Increased regional Hurst exponent reflects response inhibition related neural complexity alterations in pediatric bipolar disorder patients during an emotional Go-Nogo task.

Fractal patterns have been shown to change in resting- and task-state blood oxygen level-dependent signals in bipolar disorder patients. However, fractal characteristics of brain blood oxygen level-dependent signals when responding to external emotional stimuli in pediatric bipolar disorder remain unclear. Blood oxygen level-dependent signals of 20 PBD-I patients and 17 age- and sex-matched healthy controls were extracted while performing an emotional Go-Nogo task. Neural responses relevant to the task and Hurst exponent of the blood oxygen level-dependent signals were assessed. Correlations between clinical indices and Hurst exponent were estimated. Significantly increased activations were found in regions covering the frontal lobe, parietal lobe, temporal lobe, insula, and subcortical nuclei in PBD-I patients compared to healthy controls in contrast of emotional versus neutral distractors. PBD-I patients exhibited higher Hurst exponent in regions that involved in action control, such as superior frontal gyrus, inferior frontal gyrus, inferior temporal gyrus, and insula, with Hurst exponent of frontal orbital gyrus correlated with onset age. The present study exhibited overactivation, increased self-similarity and decreased complexity in cortical regions during emotional Go-Nogo task in patients relative to healthy controls, which provides evidence of an altered emotional modulation of cognitive control in pediatric bipolar disorder patients. Hurst exponent may be a fractal biomarker of neural activity in pediatric bipolar disorder.

Shared and specific patterns of structural and functional thalamo-frontal disturbances in manic and euthymic pediatric bipolar disorder.

Bipolar disorder (BD) is clinically defined by alternating depressive and manic episodes with a separated period of euthymia. Thalamo-frontal loop plays vital role in psychotic symptoms, altered motor control and executive difficulties in BD. It remains unclear that structural and functional alterations of thalamo-frontal loop among the different mood states in BD, especially in pediatric BD(PBD).Twenty manic PBD (mPBD), 20 euthymic PBD (ePBD) and 19 healthy controls (HCs) were included in the study. By analyzing the T1 images and fMRI signals, thalamus volume and frontal grey matter cortical thickness were tested, and functional connectivity (FC) between bilateral thalamus and frontal cortex was calculated. Relationship between clinical indices and thalamo-frontal FC was also evaluated in mPBD and ePBD adolescents.Compared to HCs, the cortical thickness of left middle frontal gyrus (MFG), bilateral superior frontal gyrus (SFG) was significantly decreased in both mPBD and ePBD patients, and volume of left thalamus and cortical thickness of right MFG significantly decreased in mPBD patients. Compared to that of the HCs and ePBD subjects, thalamo-frontal hyperconnectivity with MFG was found in mPBD, and compared with that of HCs, thalamo-frontal hypoconnectivity with precentral gyrus/SFG was found in ePBD. In ePBD patients, episode times positively correlated with FC values between thalamus and precentral gyrus.The findings of the present study demonstrate detailed knowledge regarding shared and specific structural and functional disruption in thalamo-frontal loop in mPBD and ePBD subjects. Thalamo-frontal abnormalities reported in adult BD subjects were also observed in adolescent BD patients, and thalamo-frontal dysfunction may be a crucial treatment target in BD.

Reliability and validity of the Chinese version of Questionnaire - Children with Difficulties for Chinese children or adolescents with attention-deficit/hyperactivity disorder: a cross-sectional survey.

PURPOSE: The Questionnaire - Children with Difficulties (QCD) has been developed and used to evaluate daily-life problems in children during specified periods of the day. The objective of this study was to evaluate the reliability and validity of the QCD for Chinese children or adolescents with attention-deficit/hyperactivity disorder (ADHD). PATIENTS AND METHODS: Outpatients with ADHD aged 6-18 years who visited psychiatry clinics were enrolled at four study centers in China. Patients with severe psychiatric disorders were excluded. Parents of all enrolled patients were given the QCD, the Swanson, Nolan and Pelham IV (SNAP-IV), and the Weiss Functional Impairment Scale-Parent (WFIRS-P) questionnaires and were asked to complete all three questionnaires. The reliability of the QCD was examined by Cronbach's alpha, which assessed the internal consistency of the questionnaire. Concurrent criterion validity of QCD scores was examined by Spearman's correlation of QCD with SNAP-IV and WFIRS-P scores. RESULTS: A total of 200 Chinese patients were analyzed (average age, 10.4±2.66 years). The majority of patients were male (77.5%), and 49.0% had the combined ADHD subtype. Cronbach's alpha for QCD was 0.88. Correlation coefficients of the QCD total score with SNAP-IV total score and WFIRS-P average score were -0.47 and -0.57, respectively. Correlations for the QCD with SNAP-IV and WFIRS-P were statistically significant (P<0.01). The area under the curve for sensitivity and specificity of the QCD compared with the SNAP-IV and WFIRS-P was 0.70 and 0.71, respectively. The ADHD severity discrimination threshold range of the QCD total score was 30-35. CONCLUSION: Our study results found the QCD to be a reliable and valid instrument and recommend its use in clinical practice to identify and evaluate daily-life problems of ADHD patients during specified periods of the day in China.

Associations of serotonin transporter gene promoter polymorphisms and monoamine oxidase A gene polymorphisms with oppositional defiant disorder in a Chinese Han population.

BACKGROUND: Oppositional defiant disorder (ODD) is a behavioral disorder that mainly refers to a recurrent pattern of disobedient, defiant, negativistic and hostile behaviors toward authority figures. Previous studies have showed associations of serotonin transporter (5-HTT) and monoamine oxidase A (MAOA) with behavioral and psychiatric disorders. The purposes of this study were to investigate the potential association of 5-HTT gene promoter polymorphism (5-HTTLPR) and MAOA gene polymorphism with susceptibility to ODD in a Han Chinese school population. METHODS: The 5-HTTLPR gene polymorphism and the MAOA gene polymorphism were genotyped in a case-control study of 257 Han Chinese children (123 ODD and 134 healthy controls). RESULTS: There was significant difference in the allele distribution of 5-HTTLPR (χ2 = 7.849, P = 0.005) between the ODD and control groups. Further, there were significant differences in genotype (χ2 = 5.168, P = 0.023) and allele distributions (χ2 = 10.336, P = 0.001) of the MAOA gene polymorphism that is variable-number tandem repeat (MAOA-uVNTR) between two groups. Moreover, there were significant differences in genotype (χ2 = 4.624, P = 0.032) and allele distributions (χ2 = 9.248, P = 0.002) of MAOA-uVNTR only in the male ODD and healthy groups. CONCLUSIONS: Our results suggest that 5-HTTLPR and MAOA-uVNTR gene variants may contribute to susceptibility to ODD. Further, MAOA-uVNTR gene polymorphism may play a role in susceptibility to ODD only in male children.

Uneven Expressive Language Development in Mandarin-Exposed Preschool Children with ASD: Comparing Vocabulary, Grammar, and the Decontextualized Use of Language via the PCDI-Toddler Form.

Data from children with ASD who are learning Indo-European languages indicate that (a) they vary hugely in their expressive language skills and (b) their pragmatic/socially-based language is more impaired than their structural language. We investigate whether similar patterns of language development exist for Mandarin-exposed children with ASD. Parent report data of the Putonghua Communicative Development Inventory-Toddler Form were collected from 160 17-83-month-old children with ASD. These children with ASD demonstrated similar levels of variability as Western children with ASD. In particular, they could be divided into three distinct subgroups (high verbal, middle verbal, low verbal), all of which manifested relative strengths in lexical and grammatical language compared to pragmatic usage of decontextualized language.

Interpretation of Logical Words in Mandarin-Speaking Children with Autism Spectrum Disorders: Uncovering Knowledge of Semantics and Pragmatics.

This study investigated the interpretation of the logical words 'some' and 'every…or…' in 4-15-year-old high-functioning Mandarin-speaking children with autism spectrum disorders (ASD). Children with ASD performed similarly to typical controls in demonstrating semantic knowledge of simple sentences with 'some', and they had delayed knowledge of the complex sentences with 'every…or…'. Interestingly, the children with ASD had pragmatic knowledge of the scalar implicatures of these logical words, parallel to those of the typical controls. Taken together, the interpretation of logical words may be a relative strength in children with ASD. It is possible that some aspects of semantics and pragmatics may be selectively spared in ASD, due to the contribution the language faculty makes to language acquisition in the ASD population.

Parent Ratings of ADHD Symptoms in Chinese Urban Schoolchildren: Assessment With the Chinese ADHD Rating Scale-IV: Home Version.

OBJECTIVE: The objective of this study was to assess the psychometric properties of the Chinese ADHD Rating Scale-IV (ADHD RS-IV): Home Version and to explore parent ratings of ADHD symptoms in a large sample of urban schoolchildren in China. METHOD: Parents of a representative sample of 1,616 schoolchildren (aged 6-17) in 12 Chinese cities completed the ADHD RS-IV: Home Version. RESULTS: The Chinese ADHD RS-IV: Home Version demonstrated satisfactory internal consistency, test-retest reliability, parent-teacher correlation, discriminant validity, and convergent validity. Factor analysis revealed the DSM-IV two-factor model with "inattention" and "hyperactivity-impulsivity" dimensions, accounting for equal variances. Parent ratings revealed lower/similar scores for Chinese schoolchildren compared with the U.S. CONCLUSION: The ADHD RS-IV: Home Version is a reliable and valid ADHD rating scale in China. The factor structure is similar but not identical to the U.S. STUDY: Normative data reveal cultural differences in some aspects of the parent ratings of ADHD.

[Association between MAOA-u VNTR polymorphism and its interaction with stressful life events and major depressive disorder in adolescents].

OBJECTIVE: To investigate whether the genetic polymorphism, upstream variable number of tandem repeats (uVNTR), in the monoamine oxidase A (MAOA) gene, is associated with major depressive disorder (MDD) in adolescents and to test whether there is gene-environment interaction between MAOA-uVNTR polymorphism and stressful life events (SLEs). METHODS: A total of 394 Chinese Han subjects, including 187 adolescent patients with MDD and 207 normal students as a control group, were included in the study. Genotyping was performed by SNaP-shot assay. SLEs in the previous 12 months were evaluated. The groups were compared in terms of the frequency distributions of MAOA-uVNTR genotypes and alleles using statistical software. The binary logistic regression model of gene-environment interaction was established to analyze the association of the gene-environment interaction between MAOA-u VNTR genotypes and SLEs with adolescent MDD. RESULTS: The distribution profiles of MAOA-u VNTR genotypes and alleles were not related to the onset of MDD, severity of depression, comorbid anxiety and suicidal ideation/behavior/attempt in adolescents. The gene-environment interaction between MAOA-u VNTR genotypes and SLEs was not associated with MDD in male or female adolescents. CONCLUSIONS: It is not proven that MAOA-u VNTR polymorphism is associated with adolescent MDD. There is also no gene-environment interaction between MAOA-u VNTR polymorphism and SLEs that is associated with adolescent MDD.

A randomized controlled trial of olanzapine improving memory deficits in Han Chinese patients with first-episode schizophrenia.

Olanzapine is an atypical antipsychotic for the treatment of schizophrenia, in which memory impairment is a core deficit. The methods of positive and negative syndrome scale (PANSS), Wechsler memory scale-4th edition (WMS-IV) and event-related potential (ERP) were used to study the effects of olanzapine on the cognitive function in the first-episode schizophrenic patients. We performed multicentre, randomized, double-blind, placebo-controlled, parallel-group clinical trial to study the cognitive functioning in Han Chinese first-episode schizophrenic patients in a 12-week treatment regime with olanzapine (129 cases) or placebo (132 cases). The results showed that (1) the patients with first-episode schizophrenia showed significant deficits in the long-term memory, short-term memory, immediate memory and memory quotient by WMS-IV assessment, and decreases the total scores, positive symptoms, negative symptoms and general psychopathology by PANSS assessment; (2) olanzapine could significantly improve the PANSS scores including total scores, positive symptoms, negative symptoms and general psychopathology in the first-episode schizophrenic patients; (3) olanzapine could significantly improve the short-term memory, immediate memory and memory quotient in the first-episode schizophrenic patients; and (3) although the latencies of P(2), N(2) and P(3) were significantly prolonged, P(2) and P(3) amplitudes were decreased and the latencies of N(1) did not change, olanzapine did not influence any P(300) items in the first-episode schizophrenic patients. The data suggested that that olanzapine could improve cognitive process, such as memorizing and extraction of the information although there were many changes of cognitive functions in Han Chinese first-episode schizophrenic patients.

[DRD2/ANKK1 Taq IA polymorphism and early infant temperament].

OBJECTIVE: To investigate whether there is an association between DRD2/ANKK1 Taq IA polymorphism and early infant temperament. METHODS: DRD2/ANKK1 Taq IA polymorphism (rs1800497) was determined using polymerase chain reaction-ligase detection reaction (PCR-LDR) techniques in 149 Chinese Han infants from Changsha City. Their mothers were asked to complete the Early Infant Temperament Questionnaires (EITQ) when the infants were 1 to 4 months old (mean: 2.75 months). There were three genotypes found in these infants: C/C, T/T and C/T. The subjects were subdivided into T-carrier (CT, TT) and non-T-carrier (CC) groups for statistical analysis. RESULTS: There were no differences in the temperament style distribution between the T-carrier and non-T carrier groups. There were also no statistically significant differences between the two groups in the score of the nine temperament dimensions. CONCLUSIONS: DRD2/ANKK1 Taq IA polymorphism is not associated with early infant temperament.

[Association of 14 polymorphisms in the five candidate genes and attention deficit hyperactivity disorder].

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is one of the most common behavior disorders in childhood and adolescent. The etiology of ADHD is unknown. The aim of this study was to investigate the relationship between each of the 14 polymorphisms in the five candidate genes and ADHD, and between the combination of some polymorphisms in those genes and ADHD, in attempting to examine whether combinations of genotypes would confer a significant susceptibility to ADHD. METHODS: One hundred and thirty-nine children with ADHD and one hundred and nineteen normal children were enrolled. Eight single nucleotide polymorphisms (SNP) of three candidate genes were examined with PCR and RFLP techniques. 48 bp VNTR in DRD4 gene was examined with PCR, nondenaturing polyacrylamide gel electrophoresis and silver staining. Five microsatellites (MS) of three candidate genes were examined with genotyping. The relationship between the combinations of 12 polymorphisms and ADHD was examined with logistic regression analysis. RESULTS: 1.The frequency of 1065T/1065T genotype and the 1065T allele were significantly higher in ADHD children than that in normal controls (P<0.05). The frequency of -48G/-48G genotype of the A-48G polymorphism of DRD1 gene was significantly lower in ADHD children than that in normal controls (P<0.05). 2. A specific combination of three polymorphisms in the two genes showing an association with ADHD gave a prediction level of 77.5%. CONCLUSIONS: The T1065G polymorphism in the SNAP-25 may be associated with ADHD. The 1065T/1065T genotype and the 1065T allele may be a risk factor for ADHD. The A-48G polymorphism of DRDI may be associated with ADHD. The -48G/-48G genotype may be a protective factor for ADHD. The specific combination of three sites of SNP in SNAP-25 gene and DRDI gene is found and shows an association with ADHD in 12 polymorphisms of the five candidate genes on glutamatergic/dopaminergic pathway.

Association study of astrocyte-derived protein S100B gene polymorphisms with major depressive disorder in Chinese people.

OBJECTIVE: Astroglial-derived protein S100B is known to play important roles in axonal growth, neural plasticity, and energy regulation. Disturbance of these neurodevelopmental processes is proposed as one possible etiology for mood disorder. Therefore, we performed a genetic analysis of S100B in patients with major depressive disorder (MDD). METHOD: The polymorphisms of S100B were determined by polymerase chain reaction-restriction fragment length polymorphism in patients (n = 152) with MDD and healthy control subjects (n = 150). The genotypic and allelic distributions of 2 variants were analyzed in Chinese patients. RESULTS: Two single nucleotide polymorphisms did not display significant associations with MDD. However, there were significant differences in age of onset in 3 genotypes of S100B rs9722. Significant differences in the subgroup depression (first-episode and recurrent depression) were also shown in 3 genotypes of S100B rs9722 and rs11911834 in patients and control subjects (P < 0.05). CONCLUSIONS: Our findings did not suggest association of S100B gene polymorphisms in patients with MDD in China. We found there were differences in depressive episodes among different genotypes of S100B gene.

[Relationship between impulsivity and sleep disorders in children aged 6 to 12 years].

OBJECTIVE: To study the relationship between impulsivity and sleep disorders in children. METHODS: A total of 1 736 children at ages of 6 to 12 years were randomly sampled from five districts of Changsha. Their parents completed the questionnaires about children's sleep conditions and behaviors (using Barratt Impulsiveness Scale 11th version). RESULTS: Five hundred and fifty-four children (31.9%) had sleep disorders. The incidence of sleep disorders in boys was significantly higher than that in girls (35.4% vs 28.3%; P<0.01). The scores of attentional, motor, and non-planning impulsiveness factors as well as the total score of Barratt Impulsiveness Scale in children with sleep disorders were significantly higher than those in children without (P<0.01). The incidence of daytime sleepiness (35.9%) in children with sleep disorders was significantly higher than that in children without (24.7%; P<0.01). The scores of attentional, motor, and non-planning impulsiveness factors increased with the grade of sleep disorders, and reached a peak at the fifth grade. The children with frequent sleep snoring showed higher scores of above three impulsiveness factors than children without sleep snoring or having rare snoring (P<0.01). CONCLUSIONS: Sleep disorders are associated with impulsivity in children. It is thus essential to pay close attentions to children's sleep for children with relatively high impulsiveness.

The effects of gender and numbers of depressive episodes on serum S100B levels in patients with major depression.

S100B protein is a calcium-binding protein mostly derived from glial cells, which exerts trophic or toxic effects on neural cell depending on its concentration. It has been reported that S100B played an important role as a potential marker in psychiatric disorders. Thus, we will explore the clinical implication of S100B in major depression, especially the effect of gender and numbers of depressive episodes on S100B. The levels of serum S100B were measured with enzyme-linked immunosorbent assay (ELISA) in 54 patients with major depression and 35 age-matched healthy controls. The S100B levels in major depressed patients were significantly higher than those in controls. The serum S100B levels in female patients were significantly higher than those in male patients. Patients with recurrent depressive episodes had significantly higher S100B levels than those in first-episode depression. Serum S100B levels were significantly positive related with the numbers of depressive episode, family history and cognitive disturbance scores. These findings confirmed an increase in serum S100B levels in major depressive patients and presence of a sexual dimorphism. Moreover, numbers of depressive episodes in depression seemed to have an additional increasing effect on S100B levels.

No association of the rs9722 C >T in the S100B gene and susceptibility to major depression in a Chinese population.

OBJECTIVE: Astroglial-derived protein S100B is known to play important roles in axonal growth, neural plasticity, and energy regulation. Disturbance of these neurodevelopmental processes is proposed as one of the etiologies for mood disorder, and genetic polymorphisms of S100B have a possibility to be in susceptibility to major depressive disorder (MDD). METHOD: We first investigated the association of the rs9722 C > T polymorphism of the S100B gene and susceptibility to MDD by comparing 152 major depressive patients with 150 healthy individuals in a Chinese population. RESULTS: The genotype frequencies of the S100B rs9722 C > T polymorphism were 30% (C/C), 56% (C/T), and 14% (T/T) in depressed patients, 32% (C/C), 53% (C/T), and 15% (T/T) in healthy volunteers, respectively. The allele frequencies of the S100B rs9722 C > T polymorphism were 58% (C allele) and 42% (T allele) in depressed patients, and 59% (C allele) and 41% (T allele) in healthy volunteers, respectively. CONCLUSION: There were no significant differences in the genotype distribution and allele frequencies between major depressive patients and healthy individuals. S100B rs9722 C > T polymorphism appears not to be an important factor in susceptibility to MDD in a Chinese population.

Randomized double-blind multicentre placebo-controlled clinical trial of the clonidine adhesive patch for the treatment of tic disorders.

OBJECTIVE: The aim of the present study was to evaluate the therapeutic effectiveness and safety of the clonidine adhesive patch in treating tic disorders. METHOD: A total of 437 patients, who met Chinese Classification of Mental Disorders-third edition diagnostic criteria for transient tic disorder (5%), chronic motor or vocal tic disorder (40%) or Tourette disorder (55%), aged 6-18 years, were divided randomly into an active treatment group and a clinical control group. Participants in the active treatment group were treated with a clonidine adhesive patch and participants in the clinical control group with a placebo adhesive patch for 4 weeks. The dosage of the clonidine adhesive patch was 1.0mg, 1.5mg or 2.0mg per week, depending on each participant's bodyweight. Participants whose Yale Global Tic Severity Scale (YGTSS) score decreased <30% and Clinical Global Impression score was > or =4 by the end of week 3 were withdrawn from the trial. RESULTS: After 4 weeks of treatment the active treatment group participants' YGTSS score was significantly lower than that of the clinical control group (F=4.63, p=0.03). Further, the active treatment group had a significantly better therapeutic response than the clinical control group (chi(2)=9.15, p=0.003). The response rate in the active treatment group was 68.85% compared to 46.85% in the clinical control group (chi(2)=16.98, p=0.0001). The rate of adverse events was low (active treatment group, 3.08%; clinical control group, 7.21%) and did not differ between the two groups. CONCLUSIONS: The clonidine adhesive patch is effective and safe for tic disorders.

Polymorphisms of androgen receptor gene in childhood and adolescent males with first-onset major depressive disorder and association with related symptomatology.

This study was designed to explore the association between CAG repeats in AR gene and major depressive disorder (MDD) in male children and adolescents. The results showed that there were differences between adolescent depressive patients and adolescent controls in CAG repeats' length and alleles' distributions, and the severity of depression and anxiety was negatively correlated with the length of CAG repeats in adolescent patients. This suggested that AR gene might be involved in the depressive upset in adolescents, and the age- and sex-related prevalent differences might also be associated to CAG repeats.

Comparison of the polymorphisms of androgen receptor gene and estrogen alpha and beta gene between adolescent females with first-onset major depressive disorder and controls.

This study was to elucidate the role of genetic variation in androgen receptor (AR) gene, estrogen receptor alpha (ER alpha) and ER beta gene on first-onset major depressive disorder (MDD) in female adolescents. Results showed that AR gene in MDD group have shorter microsatellites' length, and ER beta gene have shorter microsatellites' length and higher rates of S alleles, SS, genotype, and lower rate of LL genotype than control group. The results suggest that shorter length of AR and ER beta gene microsatellites might influence the onset of MDD in female adolescents, a further elucidation of the mechanisms is warranted.

P300 differences exist between Tourette's syndrome with and without attention deficiency and hyperactivity disorder in children.

OBJECTIVE: To study the characteristics of P300 in Tourette's syndrome (TS) with and without attention deficiency and hyperactivity disorder (ADHD). METHOD: Auditory evoked P300 were recorded in 19 TS only (TS-ADHD) children, 15 TS with ADHD (TS + ADHD) children and 20 unaffected control subjects, and their waveforms, amplitudes, latencies and topographies were compared at Fz, Cz, C3, C4 and Pz. RESULTS: The TS + ADHD group showed shorter latencies than control subjects at all electrode sites (P<0.05 or 0.01), and the TS-ADHD group at CZ and PZ (P<0.05); however, there was no significant difference between control subjects and the TS-ADHD group. The TS-ADHD group showed smaller amplitudes than the control group at all electrode sites (P<0.05), and the TS + ADHD group at Cz (P<0.05); however, there were no significant differences between control subjects and the TS + ADHD group. There was no significant difference in the prevalence of abnormal waveforms between the control, TS, TS-ADHD and TS + ADHD groups, but there were significant differences in the variability of localization of P300 between the control and the TS group (P=0.003), control and TS + ADHD groups (P=0.000), and the TS-ADHD and TS + ADHD groups (P=0.039). P300 in the TS + ADHD group tended to spread out to the left and that of the TS-ADHD group tended to spread out to the right. CONCLUSIONS: P300 differences exist between TS-ADHD and TS + ADHD in children. These suggested that establishment different development defects or delay of communications between different structures rather than a delay in maturation of the structures themselves may be involved in TS + ADHD and TS-ADHD children and ADHD symptoms in TS patients are likely a trait rather than adventitious or acquired within the TS syndrome.

Comorbid behavioural problems in Tourette's syndrome are positively correlated with the severity of tic symptoms.

OBJECTIVE: We studied the comorbid behavioural and mood problems in children with non-psychiatric Tourette's syndrome (TS) and their relationship with severity of tic disorder. METHOD: Sixty-nine TS children and 69 healthy controls were assessed by Child Behavior Checklist (CBCL) and Yale Global Tic Severity Scale (YGTSS). The relationships between behavioural problems and severity of tic symptoms were analysed statistically by comparison, correlation and multiple linear regression. RESULTS: Tourette's syndrome patients scored significantly lower (p<0.01) on the CBCL competency subscales and total score, and higher on all behavioural problem subscales and total score (p<0.01). Expectedly, the TS children had lower social competence than normal children. Among the TS children, the severity of tic symptoms is positively correlated with the severity of overall impairment in school and social competence. When the behavioural and mood problems commonly associated with TS were studied in detail, we found that delinquent behaviour, thought problems, attention problems, aggressive behaviour and externalizing are positively correlated with severity of tic symptoms. CONCLUSION: The findings indicated that children with TS-only also had a broad range of behavioural problems, and some of these were related to the severity of tic symptoms.