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

A review of the literature aimed to understand whether a diagnosis of a tic disorder equated to higher levels of anxiety, and how this relationship varies when considering co-occurring attention deficit hyperactivity disorder (ADHD), autism and/or obsessive-compulsive disorder (OCD). A total of 25 studies 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 adolescence 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, a tic Disorder with OCD was more frequently associated with internalising disorders (e.g., anxiety, depressive, and somatic symptoms), whereas a tic disorder and ADHD was frequently associated with externalising disorders (e.g., impulsive, disruptive conduct, substance use, and other addictive symptoms). Further studies are needed to address gender differences in anxiety, as anxiety may also be more marked in females with a tic disorder and/or in those with a later onset of tics. This review highlights the need to routinely screen for anxiety in children and adolescents with tics disorders, as well as considering how existing treatments could be modified to account for anxiety and additional co-occurring diagnoses.