Current status of assessment instruments for tic disorders severity and premonitory urges

doi:10.3877/cma.j.issn.1673-5250.2026.03.002

Tic disorders (TD) are common neurodevelopmental disorders characterized by motor and/or phonic tics, which are frequently accompanied by premonitory urges (PU)-abnormal somatic sensations preceding the occurrence of tics. Accurate assessment of tic symptom severity and PU is of great significance for disease diagnosis, treatment decisionmaking, and efficacy evaluation. However, there is still a lack of systematic review of relevant assessment tools in China. This review aims to systematically review commonly used TD severity assessment scales, including Yale global tic severity scale (YGTSS), Yale global tic severity scale-revised (YGTSSR), Tourette syndrome global scale (TSGS), Tourette′s disorder scale (TODS), parent tic questionnaire (PTQ), and PU assessment scales, including premonitory urge for tics scale (PUTS), individualized premonitory urge for tics scale (IPUTS), premonitory urge for tics scale-revised (PUTSR) at both domestic and international levels. We compare and evaluate these eight scales in terms of instrument structure, target population, assessment dimensions, psychometric properties, and application scenarios, identify the strengths and limitations of current tools in clinical practice and research, and emphasize the necessity of developing culturally adapted assessment tools within the Chinese context, so as to provide a theoretical basis and practical reference for clinicians and researchers when selecting assessment instruments for children with TD.

Key words: Tic disorders, Tourette syndrome, Severity, Scale, Assessment, Premonitory urge, Child

表1 YGTSS的评估者一致性ICC及7周重测信度比较

YGTSS项目	ICC	7周重测信度
运动抽动分量表	0.78	0.77
发声抽动分量表	0.91	0.90
总抽动分量表	0.84	0.88
损害分量表	0.80	0.88
YGTSS总量表	0.85	0.89

表1 YGTSS的评估者一致性ICC及7周重测信度比较

YGTSS项目	ICC	7周重测信度
运动抽动分量表	0.78	0.77
发声抽动分量表	0.91	0.90
总抽动分量表	0.84	0.88
损害分量表	0.80	0.88
YGTSS总量表	0.85	0.89

表2 YGTSS与YGTSS-R在频率、复杂性及干扰程度维度对TD患儿的评分描述对比

评分(分)	YGTSS	YGTSS-R
频率维度
0	无抽动	无：无特定抽动迹象
1	罕见的：前一周出现了特定抽动行为。这些行为很少发生，通常不是每天发生。如果出现阵发性抽动，则为短暂而罕见的	最小的：特定抽动行为通常每天都会出现，但白天无抽动间隔时间很长。抽动可能偶尔发生，但一次持续的时间不会超过几分钟
2	偶尔的：特定抽动行为通常每天都会出现，但白天无抽动间隔时间很长。抽动可能偶尔发生，但一次持续时间不超过几分钟	轻度的：每天都会出现特定抽动行为，长达3 h的无抽搐间隔并不少见。抽动周期性发生，但通常仅限于一种情况
3	频繁的：每天都会出现特定抽动行为。长达3 h的无抽搐间隔并不少见。抽动发作经常发生，但可能仅限于一种情况	中度的：每天醒着的每个小时几乎都会出现特定抽动行为。抽动发作很常见，可能不限于一种情况
4	几乎总是这样：每天醒着的每个小时几乎都会出现特定抽动行为，持续抽动行为的周期也会定期发生。抽动发作很常见，并不局限于一种情况	明显的：醒着的每个小时都有特定抽动行为。抽动发作很常见，可能发生在多种情况下
5	总是：特定抽动行为几乎一直存在。无抽动的间歇时间难以确定，最长不超过5~10 min	重度的：特定抽动行为几乎一直存在。无抽动的间歇时间难以确定，最长不超过5~10 min。抽动发作非常常见，出现在多种情况下
复杂性维度
0	无：如果存在，所有的抽动在性质上都很"简单"(突然、短暂、无目的)	无：无抽动
1	边缘：有些抽动在性质上并不明显"简单"	最小的：如果存在抽动，所有的抽动在性质上都很"简单"(突然、短暂、无目的)
2	轻度的：有些抽动明显"复杂"(外观上有目的性)，表现为模仿简短的"自动性"行为，如伪装成修饰音节或简短的有意义的话语，如"啊哈""嗨"	轻度的：有些抽动在性质上并不明显"简单"
3	中度的：有些抽动更"复杂"(外观上更具有目的性和持续性)，可能成管弦乐式发作且难以伪装，可能被合理化或"解释"成正常的行为或语言(轻拍，说"你打赌""亲爱的""FF""sh"，模仿语言)	中度的：有些抽动明显"复杂"(外观上有目的性)，表现为模仿简短的"自动性"行为，如伪装成修饰音节或简短的有意义的话语，如"啊哈""嗨"
4	明显的：有些抽动的性质非常"复杂"，往往呈持续性系列发作，很难伪装，而且由于持续时间长、不常见、不恰当、怪异或淫秽的特征(长时间面部扭曲、触碰生殖器、回声、言语不典型、长时间反复说"你是什么意思"，或说"fu"或"sh")，很难将其合理化为正常的行为或言语	明显的：有些抽动更"复杂"(外观上更具有目的性和持续性)，可能成系列的发作且难以伪装，可能被合理化或"解释"成正常的行为或语言(轻拍，说"你打赌""亲爱的""FF""sh"，模仿语言)
5	重度的：有些抽动涉及长时间的系列行为或言语，由于持续时间长和(或)极不寻常、不恰当、怪异或淫秽的特征，这些行为或言语不可能伪装或成功地合理化为正常行为(长时间的展示或话语，通常涉及污秽行为、自虐行为或污言秽语)	重度的：有些抽搐的性质非常"复杂"，往往呈持续性系列发作，很难伪装，而且由于持续时间长、不常见、不恰当、怪异或淫秽的特征(长时间面部扭曲、触碰生殖器、回声、言语不典型及阵发性的猥亵行为、自虐行为或污言秽语)，很难将其合理化为正常的行为或言语
干扰程度维度
0	无影响	无：无抽动
1	最小的：不会打断正常行为或语言	最小的：当抽动出现时，不会打断流畅的行为或语言
2	轻度的：偶尔会打断正常行为或语言	轻度的：当抽动出现时，偶尔会打断流畅的行为或语言
3	中度的：经常会打断正常行为或语言	中度的：当抽动出现时，经常会打断流畅的行为或语言，但不会扰乱预期的行为或语言
4	明显的：经常会打断正常的行为或语言，偶尔会扰乱预期的活动或交流	明显的：当抽动出现时，经常会打断流畅的行为或语言，偶尔会扰乱预期的活动或交流
5	重度的：当抽动出现时，经常会扰乱预期的活动或交流	重度的：当抽动出现时，经常会扰乱预期的活动或交流

表2 YGTSS与YGTSS-R在频率、复杂性及干扰程度维度对TD患儿的评分描述对比

评分(分)	YGTSS	YGTSS-R
频率维度
0	无抽动	无：无特定抽动迹象
1	罕见的：前一周出现了特定抽动行为。这些行为很少发生，通常不是每天发生。如果出现阵发性抽动，则为短暂而罕见的	最小的：特定抽动行为通常每天都会出现，但白天无抽动间隔时间很长。抽动可能偶尔发生，但一次持续的时间不会超过几分钟
2	偶尔的：特定抽动行为通常每天都会出现，但白天无抽动间隔时间很长。抽动可能偶尔发生，但一次持续时间不超过几分钟	轻度的：每天都会出现特定抽动行为，长达3 h的无抽搐间隔并不少见。抽动周期性发生，但通常仅限于一种情况
3	频繁的：每天都会出现特定抽动行为。长达3 h的无抽搐间隔并不少见。抽动发作经常发生，但可能仅限于一种情况	中度的：每天醒着的每个小时几乎都会出现特定抽动行为。抽动发作很常见，可能不限于一种情况
4	几乎总是这样：每天醒着的每个小时几乎都会出现特定抽动行为，持续抽动行为的周期也会定期发生。抽动发作很常见，并不局限于一种情况	明显的：醒着的每个小时都有特定抽动行为。抽动发作很常见，可能发生在多种情况下
5	总是：特定抽动行为几乎一直存在。无抽动的间歇时间难以确定，最长不超过5~10 min	重度的：特定抽动行为几乎一直存在。无抽动的间歇时间难以确定，最长不超过5~10 min。抽动发作非常常见，出现在多种情况下
复杂性维度
0	无：如果存在，所有的抽动在性质上都很"简单"(突然、短暂、无目的)	无：无抽动
1	边缘：有些抽动在性质上并不明显"简单"	最小的：如果存在抽动，所有的抽动在性质上都很"简单"(突然、短暂、无目的)
2	轻度的：有些抽动明显"复杂"(外观上有目的性)，表现为模仿简短的"自动性"行为，如伪装成修饰音节或简短的有意义的话语，如"啊哈""嗨"	轻度的：有些抽动在性质上并不明显"简单"
3	中度的：有些抽动更"复杂"(外观上更具有目的性和持续性)，可能成管弦乐式发作且难以伪装，可能被合理化或"解释"成正常的行为或语言(轻拍，说"你打赌""亲爱的""FF""sh"，模仿语言)	中度的：有些抽动明显"复杂"(外观上有目的性)，表现为模仿简短的"自动性"行为，如伪装成修饰音节或简短的有意义的话语，如"啊哈""嗨"
4	明显的：有些抽动的性质非常"复杂"，往往呈持续性系列发作，很难伪装，而且由于持续时间长、不常见、不恰当、怪异或淫秽的特征(长时间面部扭曲、触碰生殖器、回声、言语不典型、长时间反复说"你是什么意思"，或说"fu"或"sh")，很难将其合理化为正常的行为或言语	明显的：有些抽动更"复杂"(外观上更具有目的性和持续性)，可能成系列的发作且难以伪装，可能被合理化或"解释"成正常的行为或语言(轻拍，说"你打赌""亲爱的""FF""sh"，模仿语言)
5	重度的：有些抽动涉及长时间的系列行为或言语，由于持续时间长和(或)极不寻常、不恰当、怪异或淫秽的特征，这些行为或言语不可能伪装或成功地合理化为正常行为(长时间的展示或话语，通常涉及污秽行为、自虐行为或污言秽语)	重度的：有些抽搐的性质非常"复杂"，往往呈持续性系列发作，很难伪装，而且由于持续时间长、不常见、不恰当、怪异或淫秽的特征(长时间面部扭曲、触碰生殖器、回声、言语不典型及阵发性的猥亵行为、自虐行为或污言秽语)，很难将其合理化为正常的行为或言语
干扰程度维度
0	无影响	无：无抽动
1	最小的：不会打断正常行为或语言	最小的：当抽动出现时，不会打断流畅的行为或语言
2	轻度的：偶尔会打断正常行为或语言	轻度的：当抽动出现时，偶尔会打断流畅的行为或语言
3	中度的：经常会打断正常行为或语言	中度的：当抽动出现时，经常会打断流畅的行为或语言，但不会扰乱预期的行为或语言
4	明显的：经常会打断正常的行为或语言，偶尔会扰乱预期的活动或交流	明显的：当抽动出现时，经常会打断流畅的行为或语言，偶尔会扰乱预期的活动或交流
5	重度的：当抽动出现时，经常会扰乱预期的活动或交流	重度的：当抽动出现时，经常会扰乱预期的活动或交流

表3 目前主要用于评估TD严重程度量表(YGTSS、YGTSS-R、TSGS、TODS、PTQ)及PU评估量表(PUTS、I-PUTS、PUTS-R)的相关项目比较

量表名称(适用人群)	适用对象	评估者/评估时长(min)	抽动相关维度/其他维度	主要优势/与YGTSS的相关性
YGTSS(儿童、成年人)	TD	临床人员/15~30	数量、频率、强度、复杂性、干扰程度/损害程度	金标准/－
YGTSS-R(儿童、成年人)	TD	临床人员/15~30	数量、频率、强度、复杂性、干扰程度/损害程度	改进频率、复杂性、干扰维度的描述，减少偏倚/无相关性信息
TSGS(儿童、成年人)	TS	临床人员/－	频率、破坏程度/行为、坐立难安、学校或职业问题	早期综合量表，涵盖行为维度/TSGS总分与YGTSS总分呈高度相关(r＝0.86~0.90，P<0.05)^[5]
TODS(儿童、青少年)	TS	临床人员、父母/15~20	－/行为和情绪症状	纳入共病行为和情绪症状，可用于药物试验评估/TODS-CR/PR总分与YGTSS总分呈中度相关(r＝0.49、0.47，P<0.05)^[18]
PTQ(6~17岁人群)	TD	父母/10~15	存在、频率、强度/－	操作简便，心理测量学特性良好/PTQ总分与YGTSS总分呈高度相关(r＝0.72，P<0.05)^[6]
PUTS(≥10岁，有研究支持≥6岁人群)	TD	自评/5~10	频率、质量/－	首个PU评估量表/PUTS总分与YGTSS总分呈低至中度相关(r＝0.06~0.31，P<0.05)^[22]
I-PUTS(6~17岁人群)	TD	临床人员/20~30	数量、频率、强度/身体部位	个体化评估，区分不同抽动对应的PU/PU强度评分与YGTSS抽动复杂性评分及抽动总分均呈低至中度相关(r_s＝0.26、0.23，P<0.05)^[28]
PUTS-R(儿童、青少年、成年人)	TD	自评/5~10	频率、质量/－	条目扩展，适用年龄层扩大/PUTS-R因子分与YGTSS总体损害率评分呈低至中度相关(r_s＝0.30~0.39，P<0.05)^[30]

表3 目前主要用于评估TD严重程度量表(YGTSS、YGTSS-R、TSGS、TODS、PTQ)及PU评估量表(PUTS、I-PUTS、PUTS-R)的相关项目比较

量表名称(适用人群)	适用对象	评估者/评估时长(min)	抽动相关维度/其他维度	主要优势/与YGTSS的相关性
YGTSS(儿童、成年人)	TD	临床人员/15~30	数量、频率、强度、复杂性、干扰程度/损害程度	金标准/－
YGTSS-R(儿童、成年人)	TD	临床人员/15~30	数量、频率、强度、复杂性、干扰程度/损害程度	改进频率、复杂性、干扰维度的描述，减少偏倚/无相关性信息
TSGS(儿童、成年人)	TS	临床人员/－	频率、破坏程度/行为、坐立难安、学校或职业问题	早期综合量表，涵盖行为维度/TSGS总分与YGTSS总分呈高度相关(r＝0.86~0.90，P<0.05)^[5]
TODS(儿童、青少年)	TS	临床人员、父母/15~20	－/行为和情绪症状	纳入共病行为和情绪症状，可用于药物试验评估/TODS-CR/PR总分与YGTSS总分呈中度相关(r＝0.49、0.47，P<0.05)^[18]
PTQ(6~17岁人群)	TD	父母/10~15	存在、频率、强度/－	操作简便，心理测量学特性良好/PTQ总分与YGTSS总分呈高度相关(r＝0.72，P<0.05)^[6]
PUTS(≥10岁，有研究支持≥6岁人群)	TD	自评/5~10	频率、质量/－	首个PU评估量表/PUTS总分与YGTSS总分呈低至中度相关(r＝0.06~0.31，P<0.05)^[22]
I-PUTS(6~17岁人群)	TD	临床人员/20~30	数量、频率、强度/身体部位	个体化评估，区分不同抽动对应的PU/PU强度评分与YGTSS抽动复杂性评分及抽动总分均呈低至中度相关(r_s＝0.26、0.23，P<0.05)^[28]
PUTS-R(儿童、青少年、成年人)	TD	自评/5~10	频率、质量/－	条目扩展，适用年龄层扩大/PUTS-R因子分与YGTSS总体损害率评分呈低至中度相关(r_s＝0.30~0.39，P<0.05)^[30]

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