Prevalence of nail biting and its chronological relationship with tics in child and adolescent outpatients with Tourette syndrome: a single-centre, retrospective observational study

Abstract

Objective To evaluate the prevalence of nail biting in child and adolescent outpatients at a single institution and the chronological relationship between nail biting and tics in patients with Tourette syndrome (TS) with or without attention-deficit hyperactivity disorder (ADHD).Design Retrospective observational study.Setting Teaching hospital in Taiwan.Participants All participants were aged 4–18 years, including 535 patients with TS, 230 patients with provisional tic disorder and 1460 patients without neurological or psychiatric disorders (controls).Outcome measures Presence of nail biting, starting age for nail biting and starting age for motor and/or vocal tics.Results Nail biting was more commonly observed in patients with TS (56.6%) than in patients with provisional tic disorder (27.4%) or controls (15.0%), regardless of sex (all p<0.020). Nail biting was also more common in patients with TS with ADHD than in those without (75.0% vs 47.6%; p<0.001), but the starting age was significantly later in those with concomitant ADHD than without (5.3 vs 3.8 years; p<0.001). In patients with TS, the onset of nail biting occurred earlier than that of tics, regardless of ADHD status.Conclusion Nail biting was more prevalent and occurred earlier than tics in patients with TS, regardless of ADHD status, in the study population.