The hypothesis that prenatal masculinization of the brain increases
risk of tic disorders in postnatal life was tested by measuring gender
and gender role behavior in 89 children and adults with a clinical
diagnosis of Tourette syndrome or obsessive compulsive disorder and 67
healthy, unaffected children and adults. Consistent with this
hypothesis, a tic disorder in females was associated with more gender
dysphoria, increased masculine play preferences, and a more typically
“masculine” pattern of performance on two sex-typed spatial
tasks. Males with tic disorders reported increased masculine play
preferences, and the strength of these preferences was positively
associated with the severity of tic symptoms. In addition, unlike their
female counterparts, males with tic disorders showed a relative
impairment in mental rotation ability. These behavioral profiles are
consistent with those of children who have verifiable elevations in
prenatal androgen levels. These findings therefore support the
hypothesis that an altered androgen-dependent process of sexual
differentiation during prenatal life may contribute to the development
of tic-related disorders.This work was
supported by National Institutes of Health Grants MH01232 (B. P.) and
MH59139 (B. P.) and the Suzanne Crosby Murphy endowment in Pediatric
Neuropsychiatry, College of Physicians and Surgeons, Columbia
University. The authors thank Amy Basile and Shibani Mukerji for their
valuable assistance with behavioral testing.