Nationwide survey of psychopathology and bullying in tic disorders with and without ADHD

BACKGROUND: Attention deficit/hyperactivity disorder (ADHD) and tic disorder (TD) often co-occur. Given the well-established strong link between bullying and adverse psychiatric outcomes, understanding how TD and comorbid ADHD jointly interact to influence bullying involvement is crucial for informing clinical assessment and intervention. This study investigated psychopathology, bullying experiences, and their associations in children with TD, accounting for the influence ADHD, using data from a nationwide epidemiological survey. METHODS: The sample included 4816 children in grades 3, 5, and 7, randomly selected from 69 schools across Taiwan. Categorical psychiatric diagnoses were made through structured child interview using the Kiddie Epidemiologic Version of the Schedule for Affective Disorders and Schizophrenia, while dimensional emotional-behavioral problems were measured using the parent-reported Child Behavior Checklist. Bullying experiences were compared among four groups: TD-alone, ADHD-alone, TD+ADHD, and controls. Mediation analyses explored whether emotional-behavioral problems mediated the relationship between TD and bullying experiences. RESULTS: Among participants, 102 (2%) had TD-alone, 388 (8%) had ADHD-alone, and 24 (0.5%) had comorbid TD+ADHD. TD was primarily related to obsessive-compulsive disorder [odds ratio (OR) = 7.35, 95% confidence interval (CI) = 1.93-20.68]. Children with TD exhibited elevated risks of both school (OR = 2.64, 95% CI = 1.47-4.75) and cyberbullying victimization (OR = 2.64, 95% CI = 1.47-4.74), whereas those with ADHD were more likely to be both perpetrators (OR = 2.64, 95% CI = 1.6-4.36) and victims (OR = 2.60, 95% CI = 1.95-3.47) of school bullying. After adjusting for ADHD, age, and sex, TD exerted a direct association with bullying victimization. Social problems and internalizing problems partially mediate the relationship between TD and school bullying victimization. Notably, thought problems had reduced involvement of cyberbullying among children with TD. CONCLUSIONS: TD exerted a direct association with school- and cyber-bullying victimization. Health professionals should routinely assess school-and cyber-bullying victimization, even when ADHD is not present.