The Premonitory Urge in Chinese Children with Tic Disorders: Measurement and Characteristics

Background The Premonitory Urge for Tics Scale (PUTS) is a common self-report measure of premonitory urges for patients with tic disorders. The current study aims to revisit the Chinese version of the PUTS(PUTS-C) and report the characteristics of premonitory urges in Chinese children with tic disorders. Methods The psychometric evaluation involved 204 outpatients with tic disorders, aged 7-16 years, who were divided into two age groups:(7-10 years, n=103; 11-16 years, n=95). Results Results showed that 86.8% of participants endorse premonitory urges, and the PUTS-C demonstrated good internal consistency (α=0.84) and two-week test-retest reliability (0.80). We observed a statistically significant correlation between the total PUTS-C score and various Yale Global Tic Severity Scale (YGTSS) subscales and total tic severity scores. The PUTS-C score also showed significant correlations with the Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS), Screening Child Anxiety-Related Emotional Disorders (SCARED), Children's Depression Inventory (CDI), and the Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) oppositional behavior subscale. Notably, premonitory urges independently predicted tic severity, beyond the influence of comorbid symptoms. A two-factor structure of the PUTS-C was identified in the total sample through factor analysis. Conclusions The PUTS-C possesses acceptable validity and good reliability. Premonitory urges may be less prevalent and intense in Chinese versus Western adolescent patients. It appears that premonitory urges in Chinese patients with tic disorders are associated with obsessive-compulsive symptoms, anxiety, and depression, but can independently predict tic severity. Specific PUTS-C factors possibly related to motor and vocal tics. Future research should continue to investigate age-related differences and the association with tics and other sensory symptoms.