Question
9-year-old boy is brought to the physician because of repetitive, involuntary blinking, shrugging, and grunting for the past year. His mother states that his symptoms improve when he is physically active, while tiredness, boredom, and stress aggravate them. He has felt increasingly embarrassed by his symptoms in school, and his grades have been dropping from average levels. He has met all his developmental milestones. Vital signs are within normal limits. Mental status examination shows intact higher mental functioning and thought processes. Excessive blinking, grunting, and jerking of the shoulders and neck occur while at rest. The remainder of the examination shows no abnormalities. This patient’s condition is most likely associated with which of the following findings?
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Excessive impulsivity & inattention
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| B. |
Defiant and hostile behavior toward teachers and parents
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| C. |
Poor comprehension of numbers
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| D. |
Feelings of persistent sadness and loss of interest
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Show Answer
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Correct Answer � A
Explanation
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Excessive impulsivity & inattention
Excessive impulsivity and inattention
Excessive impulsivity, as well as hyperactivity and inattention with impairment of social, occupational, or academic performance are the core features of attention deficit hyperactive disorder (ADHD). About 60% of patients with Tourette syndrome develop concomitant ADHD, making it the most common comorbidity. Obsessive-compulsive disorders (OCD) are also common in patients with Tourette syndrome.
Defiant and hostile behavior toward teachers and parents
Defiant and hostile behavior toward teachers and parents is a classic feature of oppositional defiant disorders. Behavioral problems must persist over a period of = 6 months to make the diagnosis. This patient most likely has Tourette syndrome, which is associated with numerous neuropsychiatric conditions, including oppositional defiant disorders and conduct disorders (15% of cases). However, another childhood neuropsychiatric condition is much more common, occurring in 60% of patients with Tourette syndrome.
Poor comprehension of numbers
Dyscalculia is a specific learning disorder that is characterized by problems processing numerical information, learning arithmetic facts, and performing accurate or fluent calculations. Learning disorders may occur in isolation or in association with other neuropsychiatric disorders. Although learning disabilities occur in more than 20% of patients with Tourette syndrome, they are generally associated with concomitant ADHD rather than the tics themselves.
Feelings of persistent sadness and loss of interest
This boy most likely has Tourette syndrome, which has a high incidence of psychiatric comorbidities. Patients often express shame and anxiety regarding their tics. It is not, however, associated with an increased risk for major depression disorder (MDD). MDD is however associated with a wide range of comorbidities, such as neurodegenerative diseases (e.g., Alzheimer’s), chronic inflammatory diseases (e.g., systemic lupus erythematosus or inflammatory bowel disease), or other psychiatric disorders (e.g., panic disorder).
