The relationship between anxiety and tic severity in children and adolescents with Tic disorders: a scoping review

A review of the lPlease check whether the names of all authors are correct. iterature was conducted with the aim to understand whether a diagnosis of a tic disorder equated to higher levels of anxiety, and how this relationship varied when considering co-occurring attention deficit hyperactivity disorder (ADHD), autism and/or obsessive–compulsive disorder (OCD). A total of 25 studies were examined which highlighted children and adolescents with a tic disorder commonly met the criteria for a clinical anxiety disorder. While tic severity was found to be associated with higher levels of symptoms of anxiety in both children and adolescents with Tourette Syndrome (TS) or Chronic Tic Disorder (CTD), even higher levels of anxiety have been found in individuals who had an additional co-occurring diagnosis. For example, the diagnosis of having a tic disorder with OCD was more frequently associated with internalising disorders (e.g., anxiety, depressive, and somatic symptoms ) , whereas a diagnosis of a tic disorder and ADHD was commonly associated with externalising disorders (e.g., impulsivity disruptive conduct, substance use, and other addictive behaviours). Further studies are needed to address gender differences in anxiety, as anxiety is likely to be more prevalent in females with a tic disorder compared to both males and those with a later age of onset of tics. This review highlights the benefits of routinely screening for anxiety in children and adolescents with tics disorders, as well as the need for further considerations on how current treatments could be modified to help with anxiety and co-occurring diagnoses.