{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:31:21Z","timestamp":1790361081784,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,5,10]],"date-time":"2018-05-10T00:00:00Z","timestamp":1525910400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Develop Med Child Neuro"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To explore the heterogeneity of Tourette syndrome as part of a neurodevelopmental spectrum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Using hierarchical ascendant clustering based on tic symptoms, developmental milestones, and neurodevelopmental comorbidities, we analyzed the heterogeneity of Tourette syndrome phenotypes in a sample of 174 children and adolescents with Tourette syndrome referred to a tertiary university clinic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The model yielded three distinct clusters characterized as follows. In cluster 1, we found many neurodevelopmental comorbidities (including intellectual disabilities, autism spectrum disorder, attention\u2010deficit\u2013hyperactivity disorder [\n                      <jats:styled-content style=\"fixed-case\">ADHD<\/jats:styled-content>\n                      ], and learning disabilities) and academic impairments. In cluster 2, patients had no other neurodevelopmental comorbidities. In cluster 3, patients had higher intelligence, a high frequency of attentional impairment, school problems related to both\n                      <jats:styled-content style=\"fixed-case\">ADHD<\/jats:styled-content>\n                      and unspecific attention difficulties, and handwriting problems related to the tics themselves. Interestingly, clusters did not differ in terms of family history or anxious\u2010depressive comorbidities. The only other differences that emerged were related to prenatal or perinatal risk factors (more represented in cluster 1) and treatment profiles (higher rates of stimulants in cluster 1).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>We conclude that from a phenotypical perspective, Tourette syndrome is a heterogeneous syndrome with at least three main clusters that may help in addressing the etiological basis of Tourette syndrome and specific rehabilitative and therapeutic approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>What this paper adds<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>The clustering of Tourette syndrome based on comorbidity with other neurodevelopmental conditions reveals three clusters.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>A group of patients with Tourette syndrome show school difficulties related to non\u2010specific attention and writing problems.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Analysing only children and adolescents helps to distinguish between developmental comorbid conditions and coexistent disorders.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dmcn.13913","type":"journal-article","created":{"date-parts":[[2018,5,11]],"date-time":"2018-05-11T01:20:11Z","timestamp":1526001611000},"page":"942-950","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Disentangling Tourette syndrome heterogeneity through hierarchical ascendant clustering"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4906-3200","authenticated-orcid":false,"given":"Elena","family":"Cravedi","sequence":"first","affiliation":[{"name":"Department of Child and Adolescent Psychiatry Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital APHP Paris France"},{"name":"Pediatric Neurology Unit Children's Hospital A. Meyer University of Firenze Firenze Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuelle","family":"Deniau","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital APHP Paris France"},{"name":"Department of Neurology National Reference Centre for Tourette Syndrome Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital APHP Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Giannitelli","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital APHP Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugues","family":"Pellerin","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital APHP Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Czernecki","sequence":"additional","affiliation":[{"name":"Department of Neurology National Reference Centre for Tourette Syndrome Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital APHP Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiphanie","family":"Priou","sequence":"additional","affiliation":[{"name":"Department of Neurology National Reference Centre for Tourette Syndrome Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital APHP Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7403-9440","authenticated-orcid":false,"given":"Jean","family":"Xavier","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital APHP Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ang\u00e8le","family":"Consoli","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital APHP Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Department of Neurology National Reference Centre for Tourette Syndrome Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital APHP Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital APHP Paris France"},{"name":"Institute for Intelligent Systems and Robotics UPMC Sorbonne Universit\u00e9 Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,5,10]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/2040-2392-5-1"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1089\/brain.2014.0324"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0004867415594429"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.159.2.291"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.107.039909"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0733-8619(05)70326-1"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004583-198907000-00015"},{"issue":"20","key":"e_1_2_8_10_1","first-page":"22","article-title":"The Mini\u2010International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM\u2010IV and ICD\u201010","volume":"59","author":"Sheehan DV","year":"1998","journal-title":"J Clin Psychiatry"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1989.01810110048007"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-011-1255-4"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02172145"},{"key":"e_1_2_8_14_1","volume-title":"L2MA: Batterie Langage Oral\u2010Langage \u00e9crit\u2013M\u00e9moire\u2013Attention","author":"Chevrie\u2010Muller C","year":"1997"},{"key":"e_1_2_8_15_1","volume-title":"LMC\u2010R. Epreuve de la competence en lecture","author":"Khomsi A","year":"1999"},{"key":"e_1_2_8_16_1","volume-title":"Evaluation du langage oral","author":"Khomsi A","year":"2001"},{"key":"e_1_2_8_17_1","volume-title":"Movement Assessment Battery for Children: Manual","author":"Henderson SE","year":"1992"},{"key":"e_1_2_8_18_1","volume-title":"Evaluation de la Motricit\u00e9 Gnosopraxique distale EMG","author":"Vaivre\u2010Douret L","year":"1997"},{"key":"e_1_2_8_19_1","volume-title":"Children's Drawings as Measures of Intellectual Maturity","author":"Harris DB","year":"1963"},{"key":"e_1_2_8_20_1","volume-title":"Gen\u00e8se et formules de la lat\u00e9ralit\u00e9. Manuel pour l'examen psychologique de l'enfant","author":"Zazzo R","year":"1960"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.2466\/pms.1964.19.2.463"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/002221949302601007"},{"key":"e_1_2_8_23_1","volume-title":"The Wechsler Intelligence Scale for Children","author":"Wechsler D","year":"2004"},{"key":"e_1_2_8_24_1","volume-title":"The Test of Everyday Attention for Children","author":"Manly T","year":"1999"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00154794"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2013.09.021"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2016.07.017"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/DBP.0b013e31819e6a33"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.109.071050"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2006.02.009"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1600-0404.2003.00228.x"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2006.03.017"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2010.225029"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2016.16020240"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2016.01.051"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291717001672"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2008.01.019"}],"container-title":["Developmental Medicine &amp; Child Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fdmcn.13913","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dmcn.13913","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,16]],"date-time":"2023-09-16T19:11:05Z","timestamp":1694891465000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dmcn.13913"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,10]]},"references-count":36,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2018,9]]}},"alternative-id":["10.1111\/dmcn.13913"],"URL":"https:\/\/doi.org\/10.1111\/dmcn.13913","archive":["Portico"],"relation":{},"ISSN":["0012-1622","1469-8749"],"issn-type":[{"value":"0012-1622","type":"print"},{"value":"1469-8749","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5,10]]},"assertion":[{"value":"2018-04-03","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-05-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}