Autism spectrum disorder (ASD) is a genetically complex neurodevelopmental condition with a high heritability. However, genomic studies of ASD have been underrepresented in East Asian populations, and the molecular yield in ASD cohorts remains modest. Here, we present a whole-genome sequencing analysis of 3109 samples across 1033 Chinese ASD families. By examining a wide spectrum of genetic variation, we identified rare ASD-associated variants in 19.2% of affected individuals, providing a population-specific view of the genetic architecture of ASD. We identify significant enrichment of de novo variants in probands, nominate or strengthen candidate risk genes (e.g., NCL, SPPL3, ADGRB1, SLC9A3, KIF1B) through mutational burden, evolutionary constraint, recurrent missense site, and functional assays, and implicate convergent pathways including protein palmitoylation. By integrating over 40,000 ASD cases across unpublished and published global cohorts, we identify 245 ASD risk genes, including 45 with limited prior evidence and 32 with no prior association. Single-cell transcriptomic profiling of the developing human cortex reveals that ASD risk genes exhibit widespread yet heterogeneous expression across all major cell types, with peak expression in excitatory neurons, particularly intratelencephalic neurons, and enriched expression in microglia (e.g., C1QC, CARD11, SNX13, MEF2C, FOXP2, TCF12, MED13L), suggesting convergent involvement of both synaptic and neuroimmune mechanisms. Together, our findings expand the ASD genetic landscape and suggest convergent pathogenic axes involving transcriptional regulation, synaptic signaling and plasticity, and neuroimmune interactions. This work supports the development of inclusive diagnostic strategies and provides a foundation for mechanistic and intervention exploration in ASD.

Immune dysregulation is implicated in tic disorders (TD). We investigated the novel pan-immune-inflammation value (PIV), a composite hematologic index, in pediatric TD, focusing on symptom severity and sex-specific effects. We enrolled 425 pediatric patients with tic disorders—including 113 with transient tic disorder (TTD), 97 with chronic tic disorder (CTD), and 215 with Tourette syndrome (TS)—along with 430 healthy controls (HC). All participants were recruited from Beijing Children’s Hospital between 2024 and 2025. PIV was calculated as (neutrophils×monocytes×platelets)/lymphocytes. Tic severity was assessed using the Yale Global Tic Severity Scale (YGTSS). Group comparisons used ANOVA/Kruskal-Wallis tests. Linear regression analyzed associations between PIV (continuous/quartiles) and YGTSS scores, with sex-stratified analyses. PIV was elevated across all TD subtypes versus controls (all p < 0.05). Males with TTD had higher PIV than females ( p = 0.011). In the TTD subgroup, higher PIV was inversely associated with lower YGTSS total ( β = -4.49, p = 0.032) and motor scores ( β = -2.97, p = 0.039). Sex-stratified analysis showed this inverse association was stronger in males (YGTSS total: β = -5.21, p = 0.049; YGTSS motor: β = -4.74, p = 0.006) but absent in females. No significant associations were found in CTD or TS. Elevated PIV indicates systemic immune-inflammation in pediatric TD. The sex-specific inverse association with tic severity, unique to TTD, suggests a distinct immunomodulatory mechanism. PIV is a potential biomarker, highlighting the importance of diagnostic subtype and sex in understanding immune dysregulation in TD.

This study aimed to investigate alterations in white matter microstructure in children with Tourette syndrome (TS) and to explore its potential role in pathophysiology. Diffusion tensor imaging data were collected from 53 children with TS and 91 typically developing controls. White matter integrity was assessed and analyzed using fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). Correlations with tic severity and quality of life (QOL) were examined, followed by mediation analysis to assess whether motor tic severity mediated the relationship between FA values in the right anterior corona radiata (ACR_R) and QOL. Children with TS exhibited widespread white matter alterations, lower FA in ACR_R and left anterior limb of the internal capsule, lower MD in the inferior fronto-occipital fasciculus, and lower AD in ACR_R, alongside higher MD in the genu of the corpus callosum, higher AD in the inferior fronto-occipital fasciculus, and higher RD in ACR_R. The FA values in ACR_R showed a significant negative correlation with motor tic severity (r = − 0.302, P = 0.031) and a significant negative correlation with physical/activities of daily living (ADL) subscale of QOL (r = − 0.468, P < 0.001). Motor tic severity was positively correlated with physical/ADL subscale of QOL (r = 0.430, P = 0.008). Motor tic severity partially mediated the relationship between FA values in ACR_R and physical/ADL scores (β = − 0.091, 95

Background:Attention-deficit/hyperactivity disorder (ADHD) is characterized by substantial clinical heterogeneity, underscoring the need for a shift toward precision nursing approaches. The present study aimed to identify relatively homogeneous subgroups (phenotypes) among children with ADHD based on multidimensional clinical characteristics and to validate their distinct cognitive profiles using objective cognitive assessments, thereby providing an empirical basis for the development of a precision nursing practice pathway. Methods:A cohort of 403 treatment-naïve children with newly diagnosed ADHD were included. Behavioral, emotional, and social functioning were evaluated using the Swanson, Nolan, and Pelham Version IV Scale, the Strengths and Difficulties Questionnaire, and the Weiss Functional Impairment Rating Scale-Parent Report. Cognitive validation was conducted using the Continuous Performance Test (CPT). The primary analytical methods included latent profile analysis (LPA) and between-group comparisons. Results:The optimal LPA model identified three distinct classes: the "functionally balanced type" (25.8%), the "impulsivity-predominant type" (55.6%), and the "emotional-cognitive dysregulation subtype" (18.6%). Cognitive validation using the CPT indicated that the impulsivity-predominant type demonstrated a significantly higher commission error rate, whereas the emotional-cognitive dysregulation subtype exhibited significantly greater reaction time variability. Conclusion:The "behavioral subtyping-cognitive validation" framework proposed in this study links subjective behavioral clustering with objective cognitive indicators relevant to nursing care. This approach provides an important empirical foundation for shifting ADHD management from a uniform model toward mechanism-informed precision intervention.

Objective This study aims to investigate the associations between serum 25-hydroxyvitamin D [25(OH)D], calcium ions, and high-density lipoprotein cholesterol (HDL-C) levels with tic symptom severity in children and adolescents with tic disorders (TD), and to explore their potential as modifiable biomarkers for clinical evaluation and intervention. Methods A total of 2,430 pediatric patients with TDs who visited Beijing Children’s Hospital between May 2022 and June 2024 were included. All participants underwent concurrent testing for 25(OH)D, calcium ions, and HDL-C levels, and completed standardized assessments including the Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale (PUTS), Motor and Vocal Tic Evaluation Survey (MOVES), and Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL). Patients were stratified into mild and more severe tic groups based on YGTSS scores. Spearman correlation and multiple linear regression analyses were used to explore associations between serum biomarker levels and tic-related clinical outcomes, adjusting for age and sex. Results Lower serum concentrations of 25(OH)D, calcium ions, and HDL-C were significantly associated with greater tic severity across YGTSS, PUTS, MOVES, and GTS-QOL scores (all p < 0.05). Regression analyses confirmed that lower levels of 25(OH)D were independently associated with higher tic symptom severity (YGTSS: t = -2.747, p = 0.006), stronger premonitory urges (PUTS: t = -4.986, p < 0.001), and poorer quality of life (GTS-QOL: t = -2.014, p = 0.044), even after adjusting for age and gender. Similar negative associations were observed for calcium and HDL-C. Age was consistently found to be a significant covariate in all models. Conclusion Serum levels of 25-hydroxyvitamin D, calcium ions, and HDL-C are negatively correlated with tic severity and related functional impairments in children with TD. These biomarkers may serve as modifiable environmental factors contributing to symptom manifestation. Nutritional interventions, such as vitamin D supplementation, may represent a promising adjunctive strategy in the clinical management of TD.

Background Tic disorders are common neurodevelopmental conditions in children and adolescents, often accompanied by cognitive difficulties and sleep disturbances. Sleep problems may influence the extent to which tic severity affects cognitive performance, yet this potential moderating role remains largely unexplored. Understanding these interactions is critical for optimizing clinical management. Methods A total of 101 children and adolescents (ages 6–14) with tic disorders were recruited. Tic severity was assessed using the Yale Global Tic Severity Scale (YGTSS), and sleep was measured via the Children’s Sleep Habits Questionnaire (CSHQ). Cognitive performance was evaluated using a battery including the Continuous Performance Test (CPT) and Go/No-Go tasks. Moderation analyses were conducted in R to examine whether sleep dimensions moderated the relationship between tic severity and cognition, and whether these effects persisted after controlling for Attention-deficit/hyperactivity disorder (ADHD) symptoms. Results Across 23 significant moderation models, specific sleep dimensions—including sleep onset delay, bedtime resistance, sleep duration and other sleep aspects—significantly moderated the associations between tic severity and cognitive performance. These effects remained significant after controlling for ADHD symptoms. No direct correlations were observed between tic severity and sleep, highlighting the contextual role of sleep in cognitive performance. Conclusions Sleep problems independently shape the impact of tic severity on cognition. Assessment and management of sleep problems may mitigate cognitive deficits, suggesting that targeted sleep interventions could be an important component of comprehensive care for children and adolescents with tic disorders.

BACKGROUND:Tourette syndrome (TS) shows substantial clinical heterogeneity, but the factors contributing to this variability remain unclear. Socioeconomic status (SES) may influence brain functional connectivity (FC) and symptom expression, yet its role in pediatric TS is still not well understood. OBJECTIVE:To clarify the role of SES in modulating brain-behavior relationships in TS. METHODS:Resting-state fMRI data were acquired from 67 children and adolescents with TS and 49 matched controls. FC was computed within and between seven predefined brain networks. We identified group differences in FC, examined associations between SES and clinical measures, and tested whether SES indicators (family income, parental education, and residential location) moderated FC-symptom relationships. RESULTS:Compared with controls, children with TS showed significant alterations in FC, mainly characterized by increased connectivity involving somatomotor, frontoparietal control, default mode, attention, and limbic networks, and decreased connectivity within the right frontoparietal control network. Within the TS group, higher parental education was associated with greater premonitory urge severity. Moderation analyses showed that family income, parental education, and residential location moderated FC-premonitory urge associations; higher family income and parental education strengthened these associations, whereas rural residence weakened them. CONCLUSIONS:Socioeconomic context may contribute to variability in brain-symptom relationships in pediatric TS, particularly for premonitory urges rather than clinician-rated tic severity. These findings highlight the importance of considering socioeconomic context when interpreting neuroclinical heterogeneity in TS and may inform more context-sensitive clinical assessment and interpretation.

Premonitory urges (PUs) are common in tic disorders (TDs), but their relationships with tic severity and quality of life (QoL) in pediatric patients remain unclear. This study examined the associations among PU severity, tic severity, and QoL in drug-naïve children and adolescents with TDs, and tested whether tic severity statistically mediated the association between PU severity and QoL. Drug-naïve children and adolescents aged 6–17 years with TDs were recruited from Beijing Children’s Hospital. Tic severity, PU severity, and QoL were assessed using the Yale Global Tic Severity Scale, Premonitory Urge for Tics Scale, and Gilles de la Tourette Syndrome–Quality of Life Scale. Group comparisons, logistic regression, partial correlation, and bootstrap-based mediation analyses were performed. A total of 1,232 drug-naïve participants with TDs were included, of whom 1,060 had PUs, giving a prevalence of 86.0

BACKGROUND:Non-suicidal self-injury (NSSI) is a common behavioral problem among children and adolescents. Previous studies of NSSI have been mostly group-based and lacked specific characterization of individuals with NSSI. METHODS:Using convenience sampling, we surveyed all students from three junior high schools in a county in China, totaling 2,376 participants (mean age 13.66, SD 0.98). Assessments included NSSI, anxiety, depression, personality traits, and family environment. Based on the network template perturbation approach, we employed three steps-constructing the reference network, constructing the perturbed network, and computing the individual differential psychopathology network (IDPN). The IDPN was then constructed from questionnaire scores to capture the degree to which abnormal individuals deviate from the normative level. K-means clustering was then applied to explore the internal heterogeneity of NSSI. RESULTS:Among 2,376 students, 881 (37.1%) exhibited NSSI. Following IDPN construction, we selected 8 characteristics for clustering analysis based on significant changes in at least 2% of the samples. The elbow method indicated 2 clusters. Fisher discriminant analysis showed a classification accuracy of 95.8%, reflecting a good clustering effect. Severity of NSSI in Group 1 was lower than in Group 2, with scores for 7 out of 8 characteristics also lower in Group 1, except for "Control-Organization." NSSI was associated with personality traits, depression, and family environment, with stronger connections between individual features linked to higher NSSI severity. CONCLUSION:We introduced the concept of IDPN in psychometrics, which can reveal relationships among individual characteristics and identify distinct patient subgroups. Further research is needed to confirm its reproducibility and generalizability.

INTRODUCTION China is facing an increasingly urgent demand for children's mental health services.According to a nationwide epidemiological survey conducted by our team,the prev-alence of mental health disorders among children aged 6-16 years in China is 17.5％,with attention-deficit hyperactivity disorder(6.4％),oppositional defiant disorder(3.6％)and major depressive disorder(2.0％)being the most common diagnoses.

Premonitory urges (PU) in tic disorder (TD) are recognized as a crucial factor influencing tic symptoms and overall well-being. This study employs network analysis to explore the intricate relationships among PU, tic symptoms, obsessive-compulsive symptoms (OCS), and quality of life (QoL) in drug-naïve children and adolescents with TD. Participants were drug-naïve TD patients aged 6 to 16 years. All participants consented to undergo multiple accessments, including the Yale Global Tic Severity Scale (YGTSS), Premonitory Urge to Tic Scale (PUTS), Gilles de la Tourette-Quality of Life Scale (GTS-QOL), Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), and Obsessive-Compulsive Inventory-Revised (OCI-R). Network analysis was conducted using the R-package qgraph. Based on a sample of 344 TD patients, robust associations were identified between PU and tic symptoms, OCS, and QoL deficits. Centrality analysis identified ordering symptoms and obsessive thoughts as key nodes. Notable cross-scale associations were observed, such as the connections between PU and checking symptoms, as well as PU and obsessive thoughts. Bridge centrality analysis revealed that obsessive thoughts were identified as the strongest bridge symptom. PU was indirectly related to QoL in individuals with TD, while OCS exerted a direct association. Our study underscores the role of OCS in tic-related symptoms among individuals with TD. Highlighting the significant associations between PU and OCS, it emphasizes the necessity for targeted interventions to improve overall well-being.

Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder. Despite its significance, no large-scale epidemiological study assessing ADHD, and its associated comorbidities in children and adolescents has been conducted in China. Within a national epidemiological survey of 73,992 children and adolescents aged between 6 and 16 in China, we used the CBCL, MINI-KID, and DSM-IV to identify ADHD and its comorbid conditions. Chi-square tests were utilized to compare the prevalence estimates across varied age and sex groups. The overall ADHD prevalence was estimated at 6.4

OBJECTIVE:Tourette syndrome is often comorbid with attention-deficit/hyperactivity disorder and is associated with inhibitory control deficits. However, the differences in whole-brain functional connectivity between Tourette syndrome with and without ADHD and their neural basis for inhibitory control remain unclear. This study examines functional connectivity differences between these groups and their association with inhibitory control. METHODS:We recruited 52 children with Tourette syndrome (30 with Tourette syndrome only and 22 with Tourette syndrome + attention-deficit/hyperactivity disorder) from Beijing Children's Hospital. Resting-state functional magnetic resonance imaging was used to construct individual functional connectivity networks, and inhibitory control was assessed using the Go/No-Go task. Group differences in whole-brain functional connectivity were analyzed using the network-based statistic approach, which identifies connected subnetworks showing significant differences between groups while controlling for multiple comparisons. Multivariate linear regression models were used to examine associations between functional connectivity and inhibitory control, adjusting for comorbid attention-deficit/hyperactivity disorder. RESULTS:Compared to the Tourette syndrome only group, the Tourette syndrome + attention-deficit/hyperactivity disorder group showed decreased functional connectivity involving the default mode, somatomotor, and limbic networks. In both groups, inhibitory control was positively correlated with functional connectivity, predominantly involving the default mode, frontoparietal, somatomotor, and attention networks. The groups did not differ significantly in functional connectivity related to inhibitory control. CONCLUSIONS:Although differences in functional connectivity were observed between the Tourette syndrome and Tourette syndrome + attention-deficit/hyperactivity disorder groups, both had similar functional connectivity associated with inhibitory control. These findings highlight the neural impact of attention-deficit/hyperactivity disorder in Tourette syndrome and provide insights for future clinical interventions.

This study explores the roles of the precuneus and posterior cingulate cortex (pCunPCC) in the relationship between premonitory urge (PU) and tic severity in Tourette syndrome (TS). We recruited 58 children diagnosed with TS (age mean ± SD = 11.12 ± 2.56, F/M = 11/47). Tic and PU severity were measured using the Yale Global Tic Severity Scale (YGTSS) and the Premonitory Urge for Tics Scale (PUTS), respectively. We constructed brain functional networks for each subject based on resting-state fMRI and further calculated the degree centrality (DC), global efficiency (GE), and local efficiency (LE) of each pCunPCC region. A significant positive correlation was found between PUTS and YGTSS scores (t = 4.75, p < 0.001). The DC and GE of the right pCunPCC ROI 3 (Schaefer Atlas) showed significant negative correlations with YGTSS (t = -2.63, FDR-corrected p = 0.03 for DC; t = -2.85, FDR-corrected p = 0.04 for GE) and PUTS scores (t = -3.35, FDR-corrected p = 0.01 for DC; t = -2.95, FDR-corrected p = 0.03 for GE). Moderation analysis indicated that higher DC in the right pCunPCC ROI 3 reduced the effect of PU on tic severity. These moderation effects were also observed with PU and vocal tics, but not motor tics. The right pCunPCC serves as critical moderator in the relationship between PU and tic severity. This study highlighted the potential neural mechanisms underlying the relationship between PU and tic severity, providing potential targets for future intervention and treatment of TS.

Tic disorders are neurodevelopmental conditions that manifest in childhood or adolescence and can significantly impact the quality of life of affected children and their families to varying degrees. Integrated traditional Chinese and Western medicine treatment strategies have demonstrated more pronounced efficacy and better safety profiles. However, there is currently no standardized clinical expert consensus on this approach. To address this, the National Administration of Traditional Chinese Medicine initiated a project, and the China Association of Chinese Medicine assembled a team of authoritative domestic experts to develop this expert consensus, aiming to provide practical and feasible integrated treatment strategies for clinical practice. This consensus identified clinical issues through research, conducted literature reviews, and established evidence based on systematic evaluations. Expert surveys, two rounds of Delphi questionnaires, and expert consensus meetings were conducted to formulate a series of recommendations. We established a multidisciplinary consensus development panel. Based on systematic literature reviews, Delphi questionnaires, and consensus meetings, ten clinical issues were identified. Ultimately, a series of recommendations were developed, considering the balance of benefits and risks, the certainty of evidence, clinical feasibility, accessibility, and clinical acceptability. These recommendations comprehensively address key issues in the field of integrated traditional Chinese and Western medicine treatment, including indications for the use of Chinese or Western medicine alone or in combination, specific treatment protocols, methods for dose reduction and discontinuation, evaluation intervals, and the management of adverse reactions.

Background and objectives: The co-occurrence of attention-deficit/hyperactivity disorder (ADHD) symptoms and emotional dysregulation is highly prevalent. This study aims to explore potential subgroups within child and adolescent cohorts concerning ADHD symptoms and emotional dysregulation. Methods: The sample comprised 13,207 children and adolescents aged 4-16 years diagnosed with ADHD recruited from outpatient services at the Beijing Children's Hospital. Latent profile analysis (LPA) was used to identify subgroups based on ADHD symptoms and emotional dysregulation across different age groups (children, 4-9 years, vs. adolescents, 10-16 years). Furthermore, analysis of covariance (ANCOVA) was employed to compare differences in behavioral problems, cognitive impairments, and social dysfunctions among these subgroups. Results: We identified four distinct latent subgroups in children and three in adolescents. Significant differences in behavioral problems, cognitive impairments, and social dysfunctions were observed across these subgroups in both cohorts. Subgroups with high levels of ADHD symptoms and emotional dysregulation exhibited more severe functional impairments across both age groups. Conclusions: This study highlights developmental variations in the relationship between ADHD symptoms and emotional dysregulation, underscoring the need for tailored interventions based on age-specific profiles.

BackgroundTic disorders are neurodevelopmental disorders. Current research suggests that premonitory urges (PU) may be the cause and basis of tic disorders. The study used network analysis to investigate the detailed associations between PUs and tic symptoms the and internal relationships of PUs.MethodsWe included 1021 outpatient tic disorders. We used R 4.1.3 to perform network analysis. The “qgraph” package constructed the Premonitory Urge for Tics Scale (PUTS) and Yale Global Tic Severity Scale (YGTSS)networks for low-age and high-age group, and calculated the centrality measures for the four networks. We used the “bootnet” package to test the accuracy of the four network models and used the “NetworkComparisonTest” package to compare the networks for different age groups.ResultsThe network structures were stable (above 0.5). The node with the highest intensity was the 8th entry. The “connection” node was identified as the “all defects caused by motion or vocal tics” entry in the YGTSS. The strength and weight of the network structures did not significantly differ between the different groups. The node strength substitution test revealed that the 9th item had a significantly stronger intensity in lower age group (0.75) than in the higher age group (0.53) with a P-value of 0.03. The strength in the network was also significantly greater in the younger age group (1.34) than in the older age group (1.02) with a P-value of 0.04.ConclusionThis study validates the internal structure of the PUTS scale across different age groups from a network perspective. It provides theoretical guidance and practical basis for targeted behavioral therapy.

BACKGROUND:Tic disorder (TD) is a diverse neurodevelopmental disorder with various symptoms and comorbidities. Traditional classifications based on age onset and duration fail to adequately characterize the full clinical features of TD. This study aims to redefine TD subtypes by a comprehensive analysis of clinical features and comorbidities. METHODS:We assessed 139 children and adolescents aged 6-18 years using 14 scales covering 43 dimensions. The k-means clustering algorithm was used to identify distinct TD subtypes. Differences between these subtypes were analyzed using t-tests and network analysis, with high expected influence (EI) metric representing key symptoms within each subtype. RESULTS:We identified two distinct subtypes of TD, with 21.6% of participants classified as subtype1 and 78.4% as subtype2. Subtype1 exhibited more severe symptoms across TD, obsessive-compulsive spectrum disorders, and attention deficit hyperactivity disorder assessments compared to subtype2, with significant differences observed in 81.4% of the scale features. Network analysis revealed differences in core symptoms between the two subtypes; subtype1 primarily involved hyperactivity and vital activities, whereas subtype2 primarily involved attention deficit, hyperactivity and conduct. Furthermore, comparisons with DSM-5 classifications revealed distinct patterns, indicating the novel nature of the identified subtypes. CONCLUSION:Our study identified two novel TD subtypes, highlighting its heterogeneity. Subtype 1 had more severe attention deficits and impulsivity, requiring comprehensive treatment, while subtype 2 had milder symptoms, focusing on support and monitoring. These findings provide insights into TD classification and may help refine treatment strategies. However, the cross-sectional design limits causal interpretations, and reliance on parent-reported data may introduce bias.

Purpose:Tic disorders are neurodevelopmental disorders characterized by movements or vocalizations, often accompanied by anxiety symptoms. However, the relationships between tic severity, age, and anxiety symptoms remain unclear. Here, we investigated the association between tic severity and age and examined how anxiety symptoms might influence this relationship. Patients and Methods:Paediatric patients with tic disorders were recruited from the outpatient clinic of the in Department of Psychiatry at Beijing Children's Hospital, Capital Medical University. The final sample included 372 subjects (77 females, 295 males; mean age = 10.50 ± 2.70 years; age range: 6.33-15.92 years). Tic severity was assessed using the Yale Global Tic Severity Scale (YGTSS), while anxiety symptoms were measured using the Screen for Child Anxiety Related Emotional Disorders (SCARED). Results:We found a significant positive correlation between both total and subscale anxiety scores and tic severity. Furthermore, anxiety symptoms, particularly separation anxiety, were found to be significantly correlated with age-related differences in tic severity. In the high anxiety group, tic severity increased significantly with age, mirroring the overall trend. Conversely, in the low anxiety group, tic severity remained relatively stable with age. Conclusion:Our findings highlight the role of anxiety in the progression of tic disorders and emphasize the importance of addressing anxiety in the clinical management of children with tic disorders.

OBJECTIVE:Tic disorders (TD) is a common neurodevelopmental disorder in children and adolescents, often co-occurring with psychiatric comorbidities and significantly impairing functioning. Symptom network analysis can identify key nodes for targeted interventions. METHODS:Children and adolescents diagnosed with TD at Beijing Children's Hospital (May 2024-Feb 2025) were assessed using nine standardized scales covering tic symptoms and eight related psychological dimensions. Network analysis was applied to examine the symptom structure. Subgroup analyses were performed to compare network characteristics by gender and developmental stage. RESULTS:715 TD patients were analyzed. In total sample, the tic symptoms (TIC) was directly linked to premonitory urges symptoms (PUT) and ADHD symptoms (ADH), and indirectly to depressive symptoms (DEP) and anxiety symptoms (ANX), with DEP as the central node (strength = 1.42). Centrality analysis highlighted DEP (strength = 1.42), neuroticism (NEU, strength = 1.27), and ANX (strength = 0.97) as key influencers. Gender-based analysis revealed stronger TIC-NSI (non-suicide self-injury, p = 0.020) and ANX-MPD (mobile-phone dependence, p = 0.041) connections in females. Developmental analysis revealed a stronger ADH-NEU link in children (p = 0.002), while TIC node (p = 0.024) and DEP node (p = 0.049) was more pronounced in adolescents. CONCLUSIONS:TD symptoms were closely associated with premonitory urges and ADHD symptoms, while depressive symptoms, anxiety symptoms, and neuroticism emerged as central nodes in the network. These findings highlight the importance of comprehensive intervention strategies for achieving more sustained therapeutic outcomes in TD.