Results of a prospective, longitudinal study of 21 children recruited at age 2 1/2 to 3 1/2 years without tics but with a first-degree relative with Tourette syndrome (TS) are reported from the Department of Psychology and Child Study Center, Yale University, New Haven, CT. All subjects were evaluated annually and for 2 to 4 years. Among these high risk children, 24% had developed TS, 9% chronic tics, and 9% transient tics. Obsessive-compulsive symptoms occurred in 19%, and obsessive-compulsive disorder in 5%. Other diagnoses included attention deficit disorder, speech problems, and anxiety disorder in 24%. Children in this sample demonstrated an increased risk for tic disorders as well as other psychiatric disorders. Family functioning, independent of parental psychopathology, was associated with attention-deficit and anxiety disorders, decreased adaptive and increased maladaptive behaviors, and lower self-esteem but not tics or learning disorders. 
COMMENT. An autosomal dominant mode of transmission for TS is suggested by the rates of tic disorders observed. Stressors in family functioning play a role in comorbid disorders such as anxiety and attentional difficulties. The authors advise family, cognitive-behavioral, and interpersonal therapies to address the social-emotional difficulties that often accompany TS.
Clonazepam was a useful adjunctive treatment for tics in children with comorbid ADHD studied at the Children’s Hospital, Boston.