Computational Neuroscience Approach to Psychiatry: A Review on Theory-driven Approaches

Translating progress in neuroscience into clinical benefits for patients with psychiatric disorders is challenging because it involves the brain as the most complex organ and its interaction with a complex environment and condition. Dealing with such complexity requires powerful techniques. Computational neuroscience approach to psychiatry integrates multiple levels and types of simulation, analysis and computation according to the different types of computational models to enhance comprehending, prediction and treatment of psychiatric disorder. This approach comprises two approaches: theory-driven and data-driven. In this review, we focus on recent advances in theory-driven approaches that mathematically and mechanistically examine the relationships between disorder-related changes and behavior at different level of brain organization. We discuss recent progresses in computational neuroscience models that relate to psychiatry and show how principles of neural computational modeling can be employed to explain psychopathology.

Effects of Non-invasive Neurostimulation on Autism Spectrum Disorder: A Systematic Review

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by major impairments in social communication, stereotyped and ritualistic behaviors and deficits in sensory reactivity. Recently, noninvasive brain stimulation (NIBS) methods, namely transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS), have been examined as possible new therapeutic options for modifying the pathological neuroplasticity involved in neuropsychiatric disorders including ASD. Therefore, we conducted a systematic review on the therapeutic uses of tDCS and repetitive TMS (rTMS) in ASD patients. A systematic search was performed on Scopus, Web of Science, PubMed, Cochrane and Embase. Original articles reporting the use of tDCS or rTMS to treat ASD were screened and studied by two researchers independently based on PRISMA guidelines. We found 32 eligible studies including 8 tDCS reports, 23 rTMS reports and one report with both tDCS and rTMS. These studies comprised 6 case-reports, 9 non-controlled trials and 17 controlled trials which assessed NIBS effects on the three cognitive, behavioral and biological dimensions in ASD. Existing evidence demonstrates that NIBS methods could be helpful for treating some dimensions of ASD such as repetitive behavior, sociability or some aspects of executive and cognitive functions. However, such evidence should be regarded with care because of the quality of original researches and serious publication bias as well as the heterogeneity of data. Further randomized, double-blind, sham-controlled trials with appropriate follow-up periods should be designed to assess the efficacy of NIBS methods for ASD treatment.

Neuro-cognitive Ramifications of Fasting and Feeding in Obese and Non-obese Cases

Preliminary studies have claimed that short term fasting would negatively affect school performance and cognition. In contrast some other studies have reported not important decline in cognition and executive function as a result of fasting. Also limited attention was generally devoted to dietetic regimens, nutritional status and body weight. Yet neuroscience and neuro-cognitive aspects of acute hunger on the electroencephalogram and differences between obese and non-obese cases is not well understood. Hence, we decided to design and perform a case study in a more controlled situation similar to reality. Therefore, we performed several examinations including subjective tests (for eating status) and objective tests (cognitive tests such as Stroop effect and Sternberg search and electroencephalogram measures such as steady-state visual evoked potential and auditory steady-state responses) for an obese and a non-obese academic case before and after a simple breakfast. The results showed that the breakfast effects on the neuro-cognitive functions depend on either obesity status, nutritional status of the case or the type of cognitive task (visual or auditory). This paper would open a new insight to answer some important questions about the neuro-cognitive implications of fasting and feeding in obese and non-obese human cases.

Transsexualism: A Different Viewpoint to Brain Changes

Transsexualism refers to a condition or belief which results in gender dysphoria in individuals and makes them insist that their biological gender is different from their psychological and experienced gender. Although the etiology of gender dysphoria (or transsexualism) is still unknown, different neuroimaging studies show that structural and functional changes of the brain result from this sexual incongruence. The question here is whether these reported changes form part of the etiology of transsexualism or themselves result from transsexualism culture, behaviors and lifestyle. Responding to this question can be more precise by consideration of cultural neuroscience concepts, particularly the culture–behavior–brain (CBB) loop model and the interactions between behavior, culture and brain. In this article, we first review the studies on the brain of transgender people and then we will discuss the validity of this claim based on the CBB loop model. In summary, transgender individuals experience change in lifestyle, context of beliefs and concepts and, as a result, their culture and behaviors. Given the close relationship and interaction between culture, behavior and brain, the individual's brain adapts itself to the new condition (culture) and concepts and starts to alter its function and structure.

[Attachment to God and forgiveness among Iranian adolescents with conduct disorder at Tehran reformatory]

Conduct disorder is characterized with aggressive behaviors, deceitfulness or theft, destruction of property and serious violations of rules, prior to age 18 years. Attachment to God is a relationship with God that reveals aspects of individual thought. Secure attachment is associated with an increased ability to forgive. Various studies indicated the association between insecure attachment and delinquency and criminal behavior. The aim of this study was to evaluate the attachment to God and forgiveness in adolescents with conduct disorder at Tehran reformatory. This study is a cross-sectional study. The attachment to God and Transgression-Related Interpersonal Motivations Scale--12-Item Form [TRIM-12], were completed by 60 adolescents between 14 -18 years old with conduct disorder, with or without substance abuse disorders, and ADHD, at Tehran reformatory. Descriptive statistics and linear regression methods was used to analyze the data in SPSS-16. The results showed that anxiety and avoidant attachments to God and avoidance and revenge motivations in adolescents with conduct disorder are high. A history of addiction, criminality, and mental disorders among family members predicted increasing avoidant attachment to God among this group of adolescents in the univariate model. Also, parental divorce and attention deficit-hyperactivity variables predicted increased revenge motivation in the univariate model, and unemployed father predicted avoidance motivation, in the multivariate model. There is a defect in the ability to forgive in adolescents with insecure attachment and conduct disorder, there are basic requirements for the design of interventions and spiritual treatment programs specifically for this group of adolescents

Prevalence of behavioral inhibition among preschool aged children in Tehran, Iran

One of the identified risk factors for anxiety disorders in adolescence and adulthood is inhibited behaviors in childhood. The present study sought to examine the relationship between behavioral inhibition with some of the internal [personal] and external [family environment] factors in a sample of preschool children in kindergartens. In a cross sectional study in 2009, data was collected trough a structured questionnaire completed by parents and teachers in day-care centers. A total of 1403 children were assessed. Analysis was performed through complex sample analysis. The results showed that 7.4% [CI95%= 6.1%-9.1%] of children according to parents' and 8.1% [CI95%= 6%- 10.7%] according to teachers' evaluation classified as behaviorally inhibited. The higher levels of behavioral inhibition were shown by girls, first children, single parent families and older children. Birth year before 2004, birth rank, living in a single parent family and maternal level of education were independent predictors for behavioral inhibition in logistic regression modeling. There is relatively high prevalence of inhibited behaviors among Iranian children. Further examination of diagnosed children with behavioral inhibition by experienced psychiatrists is needed. Also establishing consultation centers for behaviorally inhibited children and instructing their parents and teachers are recommended

Discriminant of validity the Wender Utah rating scale in Iranian adults

The aim of this study is the normalization of the Wender Utah rating scale which is used to detect adults with Attention-Deficit and Hyperactivity Disorder [ADHD]. Available sampling method was used to choose 400 parents of children [200 parents of children with ADHD as compared to 200 parents of normal children]. Wender Utah rating scale, which has been designed to diagnose ADHD in adults, is filled out by each of the parents to most accurately diagnose of ADHD in parents. Wender Utah rating scale was divided into 6 sub scales which consist of dysthymia, oppositional defiant disorder; school work problems, conduct disorder, anxiety, and ADHD were analyzed with exploratory factor analysis method. The value of [Kaiser-Meyer-Olkin] KMO was 86.5% for dysthymia, 86.9% for oppositional defiant disorder, 77.5% for school related problems, 90.9% for conduct disorder, 79.6% for anxiety and 93.5% for Attention deficit/hyperactivity disorder, also the chi square value based on Bartlett's Test was 2242.947 for dysthymia, 2239.112 for oppositional defiant disorder, 1221.917 for school work problems, 5031.511 for conduct, 1421.1 for anxiety, and 7644.122 for ADHD. Since mentioned values were larger than the chi square critical values [P<0.05], it found that the factor correlation matrix is appropriate for factor analysis. Based on the findings, we can conclude that Wender Utah rating scale can be appropriately used for predicting dysthymia, oppositional defiant disorder, school work problems, conduct disorder, anxiety, in adults with ADHD

Personal and family factors affecting life time cigarette smoking among adolescents in Tehran [Iran]: a community based study

The prevalence of smoking among adolescents varies in different parts of the world. The current study aims to survey the socio-demographic and family characteristics related to adolescent lifetime cigarette smoking among 1201 Iranian adolescents aged 15- 18 years old. This study is a population-based cross-sectional survey conducted using the multistage random cluster sampling method in Tehran, Iran in the summer of 2010. The prevalence of lifetime cigarette use amongst boys [30.2%] was about 1.5 times that of girls [22.2%], [p=0.002]. Older age, low parental control, very little parental supervision in the adolescent's selection of friends, and having a friend or family member who smokes were associated with lifetime cigarette use among male adolescents. Moreover, the use of verbal punishment by the parents was a protective factor for female lifetime cigarette use. Smoking has become one of the great health threats among Iranian adolescents. As a result, health promotion programs should be gender based whilst educational and interventional programs for preventing tobacco use should begin before adolescence

Buspirone versus methylphenidate in the treatment of children with attention- deficit/ hyperactivity disorder: randomized double-blind study

A recent randomized clinical trial showed buspirone efficacy in the treatment of attentiondeficit/ hyperactivity disorder [ADHD] in children. However, results from a recent multi-site controlled clinical trial of transdermal buspirone failed to separate it from placebo in a large sample of children with ADHD. Therefore, due to these inconsistent findings, this study was designed to assess the efficacy of buspirone in the treatment of children with ADHD compared to methylphenidate in a double blind randomized clinical trial. Forty outpatients with a DSM-IV-TR diagnosis of ADHD were study population of this trial. Subjects were recruited from an outpatient child and adolescent clinic for a 6 week double blind, randomized clinical trial. All study subjects were randomly assigned to receive treatment using tablet of buspirone at a dose of 20-30 mg/day depending on weight [20 mg/day for < 30kg and 30 mg/day for > 30kg] [group 1] or methylphenidate at a dose of 20-30 mg/day depending on weight [20 mg/day for < 30kg and 30 mg/day for > 30kg [group 2] for a 6 week double blind, randomized clinical trial. The principal measure of outcome was the Teacher and Parent ADHD Rating Scale IV. Patients were assessed at baseline and at 21 and 42 days after the medication started. Significant differences were observed between the two groups on the Parent and Teacher Rating Scale scores. The changes at the endpoint compared to baseline were: -8.95 +/- 8.73 [mean +/- SD] and -15.60 +/- 7.81 [mean +/- SD] for buspirone and methyphenidate, for Parent ADHD Rating Scale. The changes at the endpoint compared to baseline were: -9.80 +/- 7.06 [mean +/- SD] and -22.40 +/- 9.90 [mean +/- SD] for buspirone and methyphenidate, respectively for Teacher ADHD Rating Scale. The difference between the buspirone and methylphenidate groups in the frequency of side effects was not significant except for decreased appetite, headache and insomnia that were observed more frequently in the methylphenidate group. The results of this study suggest that administration of buspirone was less effective than methylphenidate in the treatment of ADHD

Diagnosis, requests and timing of 503 psychiatric consultations in two general hospitals

The high comorbidity of medical and psychiatric diagnoses in the general hospital population requires collaboration between various medical fields to provide comprehensive health care. This study aims to find the rate of psychiatric consultations, their timing and overall diagnostic trend in comparison to previous studies. Tehran University of Medical Sciences has got an active psychiatric consultation-liaison service which includes services provided by four faculty psychiatrists [two full-time and two part-time]. This study was done in two general hospitals by simple sampling in available cases. For each consultation, a board-certified faculty psychiatrist conducted a clinical evaluation based on DSM-IV-TR. Other than psychiatric diagnoses, socio-demographic variables, relative consultation rates, reasons for referral, medical diagnoses and the time stay after admission were assessed. Among 503 patients who were visited by the consultation-liaison service, there were 54.3% female with mean age of 39.8 years. In 90.1% of consultations, at least one DSM-IV-TR diagnosis was made. The most frequent diagnosis groups were mood disorder [43.5%], adjustment disorder [10.9%] and cognitive disorder [7.6%]. In about 10.9% of the consultations, multiple psychiatric diagnoses were made. The mean length of hospital stay before the consultation was 12.56 days [range=1-90, SD=13]. Based on our findings, the mood and cognitive disorders still remain major foci of consultation-liaison practice in general hospitals; however our findings showed high rate of adjustment disorders diagnosis and ambiguous request for psychiatric consultation which need more interdisciplinary interaction

Mental health problems of Iranian female adolescents and its association with pubertal development: a nationwide study

Mental health problems including emotional and behavioral problems during puberty may be under influence of different risk factors including cultures, living in urban or rural areas and ethnic factors which may vary between different countries. The main aim of this study is to investigate the profile of emotional and behavioral problems and the role of factors such as age, stage of puberty, ethnicity, rurality and living in urban area, as risk factors in Iranian girls. As a part of a large national study we evaluated the emotional and behavioral problems in different stages of puberty in a community sample of Iranian adolescent girls from public schools that were selected by clustered random sampling method. In all subjects, demographic characteristics, and pubertal stages were measured. Emotional and behavioral problems were evaluated using Strength and Difficulties Questionnaire [SDQ]. The associations of age, pubertal development indices, socioeconomic and demographic factors with the behavioral problems were assessed. A total number of 4576 students enrolled the study and responded to the questions. The mean age of participants was 13.83 +/- 2.19 years. The mean total score of difficulties in participants was 14.34 +/- 5.81. According to these results 813 [17.8%] adolescents had total problem scores higher than Goodman's cutoff points and the most frequent problem domain was conduct problems [20.5%]. According to the results the most related variable with the total difficulty score of SDQ were ethnicity, residency in urban areas and development of menstrual cycle respectively. The results of this study showed that the most correlated factors with mental health problems in Iranian girls during puberty are ethnicity, urbanity and development of menstrual cycle

Substance abuse disorders in the parents of ADHD children, and parents of normal children

The objective of the study was to compare the attention-deficit/ hyperactivity, and substance abuse disorders background in the parents of children with attention-deficit/ hyperactivity disorder [ADHD], and the parents of normal children. The available sampling method was used to choose 400 parents of children [200 parents of children with ADHD and 200 parents of normal children], the ages of children were 6-18 years old. The data were collected through the Schedule for Affective Disorders and Schizophrenia [SADS] for parents and the Kiddy Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version [K-SADS-PL], Connors Adult ADHD Rating Scale [CAARS] and the Wender Utah Rating Scale [WURS] for adult ADHD. The results were analyzed by using SPSS-17 software, based on two-variable Chi-Square and t-tests.and P value in all disorders were equals to P<0.05. The results indicated that substance abuse in parents of children with ADHD is 21% more prevalent, and parents of children with ADHD compared to parents of normal children have 2% ADHD, 9% attention deficit disorder, and 1% hyperactivity disorder more in their background. Therefore, we conclude that there exists a significant difference between the above mentioned disorders in the parents of children with ADHD, and parents of normal children. The high prevalence rate of disorders and background of ADHD in families of individuals with ADHD shows the probability of effect of inheritance in the disorder. Also, it shows that parents of children with ADHD have more substance abuse and history of ADHD in their background

Adolescent males and young females in Tehran: differing perspectives, behaviors and needs for reproductive health and implications for gender sensitive interventions

Despite cultural and religious prohibitions against premarital heterosexual rela-tionships and intimacy, some recent evidence suggests some rise in premarital heterosexual interactions and relationships among young people. On the other hand, although HIV in Iran is a concentrated epidemic and mainly reported among high risk groups such as injecting drug users [IDUs], but there are evidences that the mode of transmission is shifting towards sexual contacts. This trend has caused concern among health policy makers in terms of prevention of STDs and HIV/AIDS particularly, among young people. This paper was prepared with the aim of high-lighting how gender contributes to variation in reproductive health needs and conduct of young people in Iran. Method: This paper is based on a secondary analysis and compares comparable reproductive beliefs and conducts of women and men based on the data of two surveys conducted in Tehran in 2002 and 2005. A survey among 1385 adolescent males and another survey among 1743 female undergraduate students in four multidisciplinary universities in Tehran. Both surveys used anonymous self-administered questionnaires. To make the two samples comparable, the data of unmarried female university undergraduate students who resided in Tehran were merged with the data of adolescent male students who intended to pursue higher education. Common variables of the two surveys were identified, homogenized, merged and analysed. Reproductive health knowledge among male adolescents was poor compared to that of their female peers. Although premarital friendships were moderately acceptable from view points of both males and females, the majority were against premarital sex, particularly among female participants. There were evidences of gender-based double standards in perceptions of premarital sexuality among both males and females; particularly, it was stronger among males than females. Male adolescents reported earlier and greater experiences of premarital hetero-sexual intimacy and sexual contact than females. Multiple partners were also more common among males than females. Females had a tendency to regret first sexual contact more than males, which reflects that first sex is more likely to be unplanned and unwanted among females compared to males. Significant gender based double standards prevailed current sexual attitudes and conduct of young people in Iran. Gender norms which encourage unmarried men to practice pre-marital sex lead to an earlier transition of men to sexual relations and multiple sexual partners. Due to poor knowledge and various misconceptions about sexual health and lack of consistent contraceptive and condom use among adolescents and young people in Iran, both young men and women are susceptible to sexual and reproductive health hazards such as sexually transmitted infections [STIs], HIV/AIDS, pregnancy and unsafe abortion. Changing gender norms associated with sexuality may lead to promotion of safer sexual behaviors particularly among young people. Current reproductive health and HIV prevention programs should take into account gender-based double standards among young people and their unmet reproductive health needs

survey of knowledge and attitude of non-psychiatrists [medical specialists] treating major depression

Non-diagnosed depression might postpone the physical healing of patients and negatively affects prognosis. The rate of major depressive disorder among patients of general practitioners in the United States reaches 10 percent and among patients admitted to the inner wards reaches 15 percent. A cross sectional study on physician of two hospitals was performed. A questioner was designed to assess knowledge, attitude, and practice of non-psychiatrist physicians towards depression treatment. Non-Physiatrist physicians' score in knowledge and attitude was 6.7 and 103.75, respectively. Gender and the area of specialization of the physicians had no significant effect on their knowledge, attitude and medical treatment methods applied by them. The study highlights a low level of knowledge of physicians about depression. Further studies are paramount to assess the efficacy of interventions applied to improve current situation

Autism spectrum disorders in Iran

Autistic disorder, Asperger syndrome, and PDD-Not Otherwise Specified are subsets of autism spectrum disorders [ASDs], which are characterized by impairments in social communication and stereotyped behavior. This article reviews the prevalence, etiology, diagnosis, and treatment of ASDs in Iran. We searched PubMed, ISI Web of Science, and 4 Iranian databases [IranPsych, IranMedex, Irandoc and Scientific Information Database [SID] to find Iranian studies on ASDs. The results of 39 investigations, comprising original, review and editorial articles; proceedings; and available dissertations were categorized by prevalence, etiology, diagnosis, and treatment. Several preliminary investigations have been done to evaluate the prevalence of ASDs, and risk factors and effective variables have been studied with regard to etiology. The diagnostic evaluation of ASDs, especially based on EEG, and several pharmacological and behavioral interventions for ASD have been implemented in Iran. Mental health, stress levels, and personality characteristics were examined in the parents of children with ASDs, which were focused on mothers

Selective attention and drug related attention bias in methadone maintenance patients

One of the main problems of the drug abusers is drug related attention bias, which causes craving, and as a result drive the drug abusers to take narcotics. Methadone is used as a maintenance treatment for drug abusers. The purpose of this study is evaluation of the effect of Methadone maintenance therapy [MMT] on selective attention and drug related attention bias. This study investigated drug cue-related attention bias and selective attention in 16 methadone-maintained patients before and 45 days after methadone therapy period. Stroop color-word test and addiction Stroop test were used as measurement methods. Results show less reaction time and higher accuracy in Color-Word Stroop Test after MMT and less delay for addict related word in addiction Stroop test. It is concluded that methadone can improve selective attention capability and reduce drug related attention bias

Effect of play therapy on behavioral problems of maladjusted preschool children

The present research was conducted to study the effect of play therapy on reducing behavioral problems of children with oppositional defiant disorder. Using multistage cluster sampling, regions 6, 7, and 8 in Tehran were selected. Among kindergartens of these areas, 3 kindergartens which were supported by the welfare organization were randomly selected. Of all pre-school children of these 3 kindergartens, 40 children who could have behavioral disorder, according to their teachers and parents, were carefully tested. Of them, 16 children who showed severe symptoms of oppositional defiant disorder, were selected, via the results obtained from child symptom inventory questionnaire [CSI-4], teacher's form, and a researcher-made self-control checklist. Then, the subjects were randomly divided into one control and one experimental group. This research is quasi-experimental, and is conducted using of pre-test, post-test, and control group. Values of calculated F for oppositional defiant disorder in control group and experimental group was meaningful after fixing the effect of pre-test [P<0/001]. Therefore, a meaningful difference existed between the means of post-test scores of disobedience disorder in the experimental and control groups through the fixed effect of pre-test effect. Comparison of adjusted means of 2 groups shows that the mean of attention-deficit hyperactivity disorder [ADHD] in experimental group was lower than control group. Therefore, applying play therapy reduced severity of ADHD in those children in experimental group compared to those in control group who did not receive such instructions. Results of this research demonstrates that children's disobedience can be reduced by play therapy

How to break bad news: physicians' and nurses' Attitude

Bad news disclosure is one of the most complex tasks of physicians. Recent evidences indicate that patients' and physicians' attitude toward breaking bad news has been changed since few years ago. The evidence of breaking bad news is different across cultures. The aim of this study is to evaluate the attitude of medical staff toward breaking bad news to provide a clinical guideline in Iran. A descriptive study was conducted during 2008-2009 on a sample of 100 medical staff [50 physicians and 50 nurses] at Cancer Institute of Imam Khomeini hospital. The subjects' demographic characteristics and their attitudes toward the manner of revealing the diagnosis were registered in a questionnaire. The majority of the physicians [86%, n=43] and nurses [74%, n=37], mostly the older and more experienced, tended to reveal the diagnosis to patients. Only a few physicians [8%, n=4] had been trained how to disclose bad news, which discloused diagnosis more than non trained ones. Physicians and nurses preferred to inform the patients about the diagnosis when either the patients were alone or in the presence of their spouse respectively. Only a few physicians [14%] and nurses [24%] agreed to explain life expectancy to patients. Compared to past, physicians and nurses are more willing to share cancer diagnosis with patients. However, lack of adequate communication skills in caregivers, and their concerns about managing patients' emotional reactions reduce their tendency to disclose bad news to the patients. Therefore, training physicians and nurses to expose bad news to the patients seems to be necessary

Prevalence of attention-deficit/hyperactivity disorder symptoms in preschool-aged Iranian children

The aim of this study was to determine the prevalence of attention-deficit/hyperactivity disorder [ADHD] symptoms in Iranian preschool children based on evaluations by parents and teachers because a thorough understanding of epidemiologic features of ADHD symptoms in preschool children is important for prevention and management. Children between the ages of three and six attending kindergarten participated in this study. For the survey, 37 kindergartens were selected by multistage [stratified cluster random] sampling, consisting of 2213 children with a design effect equal to 1.5. A 19-item observer-rating questionnaire was generated to assess ADHD symptoms in children within the last 6 months. This questionnaire was used by both teachers and parents to assess ADHD behavior in participating children. Of 1403 children aged 3-6 years, 362 were classified as having ADHD symptoms according to their parent evaluation [25.8% [23.6-28.1%]] and 239 according to their teachers evaluation [17% [14.1-20.4%]]. Child rank among siblings, mother's education level, and interest in aggressive television programs were all independent explanatory variables according to parents' evaluation. Gender, parent education, child rank, single parent and interest in aggressive television programs were all independent explanatory variables according to teachers' evaluation. Our findings reveal a large discrepancy in the prevalence of ADHD symptoms in preschool children based on evaluation by parents and teachers. Thus, it seems that the ADHD screening should be performed in multiple settings in order to identify children who need further investigations

Children and their parents' perceptions of symptom severity and treatment preference for Tourette syndrome

This study surveys children and their parents' perceptions, and their treatment preference of significant/bothersome symptoms in children with Tourette syndrome. Thirty five children and adolescents who referred to an out-patient clinic of a Child Psychiatry Clinic were selected as subjects for this study. The children and their parents were interviewed about their perception of significant/bothersome symptoms of motor tics, vocal tics, learning difficulties, attention deficit disorder, hyperactivity, obsessions, compulsions, and rage attacks. About two thirds of the subjects had symptom of rage. Inattentiveness and hyperactivity were observed in more than half of the children. There was a statistically significant difference between parents and their children in frequency of motor tics and rage attacks. Children reported the necessity for controlling and management of these symptoms less than their parents. The rates of motor, vocal tics and rage attacks in the Iranian sample are similar to other studies. Rage attack is one of the most common significant/bothersome symptoms reported that should be treated. While motor tics were not rated among the most common features that should be treated in a study in Canada, it was the most common significant/bothersome symptom in Iran. Parents perceive motor tics and rage attacks as more significant/bothersome symptoms compared to children