Abstract / Summary
Abstract Background : Attention-deficit/hyperactivity disorder (ADHD) and Tourette syndrome frequently co-occur. Although prior national research has compared broad impairment across diagnostic groups, contemporary estimates of family employment disruption and unmet health care need among children who already have current ADHD remain limited. We aimed to estimate the association of parent-reported current co-occurring Tourette syndrome with functional difficulty, family employment disruption, and unmet health care need among US children with current ADHD. Methods : We pooled seven independent cross-sectional waves of the National Survey of Children’s Health (2018–2024) and included children aged 6–17 years with parent-reported current ADHD. Children were classified as having ADHD alone or ADHD with current Tourette syndrome. Primary outcomes were difficulty staying calm or in control, family reduction in work hours because of the child’s health, and unmet health care need. Survey-weighted modified Poisson regression with a log link estimated adjusted prevalence ratios (aPRs), controlling for age, sex, race/ethnicity, and survey year. False discovery rate correction was applied across the three primary outcomes. Extended adjustment, analyses across six multiply imputed family-income implicates, and period-stratified analyses evaluated robustness. Results : The analysis included 28,777 children with current ADHD, of whom 383 also had Tourette syndrome. Weighted prevalence was 60.8% versus 65.9% for difficulty staying calm, 13.1% versus 28.9% for family work-hour reduction, and 8.9% versus 21.8% for unmet health care need in the ADHD-alone and ADHD-plus-Tourette groups, respectively. ADHD with co-occurring Tourette syndrome was associated with family work-hour reduction (aPR, 2.32; 95% CI, 1.71–3.14; false discovery rate q<0.001) and unmet health care need (aPR, 2.44; 95% CI, 1.69–3.53; q<0.001), but not conclusively with difficulty staying calm (aPR, 1.10; 95% CI, 0.95–1.28; q=0.201). Estimates were similar after extended socioeconomic adjustment and family-income multiple-imputation analyses. There was no evidence that associations differed between 2018–2021 and 2022–2024. Conclusions : In this repeated cross-sectional analysis of US children with current ADHD, parent-reported co-occurring Tourette syndrome was associated with higher prevalence of family employment disruption and unmet health care need. The findings support attention to family support and care coordination; the study design does not establish causality.