The role of affect lability on tic severity and impairment in youth with Tourette's disorder

A common challenge for individuals with Tourette's Disorder and Persistent Tic Disorders (collectively referred to as TD) is emotion regulation, which underlies multiple co-occurring conditions and may contribute to both tic and non-tic related impairment. This study investigated the relationships between tic severity, impairment, and affect lability—a core component of emotion regulation. Participants were 75 youth with tic disorders and their caregivers, who completed an assessment to characterize tic severity, psychiatric comorbidities, functional impairment, family accommodation due to tics, and affect lability. Hierarchical regression models examined the contributions of affect lability on tic impairment, non-tic related impairment, and family accommodation. Youth with TD experienced greater levels of non-tic impairment relative to tic impairment across functional domains (d = 0.38 -.74). Regressions revealed that greater affect lability predicted both greater tic impairment and greater non-tic related impairment, even after controlling for clinician-rated tic severity. Exploratory analyses found that both affect lability and tic-related impairment uniquely contributed to family accommodation of tics, even after accounting for tic severity. While affect lability has received minimal attention in TD, it contributes to both tic and non-tic impairment among youth with TD. Strategies that enhance emotion regulation may have the potential to alleviate non-tic related impairment and improve family functioning for youth with TD.