Linking socioeconomic context to functional brain network abnormalities and clinical severity in children with Tourette syndrome.

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.