this modified intervention for Tourette's syndrome. [ABSTRACT FROM AUTHOR]

Introduction: Violent motor tics or severe self-harm behaviors have been reported in patients with Tourette's syndrome (TS) and leading to traumatic brain injury (TBI). The study aimed to determine the risk of TBI in TS patients, the effects associated with concurrent psychiatric disorders (attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), or depressive disorder), and the effects of medication treatment (antipsychotics, antidepressants, or clonidine) on the risk of TBI.Methods: Using the National Health Insurance Research Database of Taiwan, 2261 TS patients and 20349 non-TS controls matched by gender and age were enrolled between 2000 and 2012, and followed until the end of 2013. Participants who developed TBI during the follow-up period were identified. Cox regression analysis was performed to examine the risk of TBI between TS patients and non-TS controls.Results: TS patients were associated with an increased risk of TBI compared to non-TS controls (hazard ratio (HR): 1.59, 95% confidence interval (95% CI): 1.37-1.85). Also, this study revealed TS patients with ADHD, OCD, or depressive disorder predicted a higher TBI incidence rate than those who did not, but the estimate was not statistically significant. Moreover, this study found that TS patients with frequent use of antipsychotics were associated with a lower risk of TBI than infrequent users (HR: 0.76, 95% CI: 0.57-0.99).Conclusions: This study highlights the need to pay more attention to the risk of TBI in TS patients, and the importance of adequate antipsychotic medication may reduce the risk of TBI. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore and describe the experience of social adjustment of adolescents with Tourette syndrome in Taiwan. Background: Although Tourette syndrome is a non‐life‐threatening disease, the inherent difficulties in controlling tics and comorbidities can cause long‐term physical and psychological issues, as well as social maladjustment among adolescents. Good social adjustment can promote mental health among adolescents. Currently, it is not clear how adolescents with Tourette syndrome can self‐adjust and maintain harmonious social interaction with others. Design: Descriptive phenomenological approach was used in this study. Four criteria were applied to establish the trustworthiness or methodological rigour. Methods: Sixteen adolescents with Tourette syndrome were recruited by purposive sampling from a medical centre in Northern Taiwan. Semistructured one‐on‐one interviews were performed from March 2014–April 2015 for data collection. Every participant was interviewed once or twice, and each interview lasted for duration of around 60–90 min. Data were analysed with Giorgi's phenomenological method for data analysis. Results: Three themes were identified from the adolescent' interviews. The themes were included visible and invisible destitution, moulding a socially acceptable self and coexisting friends and foes. Conclusions: Adolescents with Tourette syndrome experienced that tics are often not understood nor accepted during social interactions with others. However, with age and autonomy of adolescents, they were able to adjust and develop a socially acceptable body image and maintain amicable social interactions with others. Accompanied by positive thinking, support from friends and families, the adolescents could achieve good social adjustments for living with Tourette syndrome. Relevance to clinical practice: The experiences and feelings highlighted in this study can bring awareness to nurses and healthcare professionals for developing interventions that promote healthy social adjustment and mental health for adolescents with Tourette syndrome. [ABSTRACT FROM AUTHOR]

Purpose: Adolescents with Tourette syndrome (TS) may suffer from learning difficulties (attention-deficit/hyperactivity disorder), challenges in interpersonal interactions (especially with peers), disruptions of daily routines (disruptive behavior disorders), and increased psychosocial stress, which can result in internalizing and externalizing behavioral problems, such as venting depression and stress through self-harm. The aim of this study was to investigate peer attachment in adolescents with TS and associated risk factors., Design and Methods: Adolescents with TS aged 13-18 years were recruited from the outpatient departments of 2 hospitals in Taiwan. Participants completed a basic data sheet, the Beck Depression Inventory-II, the Chinese version of the State-Trait Anxiety Inventory, and the Chinese version of the Youth Self-Report. Descriptive statistics were performed. Structural equation modeling was used to verify the model proposed in this study and to analyze the overall fit and internal structure., Results: A total of 452 adolescents with TS aged 10-19 years participated in this study, which aimed to investigate factors affecting peer attachment, depression, anxiety, and psychosocial maladaptation and to explore causal relationships between these factors. Peer attachment was significantly associated with grade point average (r s  = -0.240, p < .001), birth order (r s  = -0.118, p = .012), parental marital status (r s  = -0.111, p = .018), parenting style (r s  = -0.138, p = .003), family monthly income (r s  = 0.124, p = .008), and weekly hours on the internet (r = -0.164, p < .001)., Conclusions: These results suggest that depression, anxiety, and peer attachment affect psychosocial development., Practical Implications: The findings may help clinical staff manage adolescents' severe emotional distress and psychosocial maladaptation., Competing Interests: Declaration of Competing Interest No conflict of interest has been declared by the authors., (Copyright © 2023 Elsevier Inc. All rights reserved.)

This study assesses the risk of fractures among children with Tourette syndrome (TS), and identifies the effects of comorbidities and antipsychotics. We randomly sampled the claims data of 1 million enrollees in the National Health Insurance program of Taiwan, and identified 1258 children with TS diagnosed between 2000 and 2010. Additionally, 12,580 children without TS who were frequency matched for sex, age, residential area, parental occupation, and index year were identified for comparison. The children's cases were followed until December 31, 2010, or censored to ascertain incident fractures cases and associations with comorbidities of attention-deficit/hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD) and treatments with antipsychotics, antidepressants, or clonidine. The TS cohort had a 1.27-fold higher incidence of fractures than did the comparison cohort (190.37 vs. 149.94 per 10,000 person-years), with an adjusted hazard ratio (HR) of 1.28 [95% confidence interval (CI) 1.06-1.55] based on multivariable Cox regression analysis. This increased risk of fractures was apparent for fractures of the skull, neck, and spine. Comorbid ADHD and OCD did not result in an additional risk of fractures. The children without both ADHD and OCD were also at a higher risk of fractures, indicating that TS alone increases the risk of fractures. The children taking antipsychotics had a reduced risk of fractures, and the adjusted HR decreased to 1.17 (95% CI 0.90-1.52). Children with TS have an increased risk of fractures. ADHD and OCD do not increase the risk further. [ABSTRACT FROM AUTHOR]

Both epilepsy and tic disorders may share common mechanisms with the involvement of abnormal cortical-basal ganglion circuit connection and dopaminergic dysfunction. However, the association between epilepsy and tic disorders has never been studied. This study investigated the risks of developing tic disorders among children with epilepsy using databases of a universal health insurance system in Taiwan. The data analyzed in this study were retrieved from the National Health Insurance Research Database in Taiwan. The study cohort included children with epilepsy between 2001 and 2007 (n=2629) and a three-fold age- and gender-matched controls (n=7887). All subjects were followed up for 3 years from the date of cohort entry to identify their admissions due to tic disorders (ICD-9-CM codes 307.2, 307.20-307.23). Cox hazard regression analysis was performed to estimate the effect of epilepsy on the occurrence of tics. The epilepsy cohort had a higher prevalence of tics (1.7% vs. 0.2%), and a 8.70-fold increased risk of developing a tic disorder compared with the controls (adjusted hazard ratio (AHR) 8.70, 95% confidence interval (CI) 4.26-16.37, p<0.001). Male patients were observed to have a higher risk of developing a tic disorder (AHR 1.90, 95% CI=1.04-3.46, p<0.001) compared to female individuals. Patients with multiple antiepileptic drugs treatment also exhibited higher crude OR for developing tic disorders. This nationwide population-based cohort study, for the first time, demonstrated that there is a significantly increased risk for tic disorders among children with epilepsy. We also found males, attention deficit disorder and the use of multiple AEDs to be independent risk factors of tic disorders. Closely evaluating possible tic disorders would be crucial for improving the outcome and life quality in children with epilepsy. [ABSTRACT FROM AUTHOR]

The association between epilepsy and Tourette syndrome has rarely been investigated. In this retrospective cohort study, we analyzed a dataset of 1,000,000 randomly sampled individuals from the Taiwan National Health Insurance Research Database to determine the risk of epilepsy in children with Tourette syndrome. The study cohort consisted of 1062 patients with Tourette syndrome aged ≤ 18 years, and the control group consisted of three times the number of age- and sex-matched patients without Tourette syndrome, who were insurants, from the same database during the same period. The Tourette syndrome group had an 18.38-fold increased risk of epilepsy than the control group [hazard ratio=18.38, 95% confidence interval (CI)=8.26-40.92; P<0.001]. Even after adjusting for the comorbidities, the risk of epilepsy in the Tourette syndrome group with comorbidities remained high (hazard ratio=16.27, 95% CI=6.26-18.46; P<0.001), indicating that the increased risk was not associated with comorbidities. This population-based retrospective cohort study provides the first and strong evidence that Tourette syndrome is associated with a higher risk of epilepsy. A close follow-up of children with Tourette syndrome for the development of epilepsy is warranted. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe the essence of the self-experience of adolescents with Tourette syndrome in the context of peer interaction. Background Tourette syndrome has an adverse impact on adolescents' physical, psychological and interpersonal interactions. Peers provide adolescents with social interactions that are crucial to the formation of self-identity. Studies exploring the self-experience of adolescents with Tourette syndrome in the context of peer relationships are lacking. Design A qualitative, phenomenological research design was used. Methods A total of 12 adolescents with Tourette syndrome from the Taiwan Tourette Family Association were selected by purposive sampling. Data were collected using open-ended questions in one-on-one in-depth interviews that lasted 60-90 minutes. Giorgi's phenomenological methods were applied to analyse the data obtained. Four criteria were employed to evaluate methodological rigour. Results The findings showed that the self-experience of adolescents with Tourette syndrome during peer interaction reflected their lived experiences of peer identity, social identity and self-identity. Themes included: (1) the inexplicable onset of tics during encounters with other people, (2) sources inspiring the courage for self-acceptance and (3) strategies of self-protection in response to changes in situation. Conclusions The self-experience of peer interaction among adolescents with Tourette syndrome is a dynamic and interactive process characterised by the symbolic meanings conferred on the tics by the interacting adolescents. The adolescents with Tourette syndrome obtain self-identity through peer responses and recognition, while the tolerance, respect and support of parents and teachers spark the adolescents' courage for self-acceptance. Relevance to clinical practice Healthcare providers who assist adolescents with Tourette syndrome must understand that tics occur in the context of peer interaction and how this affects the adolescents' relationships with their peers in various life situations. Furthermore, healthcare providers should provide support, respect and offer coping strategies regarding peer interaction based on an understanding of the social dynamics of such peer interactions. [ABSTRACT FROM AUTHOR]

The purpose was to describe the social adjustment, academic achievement, and creativity of 127 Taiwanese children with Tourete's Syndrome and a control group of 138 Taiwanese children with typical development and reports of the parents of both groups. The Tourete's Syndrome group had significantly more disruptive behaviors than the controls; most parents reported their children with Tourete's Syndrome had high academic achievement although the children scored significantly lower than controls on the Elaboration subtest of Creative Thinking. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study developed the psychometric properties of the social adjustment scale for adolescents with Tourette syndrome (SASATS)., Design and Methods: A cross-sectional study design was conducted. 346 adolescents with Tourette syndrome (TS) were purposively sampled from pediatric outpatient departments at two hospitals in Taiwan. The scale was developed through a phenomenological study of adolescents with TS and by reviewing the literature. The reliability analysis of the SASATS was performed using the corrected item-total correlations coefficients, Cronbach alpha coefficients, and test-retest correlations. An exploratory factor analysis and confirmatory factor analysis were used to examine the construct validity., Results: The content validity index of 0.89 was obtained, and acceptable model fit was achieved according to the explanatory factor analysis and confirmatory factor analysis. The final scale had 17- items and four factors: relationship between self and TS, academic performance, family relationship, and peer interaction. Acceptable values of 0.81 and 0.87 were obtained for the test-retest and internal consistency reliabilities, respectively., Conclusions: The SASATS is a reliable and valid instrument for evaluating social adjustment status in TS adolescents., Practice Implications: The SASATS is easy to use and offers an effective scale for nurses and healthcare providers in clinical and academic settings. It can quickly measure and detect the psychological functioning of the social adjustment of adolescents with TS during interpersonal interactions. Moreover, interventions can be provided to improve adolescents' social adjustment and promote their mental health., Competing Interests: Declaration of Competing Interest There is no conflict of interest in this study., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Kawasaki disease (KD) is a common vasculitis of childhood in East Asia. The complications of KD ascribed to long-term cardiovascular sequelae are considerably diverse. Although studies have investigated neurodevelopmental problems following KD in the past few decades, they have reported inconsistent conclusions. This study investigated potential epilepsy and associated neurodevelopmental disorders (NDDs) following KD in Taiwanese children., Methods: We retrospectively analyzed the data of children aged < 18 years with clinically diagnosed KD from January 1, 2005, to December 31, 2015. These patients were followed up to estimate the prevalence of epilepsy and associated NDDs in comparison with the prevalence in general pediatric population in Taiwan and worldwide., Results: A total of 612 patients with an average age of 1.6 years were included. The prevalence of associated NDDs was 16.8% (n = 103/612) in the study group, which consisted of epilepsy, intellectual disability (ID), autism spectrum disorders, Tourette syndrome (TS), attention deficit hyperactivity disorder, (ADHD), and others. Moreover, children with KD had a higher prevalence of epilepsy and TS in both Taiwan and worldwide (epilepsy: 2.61% in the KD group vs 0.33% in Taiwan and 0.05-0.8% in worldwide, p < 0.05; TS: 2.77% in the KD group vs 0.56% in Taiwan and 0.3-1% in worldwide, p < 0.05). The prevalence of ID, ADHD, and developmental language disorders was not significantly different between our study patients and those in Taiwan or worldwide., Conclusions: Results revealed a higher prevalence rate of NDDs, especially epilepsy and TS, in Taiwanese children with KD than in the general pediatric population in Taiwan. However, these NDDs could be heterogeneous. Children diagnosed with KD were followed up because they had a higher risk of heterogeneous NDDs.

We have done an epidemiological study in an elementary school with 2000 Taiwanese children aged from 6 to 12 years, and found 11 of them with Tourette''s syndrome. The prevalence rate of Tourette''s syndrome was around 0.56%. The ratio of male to female was 9 to 2. The comorbid rate of attention-deficit/hyperactivity disorder was 36%, self-injurious behaviors 27%, and obsessive-compulsive behaviors 18%. The familial rate of Tourette''s syndrome was 27%. We also found that another 98 children had transient tic disorders. For 73% of patients with mild tics, understanding and acceptance from family, teachers, and friends are the most important things. When tics are so severe that medication is necessary, haloperidol is no longer the first or only choice. We tried clonidine, atypical neuroleptics such as risperidone or olanzapine, or pergolide. The first support group was established in 1999 for children with tics in Taiwan and transformed to Taiwan Tourette Family association in June 2001 to provide further service for Tourette''s syndrome. [Copyright &y& Elsevier]