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Implementation of the Mini-Child Tourette Syndrome Impairment Scale: Relationships to Symptom Severity and Treatment Decisions.

ABSTRACT: Functional impairment is an important factor in Tic Disorder treatment decisions. We evaluated the mini Child Tourette Syndrome Impairment Scale (mini-CTIM) for correlation with symptom severity and association with interventions. A total of 61 randomly selected tic encounters were retrospectively analyzed for mini-CTIM correlation with symptom severity scores and compared between patients who received treatment and those who did not. Regression models identified factors associated with treatment decisions. Mini-CTIM-tic scores correlated with tic severity and mini-CTIM-non-tic scores correlated with attention-deficit hyperactivity disorder (ADHD) severity. Tic treatment was associated with higher child, but not parent, mini-CTIM-tic scores. Regression models identified that comorbidity treatment was predicted by ADHD severity, obsessive compulsive disorder severity, and parent but not child mini-CTIM-non-tic scores. These findings suggest children have valuable insight into their tic-related impairment, but parent assessment is important for evaluating comorbidity-related impairment. The mini-CTIM may be a useful clinical tool for assessing tic-related impairment.

SUBMITTER: Garris JF

PROVIDER: S-EPMC7855018 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Implementation of the Mini-Child Tourette Syndrome Impairment Scale: Relationships to Symptom Severity and Treatment Decisions.

Garris Jordan F JF Huddleston David A DA Jackson Hannah S HS Horn Paul S PS Gilbert Donald L DL

Journal of child neurology 20201030 4

Functional impairment is an important factor in Tic Disorder treatment decisions. We evaluated the mini Child Tourette Syndrome Impairment Scale (mini-CTIM) for correlation with symptom severity and association with interventions. A total of 61 randomly selected tic encounters were retrospectively analyzed for mini-CTIM correlation with symptom severity scores and compared between patients who received treatment and those who did not. Regression models identified factors associated with treatmen ...[more]

PMID: 33124927

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Project description:BackgroundAn automated web-based assessment and monitoring system ( www.psynary.com ) has been developed to assist non-specialist clinicians in managing common mood and anxiety disorders. Psynary promotes the use of standardised outcome measures to assess symptom severity and optimise treatments with the aim of improving outcomes and enabling faster recovery. This paper analyses the results from two parallel studies in New Zealand and Japan (OptiMA-1 NZ and Japan) to assess the validity of the R8 Depression scale, one of the system's core outcome measures.MethodsClinical samples were recruited from a public secondary care and a private psychiatry clinic. Participants completed the outcome measures for the study via the online Psynary system. The R8 Depression scale is a 30-item questionnaire which includes all symptom domains covered in the ICD-10 classification of depression. The Patient Health Questionnaire (PHQ-9) was completed at the same time points as the R8 Depression, with a smaller sample also completing a paper-based Quick Inventory of Depressive Symptomatology (QIDS-SR16). Internal validity was quantified via Cronbach's alpha and Guttman lower bounds method. External validation against the PHQ-9 and QIDS used the Pearson's and Kendall's correlation coefficients. Severity categories were set using a multivariate regression model.Results270 patients participated in the study and completed a maximum of 1 baseline and 5 reviews within a 90-day period, giving a total of 1124 assessments with the PHQ-9 also being completed in 1053 of these assessments. R8 Depression normative data was also collected from 204 non-clinical volunteers with 187 of these also completing the PHQ9. Internal reliability scores were all higher than 0.9 (n = 1328). There was overall good external validity when comparing the R8 Depression to the PHQ-9, with a correlation of 0.91 for the combined normative and clinical samples (n = 1240).ConclusionsThe R8 Depression has been developed as a patient-rated outcome measure for depression for administration on an online system called "Psynary". It has high internal and external validity against current widely used scales. Further work is underway to determine the sensitivity to change of the R8 Depression.

Project description:BackgroundThe lack of culturally adapted and validated instruments for child mental health and psychosocial support in low and middle-income countries is a barrier to assessing prevalence of mental health problems, evaluating interventions, and determining program cost-effectiveness. Alternative procedures are needed to validate instruments in these settings.MethodsSix criteria are proposed to evaluate cross-cultural validity of child mental health instruments: (i) purpose of instrument, (ii) construct measured, (iii) contents of construct, (iv) local idioms employed, (v) structure of response sets, and (vi) comparison with other measurable phenomena. These criteria are applied to transcultural translation and alternative validation for the Depression Self-Rating Scale (DSRS) and Child PTSD Symptom Scale (CPSS) in Nepal, which recently suffered a decade of war including conscription of child soldiers and widespread displacement of youth. Transcultural translation was conducted with Nepali mental health professionals and six focus groups with children (n=64) aged 11-15 years old. Because of the lack of child mental health professionals in Nepal, a psychosocial counselor performed an alternative validation procedure using psychosocial functioning as a criterion for intervention. The validation sample was 162 children (11-14 years old). The Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) and Global Assessment of Psychosocial Disability (GAPD) were used to derive indication for treatment as the external criterion.ResultsThe instruments displayed moderate to good psychometric properties: DSRS (area under the curve (AUC)=0.82, sensitivity=0.71, specificity=0.81, cutoff score ? 14); CPSS (AUC=0.77, sensitivity=0.68, specificity=0.73, cutoff score ? 20). The DSRS items with significant discriminant validity were "having energy to complete daily activities" (DSRS.7), "feeling that life is not worth living" (DSRS.10), and "feeling lonely" (DSRS.15). The CPSS items with significant discriminant validity were nightmares (CPSS.2), flashbacks (CPSS.3), traumatic amnesia (CPSS.8), feelings of a foreshortened future (CPSS.12), and easily irritated at small matters (CPSS.14).ConclusionsTranscultural translation and alternative validation feasibly can be performed in low clinical resource settings through task-shifting the validation process to trained mental health paraprofessionals using structured interviews. This process is helpful to evaluate cost-effectiveness of psychosocial interventions.

Dataset Information

Implementation of the Mini-Child Tourette Syndrome Impairment Scale: Relationships to Symptom Severity and Treatment Decisions.

Publications

Implementation of the Mini-Child Tourette Syndrome Impairment Scale: Relationships to Symptom Severity and Treatment Decisions.

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