Behavioral and emotional difficulties in 78 males, 6-16 years of age, with Tourette syndrome were examined at the Departments of Neurology, Pediatrics, Psychiatry, and Education at Johns Hopkins University School of Medicine and School of Continuing Studies, Baltimore, Maryland. Symptoms most often identified included obsessive compulsive behavior, aggressiveness, hyperactivity, immaturity, withdrawal and somatic complaints. Results were divided into two age groups, 6-11 years (21 patients) and 12-16 years (30 patients). Scores were abnormal in 24% of children and 43% of adolescents. In the younger age group, somatic complaints and obsessive compulsive scales were abnormal in 43%, whereas in the older group more than 40% were described as being uncommunicative, obsessive compulsive, aggressive, hyperactive, immature and having hostile withdrawal. Delinquency, aggressiveness and hyperactive behavior were significantly increased in the older age group and abnormal behavioral profiles were more frequent in this age group. Tic severity was not a statistically significant predictor of behavioral disturbance, although a suggestive relationship between tic severity and behavioral disturbance was observed in the 12-16 year old group. Hyperactivity did not demonstrate an increased frequency of additional behavior problems. The author’s emphasize the relative frequency of psychopathology in Tourette syndrome and the need for a comprehensive approach to this syndrome. 
COMMENT. The demonstration in this study that there is a relationship between age and psychopathology in Tourette syndrome differs from a previous study which failed to reveal a relationship to age. Behavior and emotional problems were greater in the adolescent. In previous studies, the severity of motor and phonic tics have been claimed to be a predictor of behavioral disturbances in Tourette syndrome. This study corroborates previous reports and the original description by Gilles de la Tourette (1885) describing obsessive compulsive behavior as common in Tourette syndrome. Further studies are required to define the effect of attention deficit disorder with hyperactivity on the development of psychopathology in Tourette syndrome children.