{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T15:45:10Z","timestamp":1792251910796,"version":"4.4.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T00:00:00Z","timestamp":1614211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>The Yale Global Tic Severity Scale (YGTSS) is a clinician-rated instrument considered as the gold standard for assessing tics in patients with Tourette's Syndrome and other tic disorders. Previous psychometric investigations of the YGTSS exhibit different limitations such as small sample sizes and insufficient methods. To overcome these shortcomings, we used a subsample of the large-scale \u201cEuropean Multicentre Tics in Children Study\u201d (EMTICS) including 706 children and adolescents with a chronic tic disorder and investigated convergent, discriminant and factorial validity, as well as internal consistency of the YGTSS. Our results confirm acceptable convergent and good to very good discriminant validity, respectively, indicated by a sufficiently high correlation of the YGTSS total tic score with the Clinical Global Impression Scale for tics (<jats:italic>r<\/jats:italic><jats:sub><jats:italic>s<\/jats:italic><\/jats:sub> = 0.65) and only low to medium correlations with clinical severity ratings of attention deficit\/hyperactivity symptoms (<jats:italic>r<\/jats:italic><jats:sub><jats:italic>s<\/jats:italic><\/jats:sub> = 0.24), obsessive\u2013compulsive symptoms (<jats:italic>r<\/jats:italic><jats:sub><jats:italic>s<\/jats:italic><\/jats:sub> = 27) as well as internalizing symptoms (<jats:italic>r<\/jats:italic><jats:sub><jats:italic>s<\/jats:italic><\/jats:sub> = 0.27). Internal consistency was found to be acceptable (\u03a9 = 0.58 for YGTSS total tic score). A confirmatory factor analysis supports the concept of the two factors \u201cmotor tics\u201d and \u201cphonic tics,\u201d but still demonstrated just a marginal model fit (root mean square error of approximation = 0.09 [0.08; 0.10], comparative fit index = 0.90, and Tucker Lewis index = 0.87). A subsequent analysis of local misspecifications revealed correlated measurement errors, suggesting opportunities for improvement regarding the item wording. In conclusion, our results indicate acceptable psychometric quality of the YGTSS. However, taking the wide use and importance of the YGTSS into account, our results suggest the need for further investigations and improvements of the YGTSS. In addition, our results show limitations of the global severity score as a sum score indicating that the separate use of the total tic score and the impairment rating is more beneficial.<\/jats:p>","DOI":"10.3389\/fpsyt.2021.626459","type":"journal-article","created":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T16:49:54Z","timestamp":1635266994000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":73,"title":["Yale Global Tic Severity Scale (YGTSS): Psychometric Quality of the Gold Standard for Tic Assessment Based on the Large-Scale EMTICS Study"],"prefix":"10.3389","volume":"12","author":[{"given":"Martina","family":"Haas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewgeni","family":"Jakubovski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolin","family":"Fremer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Dietrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter J.","family":"Hoekstra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burkard","family":"J\u00e4ger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten R.","family":"M\u00fcller-Vahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"The EMTICS Collaborative Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,2,25]]},"reference":[{"key":"B1","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","year":"2013"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1016\/j.neubiorev.2012.10.011","article-title":"The psychopathological spectrum of Gilles de la Tourette syndrome","volume":"37","author":"Cavanna","year":"2013","journal-title":"Neurosci Biobehav Rev"},{"key":"B3","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1007\/s00787-011-0164-6","article-title":"European clinical guidelines for Tourette Syndrome and other tic disorders. Part I: assessment","volume":"20","author":"Cath","year":"2011","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"B4","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1097\/00004583-198907000-00015","article-title":"The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity","volume":"28","author":"Leckman","year":"1989","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1002\/mds.26891","article-title":"Systematic review of severity scales and screening instruments for tics: critique and recommendations","volume":"32","author":"Martino","year":"2017","journal-title":"Mov Disord"},{"key":"B6","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1037\/1040-3590.17.4.486","article-title":"Reliability and validity of the Yale Global Tic Severity Scale","volume":"17","author":"Storch","year":"2005","journal-title":"Psychol Assess"},{"key":"B7","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1016\/j.psychres.2006.03.017","article-title":"Factor-analytic study of the Yale Global Tic Severity Scale","volume":"149","author":"Storch","year":"2007","journal-title":"Psychiatry Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e1711","DOI":"10.1212\/WNL.0000000000005474","article-title":"A multicenter examination and strategic revisions of the Yale Global Tic Severity Scale","volume":"90","author":"McGuire","year":"2018","journal-title":"Neurology"},{"key":"B9","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1207\/S15328007SEM0702_6","article-title":"Correlated errors in true score models and their effect on coefficient alpha","volume":"7","author":"Green","year":"2000","journal-title":"Struct Equ Model"},{"key":"B10","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1207\/s15327906mbr3204_2","article-title":"Scale reliability, Cronbach's coefficient alpha, and violations of essential tau-equivalence with fixed congeneric components","volume":"32","author":"Raykov","year":"1997","journal-title":"Multivariate Behav Res"},{"key":"B11","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1177\/014662169802200407","article-title":"Coefficient alpha and composite reliability with interrelated nonhomogeneous items","volume":"22","author":"Raykov","year":"1998","journal-title":"Appl Psychol Meas"},{"key":"B12","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1177\/01466216010251005","article-title":"Bias of coefficient \u03b1 for fixed congeneric measures with correlated errors","volume":"25","author":"Raykov","year":"2001","journal-title":"Appl Psychol Meas"},{"key":"B13","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1007\/s11336-008-9098-4","article-title":"Commentary on coefficient alpha: a cautionary tale","volume":"74","author":"Green","year":"2009","journal-title":"Psychometrika"},{"key":"B14","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1177\/0734282911406668","article-title":"Coefficient alpha: a reliability coefficient for the 21st century?","volume":"29","author":"Yang","year":"2011","journal-title":"J Psychoeduc Assess"},{"key":"B15","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1037\/0021-9010.78.1.98","article-title":"What is coefficient alpha? An examination of theory and applications","volume":"78","author":"Cortina","year":"1993","journal-title":"J Appl Psychol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1037\/1040-3590.8.4.350","article-title":"Uses and abuses of coefficient alpha","volume":"8","author":"Schmitt","year":"1996","journal-title":"Psychol Assess"},{"key":"B17","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1007\/s11336-008-9101-0","article-title":"On the use, the misuse, and the very limited usefulness of cronbach's alpha","volume":"74","author":"Sijtsma","year":"2009","journal-title":"Psychometrika"},{"key":"B18","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1177\/0013164493053001003","article-title":"Coefficient alpha as an estimate of test reliability under violation of two assumptions","volume":"53","author":"Zimmerman","year":"1993","journal-title":"Educ Psychol Meas"},{"key":"B19","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1177\/0013164404266386","article-title":"My current thoughts on coefficient alpha and successor procedures","volume":"64","author":"Cronbach","year":"2004","journal-title":"Educ Psychol Meas"},{"key":"B20","volume-title":"Test Theory: A Unified Treatment","author":"McDonald","year":"1999"},{"key":"B21","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1111\/bjop.12046","article-title":"From alpha to omega: a practical solution to the pervasive problem of internal consistency estimation","volume":"105","author":"Dunn","year":"2014","journal-title":"Br J Psychol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1007\/s11336-008-9102-z","article-title":"Coefficients alpha, beta, omega, and the glb: comments on sijtsma","volume":"74","author":"Revelle","year":"2009","journal-title":"Psychometrika"},{"key":"B23","volume-title":"Confirmatory Factor Analysis for Applied Research","author":"Brown","year":"2006"},{"key":"B24","volume-title":"ECDEU Assessment Manual for Psychopharmacology","author":"Guy","year":"1976"},{"key":"B25","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s00787-007-1003-7","article-title":"Tic disorders and ADHD: answers from a world-wide clinical dataset on Tourette syndrome","volume":"16","author":"Freeman","year":"2007","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"B26","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1097\/00004583-199706000-00023","article-title":"Symptoms of obsessive\u2013compulsive disorder","volume":"154","author":"Leckman","year":"1997","journal-title":"Am J Psychiatry"},{"key":"B27","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1176\/jnp.2009.21.1.13","article-title":"The behavioral spectrum of Gilles de la Tourette syndrome","volume":"21","author":"Cavanna","year":"2009","journal-title":"J Neuropsychiatry Clin Neurosci"},{"key":"B28","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1007\/s00787-018-1190-4","article-title":"European Multicentre Tics in Children Studies (EMTICS): protocol for two cohort studies to assess risk factors for tic onset and exacerbation in children and adolescents","volume":"28","author":"Schrag","year":"2018","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"B29","volume-title":"Diagnostic and Statistical Manual of Mental Disorders, DSM IV-TR","year":"2000"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1001\/archpsyc.1989.01810110054008","article-title":"The yale-brown obsessive compulsive scale. II. Validity","volume":"46","author":"Goodman","year":"1989","journal-title":"Arch Gen Psychiatry"},{"key":"B31","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1097\/00004583-200102000-00011","article-title":"Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment","volume":"40","author":"Swanson","year":"2001","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B32","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1111\/j.1469-7610.1997.tb01545.x","article-title":"The strengths and difficulties questionnaire : a research note","volume":"38","author":"Goodman","year":"1997","journal-title":"J Child Psychol Psychiatry"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10705519909540118","article-title":"Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives","volume":"6","author":"Hu","year":"1999","journal-title":"Struct Equ Model"},{"key":"B34","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1037\/1082-989X.1.2.130","article-title":"Power analysis and determination of sample size for covariance structure modeling","volume":"1","author":"Maccallum","year":"1996","journal-title":"Psychol Methods"},{"key":"B35","volume-title":"Multivariate Data Analysis: Pearson New International Edition","author":"Hair","year":"2014"},{"key":"B36","volume-title":"Structural Equation Modeling Using AMOS","author":"Awang","year":"2012"},{"key":"B37","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1080\/10705510903203433","article-title":"Testing structural equation models or detection of misspecifications?","volume":"16","author":"Saris","year":"2009","journal-title":"Struct Equ Model A Multidiscip J"},{"key":"B38","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1207\/s15327906mbr1401_4","article-title":"Hierarchical cluster analysis and the internal structure of tests","volume":"14","author":"Revelle","year":"1979","journal-title":"Multivar Behav Res"},{"key":"B39","volume-title":"Psychometric Theory","author":"Nunnally","year":"1978"},{"key":"B40","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1177\/1094428110392383","article-title":"Understanding the impact of convergent validity on research results","volume":"15","author":"Carlson","year":"2012","journal-title":"Organ Res Methods"},{"key":"B41","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1177\/001316447203200408","article-title":"Test reliability and the kuder-richardson formulas: derivation from probability theory","volume":"32","author":"Zimmerman","year":"1972","journal-title":"Educ Psychol Meas"},{"key":"B42","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1027\/1614-2241\/a000052","article-title":"Misestimation of reliability using coefficient alpha and structural equation modeling when assumptions of tau-equivalence and uncorrelated errors are violated","volume":"9","author":"Gu","year":"2013","journal-title":"Methodology"},{"key":"B43","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1037\/h0046016","article-title":"Convergent and discriminant validation by the multitrait-multimethod matrix","volume":"56","author":"Campbell","year":"1959","journal-title":"Psychol Bull"},{"key":"B44","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1037\/0021-9010.88.5.879","article-title":"Common method biases in behavioral research : a critical review of the literature and recommended remedies","volume":"88","author":"Podsakoff","year":"2003","journal-title":"J Appl Psychol"},{"key":"B45","first-page":"5","article-title":"The problem of allowing correlated errors in structural equation modeling: concerns and considerations","volume":"3","author":"Hermida","year":"2015","journal-title":"Comput Methods Soc Sci"},{"key":"B46","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1086\/208993","article-title":"On the meaning of within-factor correlated measurement errors","volume":"11","author":"Gerbing","year":"1984","journal-title":"J Consum Res"},{"key":"B47","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1016\/j.beth.2015.06.002","article-title":"Psychometric properties of a self-report instrument for the assessment of tic severity in adults with tic disorders","volume":"46","author":"Abramovitch","year":"2014","journal-title":"Behav Ther"},{"key":"B48","volume-title":"Social Research Methods: Qualitative and Quantitative Approaches","author":"Neuman","year":"1997"},{"key":"B49","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1037\/1040-3590.7.3.309","article-title":"Constructing validity: basic issues in objective scale development","volume":"7","author":"Clark","year":"1995","journal-title":"Psychol Assess"},{"key":"B50","volume-title":"Fundamental Statistics in Psychology and Education","author":"Guilford","year":"1965"},{"key":"B51","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1177\/1073191103255497","article-title":"The Tourette's Disorder Scale (TODS) development, reliability, and validity","volume":"10","author":"Shytle","year":"2003","journal-title":"Assessment"},{"key":"B52","doi-asserted-by":"publisher","first-page":"261","DOI":"10.33588\/rn.4605.2007481","article-title":"Spanish adaptation and diagnostic validity of the Yale Global Tics Severity Scale","volume":"46","author":"Garcia-Lopez","year":"2008","journal-title":"Rev Neurol"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2021.626459\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T16:50:03Z","timestamp":1635267003000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2021.626459\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,25]]},"references-count":52,"alternative-id":["10.3389\/fpsyt.2021.626459"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2021.626459","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,25]]},"article-number":"626459"}}