Tourette's Disorder Scale
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The Tourette's Disorder Scale (TODS) is a psychological instrument to assess tics and co-occurring conditions in Tourette syndrome (TS).[1]
There are two versions of TODS: TODS-CR (clinician-rated) and TODS-PR (parent-rated). Each version is a 15-item scale that helps clinicians evaluate the severity of symptoms that may be associated with tics—inattention, hyperactivity, obsessions, compulsions, aggression and mood disturbances.[2]
TODS is one of many instruments used to assess symptoms associated with tics. The Yale Global Tic Severity Scale (YGTSS) is regarded as the most developed instrument for assessing tics and is widely accepted as the standard;[3] TODS is one of several other reliable and comprehensive instruments.[3][4][5]
TODS differs from other instruments in that it measures tic severity as well as behavioral and emotional symptoms that may accompany TS.[2] According to a systematic review by Martino, et al (2017), TODS is the "only 'recommended' severity scale to measure also comorbid behavioral symptoms (inattention, hyperactivity, obsessions, compulsions, aggression, and emotional symptoms), but has lower internal consistency and interrater reliability than the YGTSS".[4]
The 15 symptoms rated by TODS include tics as well as obsessions and compulsions; attentional difficulties, restlessness and impulsiveness; and depression, anxiousness, aggression and other mood or behavioral issues.[2]
Development
In a 2003 study by Shytle and colleagues, a survey was sent to parents from a TS group email list, asking them to rate the frequency and relative significance of 32 behavioral and emotional symptoms observed in their children.[2] Of 35 respondents, 80% concurred that behavioral and emotional symptoms were more afflicting than tics.[2]
Symptoms discerned as frequently disruptive to persons with TS and rated as a "top 10" problem by over 25% of participants in the study (parents and clinicians) were included in the construction of TODS.[2] Two versions of TODs were established, one using parental ratings (PR) and the other using clinician ratings (CR).[2]
TODS-PR
For the development of the parent-rated version of TODS, parents of individuals with tics subjectively rated symptom severity in accordance with their observations over fixed time periods.[2]
TODS-CR
In developing the clinician-rated version of TODS, a semi-structured interview was conducted by clinicians in those with TS and their parents. After using the MINI-KID (child and adolescent version of the Mini International Neuropsychiatric Interview) to determine the presence of TS and comorbidities, clinicians posed questions to the children.[2] Following, parents were asked to contribute to the responses, until clinicians reached an agreement on the rating of each symptom.[2]