Parenting Stress and Depressive Symptoms Among Chinese Parents of Children With and Without Oppositional Defiant Disorder: A Three-Wave Longitudinal Study.

Parents of children with oppositional defiant disorder (ODD) experience greater stress in parenting and more parental depressive symptoms. The study examined the longitudinal and bidirectional associations between three dimensions of parenting stress (i.e., parental distress, parent-child dysfunctional interaction, and difficult child) and parental depressive symptoms from a sample of Chinese parents of children with or without ODD. The sample included 256 parents of children with ODD and 265 parents of children without ODD, along with children's teachers. Using a three wave, cross-lagged design, results showed that parents of children with ODD suffered higher levels of parenting stress across three dimensions. For both groups, the links between parental depressive symptoms and subsequent parental distress and difficult child were unidirectional, whereas the relation between parental depressive symptoms and parent-child dysfunctional interaction was bidirectional. Multi-group analysis found that there was no significant difference in the relations between parenting stress and depressive symptoms between the ODD and non-ODD groups. The findings indicated that children with ODD require comprehensive services to address the stress of their parents. The study also provided support for the dynamic and longitudinal relations between specific dimensions of parenting stress and depressive symptoms among parents of children with or without ODD.

From "4Rs and 2Ss" to "Amaka Amasanyufu" (Happy Families): Adapting a U.S.-based Evidence-Based Intervention to the Uganda Context.

In Uganda, one in five children presents mental health challenges, including disruptive behavior disorders (DBDs). DBDs can persist through adulthood and result in negative outcomes. Effective interventions for DBDs have been developed and tested in high-poverty communities in developed countries. Yet, most African countries, such as Uganda, lack such interventions. This paper describes the adaptation process of an evidence-based intervention of U.S. origin to optimize fit to context with intervention fidelity, as part of a randomized trial conducted with youth that exhibit behavioral challenges and their caregivers in 30 schools in Uganda. The process involved: initial meetings with headteachers and teachers to introduce the study and the main concepts of the intervention; initial manual review focusing on 4Rs and 2Ss content by the Uganda team; engagement of community stakeholders for additional feedback on content and cultural relevance; final revision of the manual; and collection of children's drawings for the illustration of the manual. This paper describes both similarities and differences between the original and adapted intervention content and methods of delivery. The findings also highlight the importance of involving community stakeholders in the adaptation process.

En Uganda, uno de cada cinco niños presenta problemas de salud mental, incluidos los trastornos del comportamiento disruptivo (TCD). Los TCD pueden continuar hasta la adultez y tener consecuencias negativas. Se han desarrollado intervenciones eficaces para los TCD, las cuales se han evaluado en comunidades con altos índices de pobreza en países desarrollados. Sin embargo, la mayoría de los países africanos, como Uganda, carecen de dichas intervenciones. Este artículo describe el proceso de adaptación de una intervención factual de origen estadounidense para optimizar su adaptación al contexto con la fidelidad de la intervención como parte de un ensayo aleatorizado realizado con jóvenes que presentan problemas conductuales y sus cuidadores en 30 escuelas de Uganda. El proceso consistió en reuniones iniciales con directores y maestros para presentar el estudio y los conceptos principales de la intervención; una revisión inicial del manual centrada en el contenido de la intervención "4Rs and 2 Ss" por parte del equipo de Uganda; la participación de partes interesadas de la comunidad para obtener comentarios adicionales sobre el contenido y la relevancia cultural; la revisión final del manual; y la recopilación de dibujos de los niños para la ilustración del manual. Este artículo describe tanto las similitudes como las diferencias entre el contenido de la intervención original y la adaptada y los métodos de implementación. Los resultados también destacan la importancia de hacer participar a las partes interesadas en el proceso de adaptación.

Emotional processing deficits in Italian children with Disruptive Behavior Disorder: The role of callous unemotional traits.

Research suggests that callous unemotional (CU) traits are associated with poor emotion recognition due to impairments in attention to relevant emotional cues. To further investigate the mechanisms that underlie CU traits, this study focused on the relationship between levels of CU and children's attention to, and recognition of, facial emotions. Participants were 7- to 10-year-old Italian boys, 35 with a diagnosis of Disruptive Behavior Disorder (age: M = 8.93, SD = 1.35), and 23 healthy male controls (age: M = 8.86, SD = 1.35). Children viewed standardized emotional faces (happiness, sadness, fear, disgust, anger, and neutral) while eye-tracking technology was used to evaluate scan paths for each area of interest (eyes, face, mouth), and for each emotion. CU traits were assessed using parent and teacher ratings on the Antisocial Process Screening Device. In the whole sample, elevated levels of CU traits were associated with a lower ability to recognize sadness, a lower number of fixations, and a lower average length of each fixation, specifically to the eye area of sad faces. In children with Disruptive Behavior Disorder diagnoses, high levels of CU traits were associated with lower duration of fixations to the eye-region on the eye area of sad faces, which in turns predicted lower levels of sadness recognition. The findings confirm that poor emotion recognition is associated with impairments in attention to critical information about other people's emotions. The clinical implications are discussed.

Onset, Comorbidity, and Predictors of Nicotine, Alcohol, and Marijuana Use Disorders Among North American Indigenous Adolescents.

North American Indigenous (i.e., American Indian and Canadian First Nations) youth experience inequities in rates of substance abuse and dependence. Despite this, few longitudinal studies examine the developmental course of substance use disorders (SUD) among community-based samples of Indigenous youth. The purpose of the study was to examine onset and predictors of nicotine dependence, alcohol use disorders, marijuana use disorders, any SUD, and multiple SUDs across the entire span of adolescence among a longitudinal sample (N = 744) of reservation/reserve Indigenous youth in the upper-Midwest of the United States and Ontario, Canada. Using discrete time survival analysis, the results show that rates of meeting criteria for SUDs by late adolescence were 22% for nicotine, 43% for alcohol, and 35% for marijuana. Peak periods of risk for new nicotine dependence and marijuana use disorder cases occurred around 14 years of age, whereas peak periods of risk for new alcohol use disorder cases emerged slightly later around 16 years of age. We found high rates of SUD comorbidity, and the cumulative probability of developing two or more SUDs during adolescence was 31%. Internalizing disorders increased the odds of nicotine dependence and multiple SUDs, while externalizing disorders increased the odds of all outcomes except nicotine dependence. Gender, age, and per capita family income were inconsistently associated with SUD onset. The findings are embedded within broader substance use patterns identified among Indigenous youth, and prevention, intervention, and treatment implications are discussed.

Longitudinal linkages between parenting stress and oppositional defiant disorder (ODD) symptoms among Chinese children with ODD.

Parents of children with oppositional defiant disorder (ODD) experience considerable stress and challenges in parenting. Based on a 2-year, 3-wave longitudinal study of children with ODD (N = 243, mean age = 9.47 years, SD = 1.53; 72.8% boys) and their parents in Mainland China, our study examined the relation between 3 dimensions of parenting stress (i.e., Parental Distress, Parent-Child Dysfunctional Interaction, and Difficult Child) and their children's ODD symptoms. Using cross-lagged panel models, we tested the bidirectional relation between parenting stress and children's ODD symptoms. We found evidence for both parent-driven and child-driven effects. Specifically, Parent-Child Dysfunctional Interaction (PCDI) at T2 positively predicted children's ODD symptoms at T3. Moreover, children's ODD symptoms at T1 positively predicted parental perceptions of Difficult Child and PCDI at T2. Further, children's ODD symptoms at T2 positively predicted all 3 dimensions of parenting stress at T3. Further, multiple-group path analysis by child's gender suggested that PCDI had a significant negative relation with girls' (but not boys') ODD symptoms from T1 to T2 and had a significant positive relation with boys' (but not girls) ODD symptoms from T2 to T3. These findings provided support for the dynamic relations among parenting stress, parent-child interaction, and children's ODD symptoms and highlighted the different effects of child gender in the parent-child interaction process. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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.

Prevalence of Anxiety Disorders in Hong Kong Chinese Children With ADHD.

OBJECTIVE: This study examined the prevalence and correlates of anxiety disorders in Chinese children with ADHD. METHOD: Overall, 120 children with ADHD aged 6 to 12 years were recruited, and the parent version of computerized Diagnostic Interview Schedule for Children-Version 4 was administrated to their primary caretakers. RESULTS: The prevalence rate of anxiety disorders was 27.5%, which is consistent with the reports of previous Asian and Western studies. Among the children with ADHD and anxiety disorders, more than 50% of them also had comorbid oppositional defiant disorder or conduct disorder (ODD/CD), which yielded an adjusted odds ratio of 3.0 in multivariable analysis for anxiety disorder, with comorbid ODD/CD. In addition, anxiety disorders were positively associated with inattention symptoms in children with both disorders. CONCLUSION: Clinicians should perform screening and careful assessment for anxiety symptoms in children with ADHD, particularly those suffering from comorbid ODD/CD.

Comparing working memory in bilingual and monolingual Hispanic/Latino preschoolers with disruptive behavior disorders.

The current study examined differences in working memory (WM) between monolingual and bilingual Hispanic/Latino preschoolers with disruptive behavior disorders (DBDs). A total of 149 children (Mage = 5.10 years, SD = 0.53; 76% male) with elevated levels of DBDs, as indicated by their parents or teachers, were recruited to participate in an 8-week summer program prior to the start of kindergarten (Summer Treatment Program for Pre-Kindergarteners). Prior to the start of treatment, parents completed several measures about their children's behavior and executive function, and children were administered two subtests of the Automated Working Memory Assessment to examine their current WM capabilities. After controlling for demographic variables (i.e., age, sex, socioeconomic status, IQ, and diagnostic status), no significant differences were observed between bilingual and monolingual children in verbal WM performance (ß = .03, p > .05). However, children who were bilingual did perform better than monolinguals on spatial WM tasks (ß = .23, p < .01). Finally, parent reports of WM corroborated these findings such that bilingual children were reported as having fewer WM problems by parents (ß = -.19, p < .05) and teachers (ß = -.22, p < .05). Whereas WM deficits are often found among children with DBDs, the current findings suggest that bilingualism may serve as a protective factor for preschoolers with DBDs.

Validity of Sluggish Cognitive Tempo in South America: An Initial Examination Using Mother and Teacher Ratings of Chilean Children.

OBJECTIVE: To examine the validity of sluggish cognitive tempo (SCT) and ADHD-inattention (ADHD-IN) symptoms in children from Chile. METHOD: Mothers and teachers rated SCT, ADHD-IN, ADHD-hyperactivity/impulsivity (ADHD-HI), oppositional defiant disorder (ODD), anxiety, depression, academic impairment, social impairment, and peer rejection (teachers only) in 652 Chilean children (55% boys) aged 6 to 14 years. RESULTS: For both mother and teacher ratings, the eight SCT symptoms and nine ADHD-IN symptoms showed substantial loadings on their respective factors (convergent validity) along with loadings close to zero on the alternative factor (discriminant validity). ADHD-IN showed a uniquely stronger relationship than SCT with ADHD-HI and ODD whereas SCT showed a uniquely stronger relationship than ADHD-IN with anxiety and depression. Although ADHD-IN uniquely predicted academic impairment and social difficulties, SCT did not. CONCLUSION: This study provides the first evidence for the validity of SCT among children outside of North America or Western Europe.

An exploratory clinical study of disruptive mood dysregulation disorder in children and adolescents from India.

BACKGROUND: Children with chronic non-episodic irritability were frequently diagnosed as suffering from pediatric bipolar disorder. Therefore in DSM-5 a new diagnosis of Disruptive Mood Dysregulation Disorder (DMDD) was included for such children. AIMS: This study aimed to identify DMDD in children and adolescents in Indian child and adolescent psychiatry clinic and elicit its phenomenology and co-morbidities. METHODS: Children of 6-16 years, presenting with irritability for more than one year were assessed using DSM 5 diagnostic criteria to make a diagnosis of DMDD. Severity of irritability was assessed using Affective Reactivity index (ARI). Co-morbidities were screened on Kiddie Schedule for Affective Disorders and Schizophrenia present and lifetime version (KSADS-PL) and diagnosed as per DSM-IV TR criteria. Overall behavioral problems were assessed on Conner's parent symptom questionnaire (CPSQ) and impairment in functioning on children's global assessment of functioning scale(C-GAS). RESULTS: 21 subjects were diagnosed with DMDD. Majority of the subjects (15, 71.4%) were in the age group 6-12 years (mean age11.1±2.9 years) and were males (16, 76.2%). Most common presenting complaints were, frequent irritability and anger outbursts in 21 (100%) and inattention towards studies in 20 (95.2%) subjects. Most of the subjects (18, 85.7%) had moderate to severe irritability. 13 (61.9%) subjects had co-morbidities. Mean CGAS was 46.1±6.9. CONCLUSION: DMDD can be diagnosed in Indian children using DSM 5 criteria. Such children presented with complaints of irritability and problems in studies. They commonly had co-morbidities and had moderate impairment of functioning.

Racial/Ethnic Disparities in Mental Health Service Utilization among Youth Participating in Negative Externalizing Behaviors.

PURPOSES: Racial/ethnic differences in mental health service utilization were examined among youth who reported participating in negative externalizing behaviors. METHODS: The study utilized merged data from the 2007-2010 National Survey on Drug Use and Health (NSDUH) to examine differences in utilization of inpatient or outpatient mental health services not related to substance or alcohol use by White, Black and Hispanic youth who reported engaging in negative externalizing behaviors ("acting out"). Differences in service utilization in these groups were assessed using logistic regression models. RESULTS: Race/ethnicity was a significant predictor of outpatient mental health service use. Black and Hispanic children were less likely to use outpatient services. Inpatient service use decreased with increasing income. Parental presence in the household increased the likelihood of outpatient service use for minorities. CONCLUSION: Racial/ethnic minority youth in the United States continue to use outpatient mental health services at lower rates. This may lead to high prevalence of untreated negative externalizing behaviors among minority adolescent groups and, in turn, lead to use of inpatient services from systems such as juvenile justice and foster care. Such severe treatment alternatives can be prevented if timely and culturally tailored outpatient intervention is provided.

No Association between Obesity and Behavior in Low-income, Preschool Latino Children.

BACKGROUND: The relationship between behavioral problems and obesity in early childhood in Latinos is largely unknown. METHODS: Cross-sectional anthropometric and behavioral data of children at three years of age were gathered from a cohort of 174 children of Latina mothers at two San Francisco hospitals. Child behaviors were assessed using the preschool Child Behavior Checklist (CBCL/1½-5). Logistic regression was used to analyze the association between behavior and obesity. RESULTS: At three years, 27.7% were obese. There were no associations between affective (OR = 1.89; 95% confidence interval [CI] 0.42-8.59), anxiety (OR = 1.86; 95% CI 0.53-6.47), pervasive developmental (OR = 0.42; 95% CI 0.13-1.36), attention deficit hyperactivity (OR = 0.58; 95% CI 0.12-2.76), or oppositional defiant (OR = 6.49; 95% CI 0.65-64.49) problems and obesity. CONCLUSIONS: Though psychological problems and obesity are associated among older children and adolescents, there was no association in Latino three-year olds in a low-income sample.

DISC Predictive Scales (DPS): Factor structure and uniform differential item functioning across gender and three racial/ethnic groups for ADHD, conduct disorder, and oppositional defiant disorder symptoms.

The factor structure and potential uniform differential item functioning (DIF) among gender and three racial/ethnic groups of adolescents (African American, Latino, White) were evaluated for attention deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and oppositional defiant disorder (ODD) symptom scores of the DISC Predictive Scales (DPS; Leung et al., 2005; Lucas et al., 2001). Primary caregivers reported on DSM-IV ADHD, CD, and ODD symptoms for a probability sample of 4,491 children from three geographical regions who took part in the Healthy Passages study (mean age = 12.60 years, SD = 0.66). Confirmatory factor analysis indicated that the expected 3-factor structure was tenable for the data. Multiple indicators multiple causes (MIMIC) modeling revealed uniform DIF for three ADHD and 9 ODD item scores, but not for any of the CD item scores. Uniform DIF was observed predominantly as a function of child race/ethnicity, but minimally as a function of child gender. On the positive side, uniform DIF had little impact on latent mean differences of ADHD, CD, and ODD symptomatology among gender and racial/ethnic groups. Implications of the findings for researchers and practitioners are discussed.

Does Patient Race/Ethnicity Influence Physician Decision-Making for Diagnosis and Treatment of Childhood Disruptive Behavior Problems?

Race/ethnic disparities in utilization of children's mental health care have been well documented and are particularly concerning given the long-term risks of untreated mental health problems (Institute of Medicine, 2003; Kessler et al. Am J Psychiatry 152:10026-1032, 1995). Research investigating the higher rates of unmet need among race/ethnic minority youths has focused primarily on policy, fiscal, and individual child or family factors that can influence service access and use. Alternatively, this study examines provider behavior as a potential influence on race/ethnic disparities in mental health care. The goal of the study was to examine whether patient (family) race/ethnicity influences physician diagnostic and treatment decision-making for childhood disruptive behavior problems. The study utilized an internet-based video vignette with corresponding survey of 371 randomly selected physicians from across the USA representing specialties likely to treat these patients (pediatricians, family physicians, general and child psychiatrists). Participants viewed a video vignette in which only race/ethnicity of the mother randomly varied (non-Hispanic White, Hispanic, and African American) and then responded to questions about diagnosis and recommended treatments. Physicians assigned diagnoses such as oppositional defiant disorder (48 %) and attention deficit disorder (63 %) to the child, but there were no differences in diagnosis based on race/ethnicity. The majority of respondents recommended psychosocial treatment (98 %) and/or psychoactive medication treatment (60 %), but there were no significant differences based on race/ethnicity. Thus, in this study using mock patient stimuli and controlling for other factors, such as insurance coverage, we did not find major differences in physician diagnostic or treatment decision-making based on patient race/ethnicity.

Framing black boys: parent, teacher, and student narratives of the academic lives of black boys.

The discourse on Black boys tends to suggest that Black boys are in complete peril. We begin with evidence that Black boys are excelling in certain contexts (i.e., in certain states, in certain schools, and in certain courses). We then discuss the ways in which the narratives used by parents, teachers, and Black boys themselves may serve to further reinforce views that Black boys are beyond hope. Research on Black parents suggests that they tend to view their sons as vulnerable and have lower expectations for sons than for daughters. Studies of teachers show that they tend to view Black boys as unteachable, as social problems, and as scary. Research on Black boys shows that they are sometimes complicit in supporting these narratives by engaging in negative or ste reotypical behavior. We also include recent research that includes counter-narratives of Black boys. We end with suggestions for future research.

Risking it for love: romantic relationships and early pubertal development confer risk for later disruptive behavior disorders in African-American girls receiving psychiatric care.

Disruptive behavior problems (DBP) represent a growing concern for young women (e.g., Snyder and Sickmund, 2006), but gender-specific investigations have been traditionally underrepresented in this area. The purpose of this study is to examine the associations among gender-relevant risk factors for DBP among 217 African American girls in psychiatric care. African American girls, 12-16 years old (M = 14.6; SD = 1.2), and their primary female caregivers (N = 254) were recruited from outpatient mental health clinics and reported on girls' DBP, heterosexual dating experiences (romantic and sexual), peer relationships, pubertal development, and self-silencing at baseline, 6-, and 12 months. Structural Equation Modeling examined evidence for full versus mediated (via self-silencing) models and the structural relationships (direct and indirect) among key study variables. Results suggest that the full model was a significantly better fit than the mediated model as indicated by a Chi-squared difference test (p < 0.01). In the full model, direct effects of greater romantic dating experiences and lower quality peer relationships at baseline predicted DBP at 12 months. Sexual dating experiences were more strongly linked with DBP at 12 months for early maturing compared to average or later maturing girls. Indirect effects analyses suggested that girls' suppression of relational needs, assessed through a measure of self-silencing, explained the association between peer relationships and DBP. Findings highlight the importance of the relational context for girls' DBP, with treatment implications supporting relationship-based models of care, early intervention, and skill building around negotiating needs with peers and partners.

Teacher ratings of ODD symptoms: measurement equivalence across Malaysian Malay, Chinese and Indian children.

BACKGROUND: The study examined the measurement equivalence for teacher ratings across Malaysian Malay, Chinese and Indian children. METHODS: Malaysian teachers completed ratings of the ODD symptoms for 574 Malay, 247 Chinese and 98 Indian children. RESULTS: The results supported the equivalences for the configural, metric, and error variances models, and the equivalences for ODD latent variances and mean scores. DISCUSSION: Together, these findings suggest good support for measurement and structural equivalences of the ODD symptoms across these ethnic groups. The theoretical and clinical implications of the findings for cross-cultural equivalence of the ODD symptoms are discussed.

Why do young adolescents bully? Experience in Malaysian schools.

INTRODUCTION: To determine sociodemographic and psychological factors associated with bullying behavior among young adolescents in Malaysia. METHODS: This is a cross-sectional study of four hundred ten 12-year-old adolescents from seven randomly sampled schools in the Federal Territory of Kuala Lumpur, Malaysia. Sociodemographic features of the adolescents and their parents, bullying behavior (Malaysian Bullying Questionnaire), ADHD symptoms (Conners Rating Scales), and internalizing and externalizing behavior (Child Behaviour Checklist) were obtained from adolescents, parents and teachers, respectively. RESULTS: Only male gender (OR=7.071, p=0.01*, CI=1.642-30.446) was a significant sociodemographic factor among bullies. Predominantly hyperactive (OR=2.285, p=0.00*, CI=1.507-3.467) and inattentive ADHD symptoms reported by teachers (OR=1.829, p=0.03*, CI=1.060-3.154) and parents (OR=1.709, p=0.03*, CI=1.046-2.793) were significant risk factors for bullying behavior while combined symptoms reported by young adolescents (OR=0.729, p=0.01*, CI=0.580-0.915) and teachers (OR=0.643, p=0.02*, CI=0.440-0.938) were protective against bullying behavior despite the influence of conduct behavior (OR=3.160, p=0.00*, CI=1.600-6.241). Internalizing behavior, that is, withdrawn (OR=0.653, p=0.04*, CI=0.436-0.977) and somatic complaints (OR=0.619, p=0.01*, CI=0.430-0.889) significantly protect against bullying behavior. DISCUSSIONS: Recognizing factors associated with bullying behavior, in particular factors distinctive to the local population, facilitates in strategizing effective interventions for school bullying among young adolescents in Malaysian schools.

Children and adolescents with Tourette's disorder in the USA versus Argentina: behavioral differences may reflect cultural factors.

To explore behavioral differences as possible cultural factors in presentation of psychiatric comorbidity in two clinically referred, consecutively ascertained samples of youth with Tourette's disorder (TD) from New York and Buenos Aires. Subjects were evaluated between 2002 and 2010 at the Tics and Tourette's Clinical and Research Program at the New York University Child Study Center in New York and the Interdisciplinary Center for Tourette's, Obsessive Compulsive Disorder (OCD) and Associated Disorders (CITTTA)/Institute of Cognitive Psychology (INECO) in Buenos Aires. Demographic, diagnostic, tic severity (Yale Global Tic Severity Scale; YGTSS), clinical (Child Behavior Check List-Parent version; CBCL), and global functioning (Global Assessment of Functioning; GAF) data were compared using descriptive statistics. The sample included 111 subjects ages 6-17 years, who met DSM-IV-TR diagnostic criteria for TD. Findings revealed that the BA sample (n = 35) was significantly older at initial evaluation at the tic specialty clinic, and had higher frequency of oppositional defiant disorder (ODD), mood and non-OCD anxiety disorders than the NY sample (n = 76). There were no differences in gender distribution, age at tic onset or TD diagnosis, tic severity, proportion with current diagnoses of OCD/OC behavior or attention deficit hyperactivity disorder (ADHD), CBCL internalizing, externalizing, or total problems scores, YGTSS scores, or GAF scores. The observed similarities in demographic features, clinical presentation, rates of ADHD and OCD/OCB, and global impairment may reflect similar phenomenology and illness-related characteristics of TD in these referred youth. Differences in age at initial specialty clinic evaluation and rates of ODD, mood and non-OCD anxiety disorders may need further exploration before they may be considered to reflect cultural factors. Because of these limitations (e.g. small sample size), these results can be regarded only as preliminary.