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Prenatal and Perinatal Morbidity in Children with Tourette Syndrome and Attention-Deficit Hyperactivity Disorder

Pringsheim, Tamara MD, MSc*; Sandor, Paul MD†; Lang, Anthony MD‡; Shah, Prakeshkumar MD, MSc§; O'Connor, Paul MD, MSc‡

Journal of Developmental & Behavioral Pediatrics:
doi: 10.1097/DBP.0b013e31819e6a33
Original Article

Objective: Tourette syndrome (TS) and attention-deficit hyperactivity disorder (ADHD) are frequently seen in combination, though the cause of comorbidity is uncertain. Low birth weight is a known risk factor for ADHD. The objective of the study was to assess the association between pre- and perinatal morbidity and the comorbid diagnosis of ADHD in children with TS.

Method: A nested case-control study of children evaluated for TS at a subspecialty clinic was performed. Cases were defined as children with TS and ADHD; controls had TS without ADHD. Exposure to pre- and perinatal morbidity was assessed using demographic information booklets completed by parents before the diagnostic interview.

Results: Three hundred fifty-three children were included, 181 cases and 172 controls. Children with TS and ADHD had a greater odds of exposure to low birth weight status, prematurity, breathing problems, and maternal smoking compared with children with TS only. A multivariable logistic regression model found adjusted odds ratios for the comorbid diagnosis of TS and ADHD of 2.74 (95% CI 1.03–7.29, p = .04) in children born low birth weight, and of 2.43 (95% CI 1.23–4.82, p = .01) for children exposed to maternal smoking.

Conclusion: In children with TS, there is a greater odds of comorbid ADHD in children born with low birth weight or with exposure to maternal smoking. The commonality of risk factors for ADHD only and tic-related ADHD supports a common underlying neurobiology. Women with fetuses at risk for TS should avoid smoking and preventable causes of low birth weight to minimize the risk of comorbid ADHD.

Author Information

From the *Department of Clinical Neurosciences and Pediatrics, University of Calgary, Calgary, Alberta, Canada; †Department of Psychiatry, University of Toronto, Toronto, Canada; ‡Division of Neurology, University of Toronto, Toronto, Canada; and §Department of Pediatrics, University of Toronto, Toronto, Canada.

Received November 2008; accepted January 2009.

Address for reprints: Tamara Pringsheim, MD, MSc, Alberta Children's Hospital, C4-431, 2888 Shaganappi Trail NW, Calgary AB, T3B 6A8, Canada; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.