Response to Comment on: Tics in the Pediatric Population: Pragmatic Management
Bibliographic record
Abstract
We thank Dr. Neri and colleagues for their letter highlighting the importance of learning disorders in children with Tourette syndrome and the added contribution of such disorders on global functioning.1 This is indeed an important comorbidity in children with Tourette syndrome that deserves attention and consideration by clinicians. As Neri and colleagues discuss in their letter, learning disorders can be present in a significant proportion of children with Tourette syndrome. In the Tourette Syndrome International Database Consortium (TIC database), the largest database studying individuals with tic disorders worldwide, comorbid learning disorders were present in 1494 of 6805 individuals (22%) in the data set.2 The presence of learning disorders was significantly influenced by the presence of comorbid attention-deficit/hyperactivity disorder (ADHD), and 33% of children who had Tourette syndrome plus ADHD had a learning disorder compared with 12% of children who had Tourette syndrome without ADHD (P < 0.001). Similarly, in a case-control study of adolescents with Tourette syndrome, a significantly higher proportion of learning disorders was observed in individuals who had Tourette syndrome compared with controls (odds ratio. 7.9; 95% confidence interval, 2.2–28.2; P < 0.001); however, this relationship was no longer significant after controlling for a lifetime diagnosis of ADHD.3 Therefore, the presence of learning disorders in children with Tourette syndrome appears to be very significantly influenced by comorbid ADHD. A recent population-based study of the prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-specific learning disorders in children from the second to sixth grades found a prevalence of 7.6% for global impairment, 5.4% for writing, 6.0% for arithmetic, and 7.5% for reading impairment.4 The prevalence of comorbidities, including any tic disorder and ADHD, also was studied. Those authors observed an overall prevalence in their sample of 1.1% for tic disorders and no evidence of a higher prevalence of tic disorders in individuals who had learning disorders of any type. ADHD, however, was significantly more common in individuals who had global impairment and arithmetic impairment than in those without learning disorders. As Neri et al. suggest, children with Tourette syndrome, and especially those with comorbid ADHD, should be carefully evaluated for the presence of learning disorders, although this may be beyond the expertise of many physicians. Clinicians should ask specifically about problems with school and academic achievement. Several ADHD screening questionnaires, such as the Conners 3, include subscales devoted to learning problems, and these can help physicians identify significant learning issues that require further inquiry. Psychoeducational testing by a qualified psychologist is often necessary to make a formal diagnosis of a learning disorder; and, where possible, clinicians are encouraged to make appropriate referrals. Once diagnoses are confirmed, appropriate educational interventions can be initiated. 1. Research Project: A. Conception, B. Organization, C. Execution; 2. Statistical Analysis: A. Design, B. Execution, C. Review and Critique; 3. Manuscript Preparation: A. Writing the First Draft, B. Review and Critique. T.P.: 1C, 3B D.M.: 1C, 3B C.G.: 1C, 3B Ethical Compliance Statement: We confirm that we have read the Journal's position in issues involved in ethical publication and affirm that this work is consistent with those guidelines. Funding Sources and Conflicts of Interest: The authors report no sources of funding and no conflicts of interest. Financial Disclosures for the previous 12 months: Christos Ganos reports academic research support from the German Parkinson Society. Tamara Pringsheim and Davide Martino report no sources of funding and no conflicts of interest.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".