Sleep Problems Moderate the Association Between Tic Severity and Cognitive Function in Children: Effects Beyond ADHD Symptoms

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Sleep problems may influence the extent to which tic severity affects cognitive performance, yet this potential moderating role remains largely unexplored. Understanding these interactions is critical for optimizing clinical management. Methods A total of 101 children and adolescents (ages 6–14) with tic disorders were recruited. Tic severity was assessed using the Yale Global Tic Severity Scale (YGTSS), and sleep was measured via the Children’s Sleep Habits Questionnaire (CSHQ). Cognitive performance was evaluated using a battery including the Continuous Performance Test (CPT) and Go/No-Go tasks. Moderation analyses were conducted in R to examine whether sleep dimensions moderated the relationship between tic severity and cognition, and whether these effects persisted after controlling for Attention-deficit/hyperactivity disorder (ADHD) symptoms. Results Across 23 significant moderation models, specific sleep dimensions—including sleep onset delay, bedtime resistance, sleep duration and other sleep aspects—significantly moderated the associations between tic severity and cognitive performance. These effects remained significant after controlling for ADHD symptoms. No direct correlations were observed between tic severity and sleep, highlighting the contextual role of sleep in cognitive performance. Conclusions Sleep problems independently shape the impact of tic severity on cognition. Assessment and management of sleep problems may mitigate cognitive deficits, suggesting that targeted sleep interventions could be an important component of comprehensive care for children and adolescents with tic disorders. tic disorders sleep cognitive function moderate analysis Figures Figure 1 Introduction Tic disorders are common neurodevelopmental conditions characterized by sudden, rapid, recurrent, and nonrhythmic motor movements or vocalizations (American Psychiatric Association, 2013)[ 1 ], encompassing transient tic disorder, chronic motor or vocal tic disorder, and Tourette syndrome (TS). They are among the most prevalent movement disorders in children, with community-based studies estimating lifetime prevalence ranging from approximately 0.2% to 46.3%[ 2 ]–variability largely attributable to differences in study design, diagnostic criteria, and sample characteristics. Transient tics may affect up to 20% of school-aged youth[ 3 ], while the prevalence of TS is estimated at 0.85–1.0%[ 4 ]. Tic onset typically occurs in early childhood (around ages 5–6) and is more common in males than in females[ 5 ]. Symptoms often fluctuate, can be briefly suppressed, and tend to worsen under stress, fatigue, or excitement. Although symptoms often decline with age, a considerable subset of individuals continue to experience clinically significant tics and associated impairments into adolescence and adulthood, highlighting the enduring clinical relevance of tic disorders[ 6 ]. Sleep disturbances are highly prevalent in children and adolescents with tic disorders, manifesting as delayed sleep onset, bedtime resistance, frequent night wakings, parasomnias, restless sleep, and sleep-disordered breathing[ 7 ]. A recent meta-analysis reported that approximately one-third of individuals with tic disorders experience clinically significant sleep problems, with a pooled prevalence estimate of around 34%[ 8 ]. Importantly, sleep problems in this population are not merely secondary complaints but are associated with greater tic severity, increased psychiatric comorbidities (such as Attention-deficit/hyperactivity disorder and anxiety), and impaired daytime functioning[ 9 , 10 ]. From a neurocognitive perspective, inadequate or fragmented sleep is known to impair attention, response inhibition, and executive control—domains already vulnerable in tic disorders[ 11 ]. Accordingly, sleep may act as a critical moderator that influences how tic severity translates into cognitive and functional impairments, either buffering or exacerbating their impact. Considering sleep as an interactive factor, rather than a mere comorbidity, provides new insights into the complex clinical presentation of tic disorders and highlights novel avenues for targeted interventions. Cognitive functioning is often impaired in children and adolescents with tic disorders, particularly in attention, executive control, and inhibitory processes. Previous studies have yielded mixed results, with some reporting deficits in inhibitory control and attentional regulation[ 12 ], whereas others found largely intact or compensatory performance, suggesting heterogeneity across individuals and the need for more nuanced models that account for moderating factors[ 13 ]. Attention-deficit/hyperactivity disorder (ADHD) is commonly comorbid, with co-occurrence rates reported up to 54.3%[ 14 ]. ADHD symptoms, including inattention and impulsivity, can independently influence cognitive performance and confound tic–cognition associations, making it critical to account for ADHD when examining cognitive outcomes in tic disorders. Despite mounting evidence linking sleep to both tics and cognition, few studies have directly tested whether sleep moderates the relationship between tic severity and neurocognitive performance. Examining these moderating effects is clinically important, as it may explain why children with similar tic severity differ in cognitive performance. The present study aimed to determine whether specific sleep dimensions moderate the relationship between tic severity and cognitive performance. We also tested whether these moderating effects remain significant after controlling for ADHD symptoms, isolating the independent contribution of sleep. Method Participants A total of 101 children and adolescents were recruited from the Pediatric Psychiatry Department of Beijing Children’s Hospital between December 2022 and February 2024. Participants ranged in age from 6 to 14 years, covering both childhood and early adolescence. All participants met DSM-5[ 1 ] diagnostic criteria for tic disorders, including Tourette syndrome, chronic motor or vocal tic disorder, or provisional tic disorder. Exclusion criteria included a history of other psychiatric disorders (such as intellectual disability, autism spectrum disorder, major mood disorders), neurological conditions (e.g., epilepsy or other movement disorders), serious physical illnesses, or use of medications known to affect cortical excitability. Individuals who had difficulty comprehending instructions or completing the cognitive assessments were also excluded. Diagnoses were made independently by two experienced child psychiatrists (LN and CYH), with an inter-rater intraclass correlation coefficient (ICC) exceeding 0.85, indicating high diagnostic agreement. Sample size estimation was conducted using R software (package “pwr”), targeting a medium effect size (Cohen’s f² = 0.15) and a conventional power level of 0.80. The result suggested that at least 77 participants were necessary to detect statistically meaningful effects. To increase the stability of the statistical models and account for potential heterogeneity in the sample, a total of 101 participants were ultimately enrolled in the study. The study protocol was approved by the Ethics Committee of Beijing Children’s Hospital, Capital Medical University (approval number: IEC-C-006-A04-V.07). Informed verbal consent was obtained from the parents or guardians of all participants, in accordance with institutional and ethical guidelines. Measures Yale Global Tic Severity Scale (YGTSS) Tic severity in this study was evaluated using the Yale Global Tic Severity Scale (YGTSS) [ 15 ], a semi-structured clinician-administered instrument that provides a comprehensive assessment of tic symptoms over the previous week. The scale demonstrates strong psychometric properties, including excellent internal consistency, interrater reliability[ 16 ], and both convergent and divergent validity, and is widely regarded as the gold standard for tic assessment. In our study, trained psychotherapists (XC, CRJ) conducted the assessments through structured interviews, which incorporated both direct observation and patient self-report[ 17 ]. The YGTSS evaluates five key domains of tic expression: number, frequency, intensity, complexity, and the degree of functional interference caused by the tics. The assessment begins with a checklist covering up to 40 types of tics, categorized into simple motor, complex motor, simple vocal, and complex vocal tics. The YGTSS yields three core scores: a Motor Tic Score (0–25), a Vocal Tic Score (0–25), and a combined Total Tic Score (0–50). An additional Impairment Score (0–50) captures the impact of tics on daily functioning[ 15 , 16 ]. The combined scoring system facilitates a nuanced evaluation of both symptom severity and related impairment, and is sensitive to clinically meaningful changes in tic presentation. Children’s Sleep Habits Questionnaire (CSHQ) The Children’s Sleep Habits Questionnaire (CSHQ) is a well-validated parent-report measure designed to screen for sleep difficulties in children. It includes 33 items and has been extensively applied in both clinical and research settings across various populations[ 18 ]. Caregivers are asked to evaluate the frequency of sleep-related behaviors observed in their child over the past week using a 3-point Likert scale (“usually,” “sometimes,” and “rarely”). The questionnaire is composed of eight subdomains: bedtime resistance, delay in sleep onset, insufficient sleep duration, sleep-related anxiety, night-time awakenings, parasomnias, symptoms suggestive of sleep-disordered breathing, and excessive daytime sleepiness[ 18 ]. Higher scores on the total scale and each subscale reflect greater severity of sleep problems. The scale has demonstrated satisfactory internal consistency, acceptable test–retest reliability, and sound discriminant validity[ 18 , 19 ]. Swanson, Nolan, and Pelham Questionnaire (SNAP-IV) The SNAP-IV is a widely used instrument designed to assess symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional behaviors in children and adolescents. It consists of 26 items, each rated on a 4-point Likert scale (0 = not at all, 1 = just a little, 2 = quite a bit, 3 = very much), and is typically completed by parents or teachers[ 20 ]. The items are divided into three subscales: Inattention (9 items), Hyperactivity/Impulsivity (9 items), and Oppositional Defiant Behaviors (8 items)[ 20 ]. Each subscale score is calculated as the average of its respective items, and a combined ADHD score can be derived by averaging the inattention and hyperactivity/impulsivity subscales. Higher scores indicate more severe symptomatology. The SNAP-IV has demonstrated good psychometric properties, including strong internal consistency and construct validity across both clinical and general populations[ 21 ]. Cognitive tasks The Continuous Performance Test (CPT) is a computerized task commonly used to assess sustained attention and inhibitory control. In this task, participants were presented with 360 letters, each displayed for approximately 250 milliseconds, across 18 sub-blocks. Interstimulus intervals (ISI) varied randomly between 1, 2, and 4 seconds. Participants were instructed to press the spacebar in response to all letters except the letter “X,” which served as the No-Go stimulus. Non-target stimuli accounted for 90% of trials, requiring consistent attention and motor response, while infrequent “X” trials assessed response inhibition[ 22 ]. Key outcome measures included reaction time (RT), reaction time variability (VRT), omission errors, and commission errors. To reduce the impact of test familiarity, all participants completed a brief practice session prior to the formal task. The CPT has demonstrated good reliability, with Cronbach’s alpha typically ranging from 0.83 to 0.92[ 23 ], and takes approximately 14–15 minutes to complete. The Go/No-Go task is a widely used paradigm to evaluate response inhibition and sustained attention. In this task, participants are required to respond as quickly as possible to frequent “Go” stimuli by pressing a key and to withhold their response when infrequent “No-Go” stimuli appear. Typically, Go trials constitute around 70–90% of total trials, which induces a prepotent tendency to respond, making inhibition on No-Go trials more demanding[ 24 ]. The primary outcome measures include commission errors (responding to No-Go stimuli), omission errors (failing to respond to Go stimuli), reaction times (RTs) on Go trials, and reaction time variability. These metrics reflect aspects of impulsivity, inhibitory control, and attentional consistency. The task is brief (generally lasting 10–15 minutes), easy to administer, and has been validated across various age groups. Statistical analysis All statistical analyses were performed using R software (version 4.5.0). Descriptive statistics were computed to summarize the demographic and clinical characteristics of the sample. Pearson correlation analyses were conducted to examine the bivariate associations among tic severity, sleep problems, and cognitive task performance. This allowed for a preliminary assessment of the relationships among the key variables. To further explore the predictive relationships between tic severity and cognitive performance, multiple linear regression analyses were conducted, with cognitive task outcomes as dependent variables and tic severity and sleep problems as independent variables. ADHD symptoms were included as covariates to control for their potential confounding effects. Moderation analyses were conducted using the lm() function in R to examine whether sleep problems moderated the relationship between tic severity and cognitive function. Interaction terms between tic severity and sleep measures were entered into the regression models to test for moderation effects. To control for multiple comparisons across the large number of models, p -values were adjusted using the false discovery rate (FDR) correction method[ 25 ]. Results were first examined at an uncorrected threshold ( p < .05) and then re-evaluated after FDR adjustment. All models controlled for attention-deficit/hyperactivity disorder (ADHD) symptom severity, as assessed by the SNAP-IV, to evaluate the robustness of the findings beyond ADHD symptoms. And simple slope analyses were conducted for significant interactions to probe the nature of the moderation effects. All continuous variables were mean-centered prior to interaction testing to reduce multicollinearity. A significance threshold of p < .05 was used for all statistical tests. All continuous variables were standardized before inclusion in the regression models to facilitate interpretation of interaction terms. Results Sample characteristics A total of 101 outpatients diagnosed with tic disorders were included in the study, of whom the majority were boys (81.2%). The mean age of participants was 9.02 ± 1.61 years. Tic severity, as measured by the Yale Global Tic Severity Scale (YGTSS), showed an average total score of 18.45 ± 6.37, with mean motor tic and phonic tic scores of 11.51 ± 4.45 and 6.93 ± 4.82, respectively. Most participants presented with mild tics (79.2%), while 20.8% had moderate tics. The mean SNAP-IV total score was 26.72 ± 14.88, indicating variable levels of ADHD-related symptoms. Sleep problems were common, with a high mean total score on the Children’s Sleep Habits Questionnaire (CSHQ) of 82.35 ± 6.07. Scores for the eight CSHQ subscales are summarized in Table 1 . In terms of cognitive performance, results from the neuropsychological battery revealed variability across multiple domains, including task accuracy, commission and omission errors, mean reaction times, reaction time variability, etc. Detailed descriptive statistics for all cognitive outcomes are shown in Table 1 . Table 1 Demographic and clinical characteristics of participants Variables Mean ± SD/N (%) age 9.02±1.61 Sex boys 82(81.2) girls 19(18.8) CSHQ 82.35±6.07 Bedtime resistance 13.58±3.40 Sleep onset delay 2.39±0.73 Sleep duration 7.51±1.54 Sleep anxiety 9.32±2.31 Night waking 8.54±0.82 Parasomnias 19.91±1.25 Sleep disordered breathing 8.59±0.85 Daytime sleepiness 16.59±2.41 YGTSS 18.45±6.37 Motor scores 11.51±4.45 Phonic scores 6.93±4.82 Impairment 1.23±0.42 Tic severity Mild 80(79.2) Moderate 21(20.8) SNAP 26.72±14.88 Continuous Performance Test (CPT) Accuracy 95.85±4.80 Error rate 71.60±18.03 Omission errors 4.15±4.80 Mean reaction time (RT) 390.55±65.17 Reaction time variability (RTV) 163.04±66.45 Go/No-Go task Total errors 20.58±5.65 Commission errors 12.96±3.00 Omission errors 7.61±5.46 Mean reaction time (RT) 403.05±61.87 Reaction time variability (RTV) 187.72±49.30 Correlation analysis Bivariate Pearson correlation analyses were conducted to examine the associations among tic severity scores, sleep variables, and cognitive performance indices. As shown in Table 2 , higher YGTSS total scores were positively correlated with CPT accuracy and negatively correlated with CPT omission errors. Regarding sleep, longer sleep onset delay and shorter sleep duration were both negatively associated with Go/No-go omission errors, suggesting that sleep disturbances were related to impaired inhibitory control. No significant correlations were observed between tic severity and sleep variables. In addition, strong intercorrelations were observed across cognitive tasks, such that indices of accuracy, error rates, mean reaction times, and reaction time variability were significantly associated with one another across CPT and Go/No-go paradigms (all p < 0.05). Table 2 Correlation Matrix Between Tic Severity, Sleep Variables, and Cognitive Performance 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 1 1.000 2 0.812 *** 1.000 3 0.430 *** 0.201 * 1.000 4 0.277 ** 0.028 0.238 * 1.000 5 0.713 *** 0.867 *** 0.075 -0.162 1.000 6 0.246 * 0.172 0.029 -0.114 0.183 1.000 7 0.373 *** 0.241 * 0.158 -0.028 0.252 * 0.087 1.000 8 0.124 0.090 0.029 -0.106 0.025 0.019 0.079 1.000 9 0.523 *** 0.159 0.180 0.079 0.160 -0.003 -0.092 -0.160 1.000 10 -0.045 -0.058 0.121 -0.010 -0.046 0.108 0.039 0.054 -0.111 1.000 11 0.007 0.010 0.085 -0.023 -0.003 0.070 0.042 0.143 -0.091 0.656 *** 1.000 12 -0.066 -0.087 0.081 0.008 -0.058 0.078 0.012 -0.061 -0.063 0.717 *** -0.056 1.000 13 -0.045 -0.015 0.114 0.062 -0.132 0.070 0.050 -0.076 -0.112 0.213 * 0.167 0.128 1.000 14 -0.033 -0.060 -0.052 0.010 -0.004 -0.118 -0.115 -0.146 0.154 0.044 -0.088 0.140 -0.139 1.000 15 0.045 0.015 -0.114 -0.062 0.132 -0.070 -0.050 0.076 0.112 -0.213 * -0.167 -0.128 -1.000 *** 0.139 1.000 16 -0.114 -0.096 -0.126 0.147 -0.120 -0.083 0.049 -0.014 -0.145 0.006 0.065 -0.052 -0.196 -0.574 *** 0.196 1.000 17 0.047 0.018 -0.141 0.035 0.135 0.011 -0.122 -0.077 0.148 0.046 -0.016 0.076 -0.678 *** 0.339 ** 0.678 *** 0.192 1.000 18 0.066 0.072 -0.147 -0.177 0.177 0.057 0.039 0.065 0.091 -0.053 -0.041 -0.033 -0.705 *** 0.279 ** 0.705 *** 0.023 0.603 *** 1.000 19 0.129 0.093 0.098 0.046 0.133 -0.015 0.007 0.016 0.084 0.034 -0.105 0.141 -0.080 0.651 *** 0.080 -0.595 *** 0.250 * 0.326 ** 1.000 20 -0.003 0.023 -0.205 * -0.208 * 0.110 0.067 0.036 0.059 0.048 -0.073 0.015 -0.111 -0.685 *** -0.068 0.685 *** 0.350 *** 0.486 *** 0.855 *** -0.212 * 1.000 21 -0.128 -0.131 -0.059 0.096 -0.152 -0.064 0.053 0.047 -0.157 0.104 0.195 -0.042 -0.100 -0.417 *** 0.100 0.755 *** 0.054 -0.011 -0.668 *** 0.355 *** 1.000 22 0.007 0.035 -0.147 0.031 0.096 -0.030 -0.058 -0.001 0.008 0.034 0.056 -0.006 -0.546 *** 0.291 ** 0.546 *** 0.151 0.709 *** 0.626 *** 0.286 * 0.490 *** 0.182 1.000 Note: *p < 0.05, **p < 0.01, ***p < 0.001; 1 = CSHQ total scores; 2 = bedtime resistance; 3 = sleep onset delay; 4 = sleep duration; 5 = sleep anxiety; 6 = night waking; 7 = parasomnias; 8 = sleep disordered breathing; 9 = daytime sleepiness; 10 = YGTSS total scores; 11 = motor tics; 12 = phonic tics; 13 = CPT accuracy; 14 = CPT error rate; 15 = CPT omission errors; 16 = CPT mean reaction time(RT); 17 = CPT reaction time variability (RTV); 18 = Go/no-go total errors; 19 = Go/no-go commission errors ; 20 = Go/no-go omission errors; 21 = Go/no-go mean reaction time (RT); 22 = Go/no-go reaction time variability (RTV). Moderation analyses Despite the absence of direct associations between tic severity and sleep problems, moderation analyses demonstrated that several sleep domains significantly influenced the relationship between tic severity and cognitive outcomes. Across all tested models, 23 significant moderation effects were observed. Specifically, sleep onset delay significantly moderated the relationship between YGTSS total scores and CPT error rate, as well as between tic severity and Go/No-Go commission errors and mean reaction time. Bedtime resistance was found to moderate the associations between motor tics and CPT reaction time variability, as well as between motor tics and Go/No-Go total errors. Moreover, sleep duration played a prominent moderating role, influencing the relationships between phonic tics and CPT accuracy, CPT omission errors, CPT mean reaction time, and Go/No-Go omission errors. Finally, the total score of the CSHQ moderated the association between YGTSS total scores and CPT mean reaction time. Importantly, all of these moderation effects remained significant after controlling for ADHD symptoms as measured by the SNAP-IV, suggesting that the observed effects are robust and not attributable to comorbid attentional problems. To aid interpretation, representative interactions are visualized as simple-slope (interaction) plots in Fig. 1 , illustrating the direction and magnitude of effects at lower vs higher levels of the sleep moderator. While full significant model results are summarized in Table 3 . All moderation analyses were corrected for multiple comparisons using the false discovery rate (FDR) procedure. Although several interactions reached nominal significance at p < .05, none survived after FDR correction. Given the exploratory nature of this study and the consistency of these effects with theoretical expectations, uncorrected results are reported for completeness and to guide future hypothesis-driven research. Table 3. Significant Moderation Effects Before and After Controlling for ADHD Symptoms Dependent variables Independent variables Moderators Controlling for ADHD symptoms Before After β Std p β Std p CPT reaction time variability Motor tics Bedtime resistance 0.258 0.099 0.011 0.254 0.099 0.012 Go/no-go total errors Motor tics Bedtime resistance 0.210 0.100 0.039 0.210 0.101 0.040 CPT mean reaction time Phonic tics Bedtime resistance 0.237 0.099 0.018 0.225 0.098 0.024 Go/no-go mean reaction time Motor tics Sleep onset delay 0.220 0.101 0.032 0.231 0.101 0.025 CPT error rate Phonic tics Sleep onset delay -0.231 0.098 0.020 -0.220 0.098 0.027 Go/no-go commission errors Phonic tics Sleep onset delay -0.220 0.098 0.027 -0.218 0.099 0.030 CPT error rate YGTSS Sleep onset delay -0.216 0.095 0.026 -0.218 0.095 0.024 Go/no-go commission errors YGTSS Sleep onset delay -0.225 0.095 0.020 -0.225 0.095 0.020 Go/no-go mean reaction time YGTSS Sleep onset delay 0.198 0.095 0.040 0.200 0.095 0.038 CPT accuracy Phonic tics Sleep duration -0.207 0.101 0.043 -0.205 0.100 0.042 CPT omission errors Phonic tics Sleep duration 0.207 0.101 0.043 0.205 0.100 0.042 CPT mean reaction time Phonic tics Sleep duration 0.216 0.100 0.034 0.214 0.098 0.031 Go/no-go omission errors Phonic tics Sleep duration 0.278 0.097 0.005 0.278 0.098 0.005 CPT reaction time variability Motor tics Sleep anxiety 0.220 0.104 0.036 0.215 0.103 0.039 Go/no-go reaction time variability Motor tics Sleep anxiety 0.238 0.103 0.024 0.231 0.102 0.026 CPT reaction time variability Phonic tics Parasomnias -0.229 0.110 0.040 -0.242 0.110 0.031 CPT mean reaction time Phonic tics Sleep disordered breathing 0.249 0.100 0.015 0.272 0.098 0.006 Go/no-go mean reaction time Phonic tics Sleep disordered breathing 0.207 0.101 0.044 0.221 0.101 0.031 CPT error rate Phonic tics Daytime sleepiness -0.209 0.096 0.033 -0.199 0.098 0.044 CPT reaction time variability Motor tics CSHQ total scores 0.224 0.102 0.030 0.221 0.101 0.031 CPT error rate Phonic tics CSHQ total scores -0.237 0.099 0.018 -0.225 0.099 0.025 CPT mean reaction time Phonic tics CSHQ total scores 0.249 0.099 0.013 0.234 0.098 0.019 CPT mean reaction time YGTSS CSHQ total scores 0.198 0.097 0.044 0.190 0.095 0.049 Discussion The present study investigated whether sleep problems moderate the relationship between tic severity and cognitive performance in children and adolescents with tic disorders. Several key findings emerged. First, specific dimensions of sleep problems significantly moderated the associations between tic severity and multiple domains of neurocognitive functioning, including sustained attention, inhibitory control, and response inhibition. Importantly, these moderating effects remained robust even after controlling for ADHD symptoms, underscoring the independent role of sleep in shaping the interplay between tics and cognition. Although no direct correlations were observed between tic severity and sleep problems, the moderation results suggest that sleep may act as a contextual factor determining whether tic symptoms translate into cognitive impairments. Interestingly, tic severity was positively correlated with CPT accuracy and negatively correlated with omission errors. At first glance, this pattern may seem counterintuitive, as tic disorders are often assumed to involve attentional deficits. One possible explanation is that children with more severe tics may exert increased cognitive effort or adopt compensatory strategies during structured laboratory tasks, thereby maintaining higher accuracy. Alternatively, the CPT may not fully capture everyday attentional challenges, and task-specific vigilance could contribute to better accuracy scores. This association should not be interpreted as enhanced attentional efficiency, since other indices such as reaction time or variability may still reflect subtle deficits. Previous literature on cognition in tic disorders has been mixed: while several studies and reviews report deficits in inhibitory control and attentional regulation in some patients with Tourette syndrome or chronic tic disorders[ 26 ], other investigations — particularly those controlling for comorbidities or testing “pure” TD samples — have observed largely intact or even compensatory performance on tasks such as Go/No-Go and stop-signal paradigms[ 27 ], highlighting substantial heterogeneity across individuals and methodologies. Concurrently, a substantial body of work demonstrates that inadequate or fragmented sleep reliably impairs core neurocognitive domains relevant to our outcome measures — including sustained attention, response inhibition, processing speed, and executive control — across experimental, longitudinal, and population studies in children and adults[ 28 , 29 ]. Meta-analytic and review evidence links sleep restriction/poor sleep quality to worse attention and executive functioning[ 29 ], and experimental sleep-restriction/fragmentation studies show causal decrements in inhibitory control and increased reaction-time variability[ 30 ]. Importantly, experimental work also indicates that sleep can act as a moderator of cognitive performance: acute sleep restriction or fragmentation amplifies deficits in response inhibition and self-regulation in vulnerable individuals, implying that sleep problems may not only exert main effects but also change the strength or direction of relationships between clinical symptoms and cognition[ 31 ]. Taken together, these streams of evidence help explain why prior studies of tic–cognition associations have been inconsistent: differences in sample composition (presence/absence of comorbid ADHD), variability in sleep status across samples, and heterogeneity in cognitive paradigms can all produce divergent results. Our finding that specific sleep dimensions moderate the tic–cognition link therefore dovetails with and extends the existing literature by showing that sleep may be one of the contextual factors that accounts for heterogeneity in cognitive outcomes among youth with tic disorders. Mechanistically, the moderating role of sleep on the tic–cognition relationship may be understood through multiple, interrelated pathways. First, inadequate sleep and fragmented sleep patterns have been shown to impair multiple cognitive domains, particularly sustained attention, executive function, and inhibitory control — domains that overlap with those often challenged in tic disorders[ 29 ]. For example, a meta-analytic review of 61 studies found significant negative effects of sleep restriction on executive functioning (g = − 0.324, p < 0.001) and sustained attention (g = − 0.409, p < 0.001)[ 29 ]. Second, sleep disruption may reduce frontal-cortical resource availability and increase daytime fatigue, thereby limiting the cognitive reserve available to manage both tic impulses and task demands[ 32 , 33 ]. Third, in children with tic disorders, high tic severity may already place added demands on attentional and inhibitory systems; when sleep is compromised, these systems may be less capable of compensating, thereby magnifying tic-related cognitive deficits. In this way, sleep functions not merely as a coexisting problem but as a contextual amplifier of tic–cognition associations. The findings of the present study have important clinical and research implications. Clinically, the demonstration that specific sleep-disturbance dimensions moderate the relationship between tic severity and cognitive performance suggests that sleep assessment and targeted sleep interventions should be integrated into the routine management of children and adolescents with tic disorders. Given that all moderating effects remained significant even after controlling for ADHD symptoms, it indicates that sleep problems represent an independent treatment target rather than merely a by-product of comorbid ADHD or tic severity. Recent evidence from large-scale meta-analyses supports the value of sleep screening in tic disorders (pooled prevalence 34%)[ 8 ] and shows that co-occurring psychiatric symptoms such as ADHD and anxiety increase the likelihood of sleep problems in this population. From a research perspective, these results highlight the value of longitudinal designs and intervention trials to determine whether improving sleep (for example via behavioral sleep hygiene, structured bedtime routines, or chronotherapy) can attenuate tic-related cognitive impairments. In addition, future studies should explore whether sleep functions not only as a moderator but potentially as a mediator in the tic–cognition pathway, and whether interventions focused on sleep produce downstream improvements in executive function, attentional control, and overall academic/behavioral outcomes. Finally, given the emerging evidence implicating cortico-striato-thalamo-cortical (CSTC) circuitry in tics, sleep, and cognition alike[ 34 ], translational studies integrating neuroimaging, actigraphy, and neuropsychological testing may provide a mechanistic basis for sleep-focused interventions in tic disorders. Several limitations of the present study should be acknowledged. First, the cross-sectional design precludes causal inference regarding the directional relationships among tic severity, sleep disturbances, and cognitive outcomes. Longitudinal or interventional studies are needed to determine whether improving sleep leads to downstream benefits in cognitive performance or tic control. Second, sleep characteristics were assessed by parent-reported questionnaires (CSHQ), which may be subject to recall or perception bias; future research should incorporate objective measures such as actigraphy or polysomnography. Third, although ADHD symptom severity was statistically controlled (SNAP-IV total scores), other comorbidities—such as anxiety, obsessive–compulsive symptoms, or medication use—were not systematically accounted for, which might have influenced both sleep and cognition. Importantly, although multiple moderation effects reached nominal significance, these associations did not survive false discovery rate (FDR) correction. Therefore, the findings should be interpreted as preliminary and hypothesis-generating rather than conclusive. The pattern of results nevertheless suggests meaningful trends worthy of further investigation in larger samples with greater statistical power. Finally, our sample consisted of outpatients within a limited age range (6–14 years), which may restrict generalizability to younger children, adults, or community populations. Future studies should adopt longitudinal and multimodal approaches to clarify the causal pathways linking tics, sleep, and cognition, and to explore whether targeted sleep interventions could mitigate cognitive dysfunction in this population. Conclusion In summary, this study provides novel evidence that specific dimensions of sleep problems—such as sleep onset delay, bedtime resistance, sleep duration, and overall sleep problems—moderate the relationship between tic severity and cognitive performance in children and adolescents with tic disorders. These moderating effects remained significant even after controlling for ADHD symptoms, demonstrating that sleep independently influences how tic symptoms translate into attentional and executive function impairments. Importantly, the findings suggest that sleep problems act as a contextual factor rather than a mere comorbid condition, shaping the cognitive outcomes of affected individuals. These results underscore the importance of assessing and addressing sleep problems in clinical management, as interventions targeting sleep may help mitigate the cognitive consequences of tic disorders. Future longitudinal and interventional studies are warranted to establish causality and explore the therapeutic potential of sleep optimization in this population. Declarations Contributors Yonghua Cui and Na Li developed the research question and study design. Na Li, Xu Hong, Chang Xu and Ruijie Chen conducted the data collection. Na Li took the data analysis under the supervision of Yonghua Cui. Na Li contributed to data interpretation and writing of the report. Yonghua Cui oversaw the data analysis. Yonghua Cui and Junjuan Yan revised the report. All authors revised and approved the final report. Declaration of conflicting interests The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. Funding This work was supported by the grant from National Natural Science Foundation of China (NSFC) under Grant No. 82171538 and the Beijing High Level Public Health Technology Talent Construction Project No.2022-2-007. Acknowledgement The data collected in this study is based on the children's mental intelligence digital system Version 1.0 jointly developed and designed by Ying Li, Xu Hong and Yonghua Cui. Thanks to the three personnel who designed the system. References Association AP (2013) Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 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Assessment 27:1258-1271.10.1177/1073191119842255 Bussing R, Fernandez M, Harwood M, Wei H, Garvan CW, Eyberg SM, Swanson JM (2008) Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: psychometric properties and normative ratings from a school district sample. Assessment 15:317-328.10.1177/1073191107313888 D'Aiello B, Menghini D, Di Vara S, De Rossi P, Vicari S (2024) Predictors of Methylphenidate response in children and adolescents with ADHD: the role of sleep disturbances. Eur Arch Psychiatry Clin Neurosci10.1007/s00406-024-01932-7 Soreni N, Crosbie J, Ickowicz A, Schachar R (2009) Stop signal and Conners' continuous performance tasks: test--retest reliability of two inhibition measures in ADHD children. J Atten Disord 13:137-143.10.1177/1087054708326110 Dougherty DM, Mathias CW, Marsh DM, Jagar AA (2005) Laboratory behavioral measures of impulsivity. Behavior Research Methods 37:82-90.10.3758/BF03206401 Benjamini Y, Hochberg Y (1995) Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing. Journal of the Royal Statistical Society. Series B (Methodological) 57:289-300. Morand-Beaulieu S, Leclerc JB, Valois P, Lavoie ME, O'Connor KP, Gauthier B (2017) A Review of the Neuropsychological Dimensions of Tourette Syndrome. Brain Sci 710.3390/brainsci7080106 Indrajeet I, Atkinson-Clement C, Worbe Y, Pouget P, Ray S (2022) Compromised reactive but intact proactive inhibitory motor control in Tourette disorder. Sci Rep 12:2193.10.1038/s41598-022-05692-z Short MA, Blunden S, Rigney G, Matricciani L, Coussens S, C MR, Galland B (2018) Cognition and objectively measured sleep duration in children: a systematic review and meta-analysis. Sleep Health 4:292-300.10.1016/j.sleh.2018.02.004 Lowe CJ, Safati A, Hall PA (2017) The neurocognitive consequences of sleep restriction: A meta-analytic review. Neuroscience & Biobehavioral Reviews 80:586-604.https://doi.org/10.1016/j.neubiorev.2017.07.010 García A, Angel JD, Borrani J, Ramirez C, Valdez P (2021) Sleep deprivation effects on basic cognitive processes: which components of attention, working memory, and executive functions are more susceptible to the lack of sleep? Sleep Sci 14:107-118.10.5935/1984-0063.20200049 Schumacher AM, Miller AL, Watamura SE, Kurth S, Lassonde JM, LeBourgeois MK (2017) Sleep Moderates the Association Between Response Inhibition and Self-Regulation in Early Childhood. Journal of Clinical Child and Adolescent Psychology : the Official Journal For the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 46:222-235.10.1080/15374416.2016.1204921 Nofzinger EA, Buysse DJ, Germain A, Price JC, Miewald JM, Kupfer DJ (2004) Functional neuroimaging evidence for hyperarousal in insomnia. Am J Psychiatry 161:2126-2128.10.1176/appi.ajp.161.11.2126 Benkirane O, Delwiche B, Mairesse O, Peigneux P (2022) Impact of Sleep Fragmentation on Cognition and Fatigue. Int J Environ Res Public Health 1910.3390/ijerph192315485 Hall MD, Gipson KS, Gipson SYT, Colvin MK, Nguyen STT, Greenberg E (2025) Disrupted Cortico-Striato-Thalamo-Cortical Circuitry and Sleep Disturbances in Obsessive-Compulsive Spectrum, Chronic Tic, and Attention-Deficit/Hyperactivity Disorders. Harv Rev Psychiatry 33:114-126.10.1097/hrp.0000000000000429 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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11:30:08","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":155227,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8488651/v1/a4fc08ee62eb437caf1d72fb.html"},{"id":100778943,"identity":"9396ccff-d926-4427-a307-aab444d7da02","added_by":"auto","created_at":"2026-01-21 11:29:59","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":492281,"visible":true,"origin":"","legend":"\u003cp\u003eSelected interaction effects of tic severity and sleep variables on cognitive performance.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8488651/v1/21a3c388c96aafbd78b3e0a7.jpeg"},{"id":104834998,"identity":"1240d4da-65c7-4cce-81bb-700ce16a83fd","added_by":"auto","created_at":"2026-03-17 17:37:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1442683,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8488651/v1/8232e8b6-047e-4a91-a019-5929e4c7f3d4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sleep Problems Moderate the Association Between Tic Severity and Cognitive Function in Children: Effects Beyond ADHD Symptoms","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTic disorders are common neurodevelopmental conditions characterized by sudden, rapid, recurrent, and nonrhythmic motor movements or vocalizations (American Psychiatric Association, 2013)[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], encompassing transient tic disorder, chronic motor or vocal tic disorder, and Tourette syndrome (TS). They are among the most prevalent movement disorders in children, with community-based studies estimating lifetime prevalence ranging from approximately 0.2% to 46.3%[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u0026ndash;variability largely attributable to differences in study design, diagnostic criteria, and sample characteristics. Transient tics may affect up to 20% of school-aged youth[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], while the prevalence of TS is estimated at 0.85\u0026ndash;1.0%[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Tic onset typically occurs in early childhood (around ages 5\u0026ndash;6) and is more common in males than in females[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Symptoms often fluctuate, can be briefly suppressed, and tend to worsen under stress, fatigue, or excitement. Although symptoms often decline with age, a considerable subset of individuals continue to experience clinically significant tics and associated impairments into adolescence and adulthood, highlighting the enduring clinical relevance of tic disorders[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSleep disturbances are highly prevalent in children and adolescents with tic disorders, manifesting as delayed sleep onset, bedtime resistance, frequent night wakings, parasomnias, restless sleep, and sleep-disordered breathing[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A recent meta-analysis reported that approximately one-third of individuals with tic disorders experience clinically significant sleep problems, with a pooled prevalence estimate of around 34%[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Importantly, sleep problems in this population are not merely secondary complaints but are associated with greater tic severity, increased psychiatric comorbidities (such as Attention-deficit/hyperactivity disorder and anxiety), and impaired daytime functioning[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. From a neurocognitive perspective, inadequate or fragmented sleep is known to impair attention, response inhibition, and executive control\u0026mdash;domains already vulnerable in tic disorders[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Accordingly, sleep may act as a critical moderator that influences how tic severity translates into cognitive and functional impairments, either buffering or exacerbating their impact. Considering sleep as an interactive factor, rather than a mere comorbidity, provides new insights into the complex clinical presentation of tic disorders and highlights novel avenues for targeted interventions.\u003c/p\u003e \u003cp\u003eCognitive functioning is often impaired in children and adolescents with tic disorders, particularly in attention, executive control, and inhibitory processes. Previous studies have yielded mixed results, with some reporting deficits in inhibitory control and attentional regulation[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], whereas others found largely intact or compensatory performance, suggesting heterogeneity across individuals and the need for more nuanced models that account for moderating factors[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Attention-deficit/hyperactivity disorder (ADHD) is commonly comorbid, with co-occurrence rates reported up to 54.3%[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. ADHD symptoms, including inattention and impulsivity, can independently influence cognitive performance and confound tic\u0026ndash;cognition associations, making it critical to account for ADHD when examining cognitive outcomes in tic disorders.\u003c/p\u003e \u003cp\u003eDespite mounting evidence linking sleep to both tics and cognition, few studies have directly tested whether sleep moderates the relationship between tic severity and neurocognitive performance. Examining these moderating effects is clinically important, as it may explain why children with similar tic severity differ in cognitive performance. The present study aimed to determine whether specific sleep dimensions moderate the relationship between tic severity and cognitive performance. We also tested whether these moderating effects remain significant after controlling for ADHD symptoms, isolating the independent contribution of sleep.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eA total of 101 children and adolescents were recruited from the Pediatric Psychiatry Department of Beijing Children\u0026rsquo;s Hospital between December 2022 and February 2024. Participants ranged in age from 6 to 14 years, covering both childhood and early adolescence. All participants met DSM-5[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] diagnostic criteria for tic disorders, including Tourette syndrome, chronic motor or vocal tic disorder, or provisional tic disorder. Exclusion criteria included a history of other psychiatric disorders (such as intellectual disability, autism spectrum disorder, major mood disorders), neurological conditions (e.g., epilepsy or other movement disorders), serious physical illnesses, or use of medications known to affect cortical excitability. Individuals who had difficulty comprehending instructions or completing the cognitive assessments were also excluded. Diagnoses were made independently by two experienced child psychiatrists (LN and CYH), with an inter-rater intraclass correlation coefficient (ICC) exceeding 0.85, indicating high diagnostic agreement.\u003c/p\u003e \u003cp\u003eSample size estimation was conducted using R software (package \u0026ldquo;pwr\u0026rdquo;), targeting a medium effect size (Cohen\u0026rsquo;s \u003cem\u003ef\u0026sup2;\u003c/em\u003e = 0.15) and a conventional power level of 0.80. The result suggested that at least 77 participants were necessary to detect statistically meaningful effects. To increase the stability of the statistical models and account for potential heterogeneity in the sample, a total of 101 participants were ultimately enrolled in the study.\u003c/p\u003e \u003cp\u003e The study protocol was approved by the Ethics Committee of Beijing Children\u0026rsquo;s Hospital, Capital Medical University (approval number: IEC-C-006-A04-V.07). Informed verbal consent was obtained from the parents or guardians of all participants, in accordance with institutional and ethical guidelines.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eYale Global Tic Severity Scale (YGTSS)\u003c/h2\u003e \u003cp\u003eTic severity in this study was evaluated using the \u003cem\u003eYale Global Tic Severity Scale (YGTSS)\u003c/em\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], a semi-structured clinician-administered instrument that provides a comprehensive assessment of tic symptoms over the previous week. The scale demonstrates strong psychometric properties, including excellent internal consistency, interrater reliability[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and both convergent and divergent validity, and is widely regarded as the gold standard for tic assessment. In our study, trained psychotherapists (XC, CRJ) conducted the assessments through structured interviews, which incorporated both direct observation and patient self-report[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The YGTSS evaluates five key domains of tic expression: number, frequency, intensity, complexity, and the degree of functional interference caused by the tics. The assessment begins with a checklist covering up to 40 types of tics, categorized into simple motor, complex motor, simple vocal, and complex vocal tics. The YGTSS yields three core scores: a Motor Tic Score (0\u0026ndash;25), a Vocal Tic Score (0\u0026ndash;25), and a combined Total Tic Score (0\u0026ndash;50). An additional Impairment Score (0\u0026ndash;50) captures the impact of tics on daily functioning[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The combined scoring system facilitates a nuanced evaluation of both symptom severity and related impairment, and is sensitive to clinically meaningful changes in tic presentation.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eChildren’s Sleep Habits Questionnaire (CSHQ)\u003c/h3\u003e\n\u003cp\u003eThe Children\u0026rsquo;s Sleep Habits Questionnaire (CSHQ) is a well-validated parent-report measure designed to screen for sleep difficulties in children. It includes 33 items and has been extensively applied in both clinical and research settings across various populations[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Caregivers are asked to evaluate the frequency of sleep-related behaviors observed in their child over the past week using a 3-point Likert scale (\u0026ldquo;usually,\u0026rdquo; \u0026ldquo;sometimes,\u0026rdquo; and \u0026ldquo;rarely\u0026rdquo;). The questionnaire is composed of eight subdomains: bedtime resistance, delay in sleep onset, insufficient sleep duration, sleep-related anxiety, night-time awakenings, parasomnias, symptoms suggestive of sleep-disordered breathing, and excessive daytime sleepiness[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Higher scores on the total scale and each subscale reflect greater severity of sleep problems. The scale has demonstrated satisfactory internal consistency, acceptable test\u0026ndash;retest reliability, and sound discriminant validity[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eSwanson, Nolan, and Pelham Questionnaire (SNAP-IV)\u003c/h3\u003e\n\u003cp\u003eThe SNAP-IV is a widely used instrument designed to assess symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional behaviors in children and adolescents. It consists of 26 items, each rated on a 4-point Likert scale (0\u0026thinsp;=\u0026thinsp;not at all, 1\u0026thinsp;=\u0026thinsp;just a little, 2\u0026thinsp;=\u0026thinsp;quite a bit, 3\u0026thinsp;=\u0026thinsp;very much), and is typically completed by parents or teachers[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The items are divided into three subscales: Inattention (9 items), Hyperactivity/Impulsivity (9 items), and Oppositional Defiant Behaviors (8 items)[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Each subscale score is calculated as the average of its respective items, and a combined ADHD score can be derived by averaging the inattention and hyperactivity/impulsivity subscales. Higher scores indicate more severe symptomatology. The SNAP-IV has demonstrated good psychometric properties, including strong internal consistency and construct validity across both clinical and general populations[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCognitive tasks\u003c/h2\u003e \u003cp\u003eThe Continuous Performance Test (CPT) is a computerized task commonly used to assess sustained attention and inhibitory control. In this task, participants were presented with 360 letters, each displayed for approximately 250 milliseconds, across 18 sub-blocks. Interstimulus intervals (ISI) varied randomly between 1, 2, and 4 seconds. Participants were instructed to press the spacebar in response to all letters except the letter \u0026ldquo;X,\u0026rdquo; which served as the No-Go stimulus. Non-target stimuli accounted for 90% of trials, requiring consistent attention and motor response, while infrequent \u0026ldquo;X\u0026rdquo; trials assessed response inhibition[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Key outcome measures included reaction time (RT), reaction time variability (VRT), omission errors, and commission errors. To reduce the impact of test familiarity, all participants completed a brief practice session prior to the formal task. The CPT has demonstrated good reliability, with Cronbach\u0026rsquo;s alpha typically ranging from 0.83 to 0.92[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and takes approximately 14\u0026ndash;15 minutes to complete.\u003c/p\u003e \u003cp\u003eThe Go/No-Go task is a widely used paradigm to evaluate response inhibition and sustained attention. In this task, participants are required to respond as quickly as possible to frequent \u0026ldquo;Go\u0026rdquo; stimuli by pressing a key and to withhold their response when infrequent \u0026ldquo;No-Go\u0026rdquo; stimuli appear. Typically, Go trials constitute around 70\u0026ndash;90% of total trials, which induces a prepotent tendency to respond, making inhibition on No-Go trials more demanding[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The primary outcome measures include commission errors (responding to No-Go stimuli), omission errors (failing to respond to Go stimuli), reaction times (RTs) on Go trials, and reaction time variability. These metrics reflect aspects of impulsivity, inhibitory control, and attentional consistency. The task is brief (generally lasting 10\u0026ndash;15 minutes), easy to administer, and has been validated across various age groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using R software (version 4.5.0). Descriptive statistics were computed to summarize the demographic and clinical characteristics of the sample. Pearson correlation analyses were conducted to examine the bivariate associations among tic severity, sleep problems, and cognitive task performance. This allowed for a preliminary assessment of the relationships among the key variables.\u003c/p\u003e \u003cp\u003eTo further explore the predictive relationships between tic severity and cognitive performance, multiple linear regression analyses were conducted, with cognitive task outcomes as dependent variables and tic severity and sleep problems as independent variables. ADHD symptoms were included as covariates to control for their potential confounding effects.\u003c/p\u003e \u003cp\u003eModeration analyses were conducted using the lm() function in R to examine whether sleep problems moderated the relationship between tic severity and cognitive function. Interaction terms between tic severity and sleep measures were entered into the regression models to test for moderation effects. To control for multiple comparisons across the large number of models, \u003cem\u003ep\u003c/em\u003e-values were adjusted using the false discovery rate (FDR) correction method[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Results were first examined at an uncorrected threshold (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05) and then re-evaluated after FDR adjustment. All models controlled for attention-deficit/hyperactivity disorder (ADHD) symptom severity, as assessed by the SNAP-IV, to evaluate the robustness of the findings beyond ADHD symptoms. And simple slope analyses were conducted for significant interactions to probe the nature of the moderation effects. All continuous variables were mean-centered prior to interaction testing to reduce multicollinearity. A significance threshold of p\u0026thinsp;\u0026lt;\u0026thinsp;.05 was used for all statistical tests. All continuous variables were standardized before inclusion in the regression models to facilitate interpretation of interaction terms.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSample characteristics\u003c/h2\u003e \u003cp\u003eA total of 101 outpatients diagnosed with tic disorders were included in the study, of whom the majority were boys (81.2%). The mean age of participants was 9.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61 years. Tic severity, as measured by the Yale Global Tic Severity Scale (YGTSS), showed an average total score of 18.45\u0026thinsp;\u0026plusmn;\u0026thinsp;6.37, with mean motor tic and phonic tic scores of 11.51\u0026thinsp;\u0026plusmn;\u0026thinsp;4.45 and 6.93\u0026thinsp;\u0026plusmn;\u0026thinsp;4.82, respectively. Most participants presented with mild tics (79.2%), while 20.8% had moderate tics. The mean SNAP-IV total score was 26.72\u0026thinsp;\u0026plusmn;\u0026thinsp;14.88, indicating variable levels of ADHD-related symptoms. Sleep problems were common, with a high mean total score on the Children\u0026rsquo;s Sleep Habits Questionnaire (CSHQ) of 82.35\u0026thinsp;\u0026plusmn;\u0026thinsp;6.07. Scores for the eight CSHQ subscales are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. In terms of cognitive performance, results from the neuropsychological battery revealed variability across multiple domains, including task accuracy, commission and omission errors, mean reaction times, reaction time variability, etc. Detailed descriptive statistics for all cognitive outcomes are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and clinical characteristics of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean \u0026plusmn; SD/N (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.02\u0026plusmn;1.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eboys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82(81.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCSHQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.35\u0026plusmn;6.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBedtime resistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.58\u0026plusmn;3.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep onset delay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.39\u0026plusmn;0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.51\u0026plusmn;1.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.32\u0026plusmn;2.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNight waking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.54\u0026plusmn;0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParasomnias\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.91\u0026plusmn;1.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep disordered breathing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.59\u0026plusmn;0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDaytime sleepiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.59\u0026plusmn;2.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYGTSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.45\u0026plusmn;6.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMotor scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.51\u0026plusmn;4.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhonic scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.93\u0026plusmn;4.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImpairment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.23\u0026plusmn;0.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTic severity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80(79.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(20.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSNAP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.72\u0026plusmn;14.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContinuous Performance Test (CPT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAccuracy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95.85\u0026plusmn;4.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eError rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.60\u0026plusmn;18.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOmission errors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.15\u0026plusmn;4.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean reaction time (RT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e390.55\u0026plusmn;65.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReaction time variability (RTV)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e163.04\u0026plusmn;66.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGo/No-Go task\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal errors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.58\u0026plusmn;5.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommission errors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.96\u0026plusmn;3.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOmission errors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.61\u0026plusmn;5.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean reaction time (RT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e403.05\u0026plusmn;61.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReaction time variability (RTV)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e187.72\u0026plusmn;49.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation analysis\u003c/h2\u003e \u003cp\u003eBivariate Pearson correlation analyses were conducted to examine the associations among tic severity scores, sleep variables, and cognitive performance indices. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, higher YGTSS total scores were positively correlated with CPT accuracy and negatively correlated with CPT omission errors. Regarding sleep, longer sleep onset delay and shorter sleep duration were both negatively associated with Go/No-go omission errors, suggesting that sleep disturbances were related to impaired inhibitory control. No significant correlations were observed between tic severity and sleep variables. In addition, strong intercorrelations were observed across cognitive tasks, such that indices of accuracy, error rates, mean reaction times, and reaction time variability were significantly associated with one another across CPT and Go/No-go paradigms (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation Matrix Between Tic Severity, Sleep Variables, and Cognitive Performance\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"25\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c19\" colnum=\"19\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c20\" colnum=\"20\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c21\" colnum=\"21\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c22\" colnum=\"22\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c23\" colnum=\"23\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c24\" colnum=\"24\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c25\" colnum=\"25\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e 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colname=\"c21\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c23\" namest=\"c22\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c25\" namest=\"c24\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.812\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.430\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.201\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.277\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.238\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e 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namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.713\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.867\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.246\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.373\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.241\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.252\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.523\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-0.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-0.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.656\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.087\u003c/p\u003e \u003c/td\u003e 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align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.213\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e 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namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e 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colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-0.213\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-0.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e-1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e 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\u003cp\u003e-0.574\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-0.016\u003c/p\u003e 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colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e-0.705\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.279\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.705\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e0.603\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-0.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e-0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.651\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e-0.595\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e0.250\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e0.326\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.205\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.208\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-0.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e-0.685\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e-0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.685\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.350\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e0.486\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e0.855\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e-0.212\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-0.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e-0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e-0.417\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.755\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e-0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e-0.668\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e \u003cp\u003e0.355\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e-0.546\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.291\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.546\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e0.709\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e0.626\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e0.286\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e \u003cp\u003e0.490\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c22\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c24\" namest=\"c23\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c25\" namest=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"25\"\u003eNote: *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; 1\u0026thinsp;=\u0026thinsp;CSHQ total scores; 2\u0026thinsp;=\u0026thinsp;bedtime resistance; 3\u0026thinsp;=\u0026thinsp;sleep onset delay; 4\u0026thinsp;=\u0026thinsp;sleep duration; 5\u0026thinsp;=\u0026thinsp;sleep anxiety; 6\u0026thinsp;=\u0026thinsp;night waking; 7\u0026thinsp;=\u0026thinsp;parasomnias; 8\u0026thinsp;=\u0026thinsp;sleep disordered breathing; 9\u0026thinsp;=\u0026thinsp;daytime sleepiness; 10\u0026thinsp;=\u0026thinsp;YGTSS total scores; 11\u0026thinsp;=\u0026thinsp;motor tics; 12\u0026thinsp;=\u0026thinsp;phonic tics; 13\u0026thinsp;=\u0026thinsp;CPT accuracy; 14\u0026thinsp;=\u0026thinsp;CPT error rate; 15\u0026thinsp;=\u0026thinsp;CPT omission errors; 16\u0026thinsp;=\u0026thinsp;CPT mean reaction time(RT); 17\u0026thinsp;=\u0026thinsp;CPT reaction time variability (RTV); 18\u0026thinsp;=\u0026thinsp;Go/no-go total errors; 19\u0026thinsp;=\u0026thinsp;Go/no-go commission errors ; 20\u0026thinsp;=\u0026thinsp;Go/no-go omission errors; 21\u0026thinsp;=\u0026thinsp;Go/no-go mean reaction time (RT); 22\u0026thinsp;=\u0026thinsp;Go/no-go reaction time variability (RTV).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eModeration analyses\u003c/h2\u003e \u003cp\u003eDespite the absence of direct associations between tic severity and sleep problems, moderation analyses demonstrated that several sleep domains significantly influenced the relationship between tic severity and cognitive outcomes. Across all tested models, 23 significant moderation effects were observed. Specifically, sleep onset delay significantly moderated the relationship between YGTSS total scores and CPT error rate, as well as between tic severity and Go/No-Go commission errors and mean reaction time. Bedtime resistance was found to moderate the associations between motor tics and CPT reaction time variability, as well as between motor tics and Go/No-Go total errors. Moreover, sleep duration played a prominent moderating role, influencing the relationships between phonic tics and CPT accuracy, CPT omission errors, CPT mean reaction time, and Go/No-Go omission errors. Finally, the total score of the CSHQ moderated the association between YGTSS total scores and CPT mean reaction time. Importantly, all of these moderation effects remained significant after controlling for ADHD symptoms as measured by the SNAP-IV, suggesting that the observed effects are robust and not attributable to comorbid attentional problems. To aid interpretation, representative interactions are visualized as simple-slope (interaction) plots in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, illustrating the direction and magnitude of effects at lower vs higher levels of the sleep moderator. While full significant model results are summarized in \u003cb\u003eTable\u0026nbsp;3\u003c/b\u003e. All moderation analyses were corrected for multiple comparisons using the false discovery rate (FDR) procedure. Although several interactions reached nominal significance at p\u0026thinsp;\u0026lt;\u0026thinsp;.05, none survived after FDR correction. Given the exploratory nature of this study and the consistency of these effects with theoretical expectations, uncorrected results are reported for completeness and to guide future hypothesis-driven research.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"10\" nameend=\"c11\" namest=\"c2\"\u003e \u003cp\u003eTable\u0026nbsp;3. Significant Moderation Effects Before and After Controlling for ADHD Symptoms\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDependent variables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIndependent variables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c11\" namest=\"c6\"\u003e \u003cp\u003eControlling for ADHD symptoms\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003eAfter\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eStd\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCPT reaction time variability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMotor tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBedtime resistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGo/no-go total errors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMotor tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBedtime resistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCPT mean reaction time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhonic tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBedtime resistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGo/no-go mean reaction time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMotor tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSleep onset delay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCPT error rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhonic tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSleep onset delay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGo/no-go commission errors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhonic tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSleep onset delay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCPT error rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYGTSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSleep onset delay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGo/no-go commission errors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYGTSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSleep onset delay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGo/no-go mean reaction time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYGTSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSleep onset delay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCPT accuracy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhonic tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSleep duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCPT omission errors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhonic tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSleep duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCPT mean reaction time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhonic tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSleep duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGo/no-go omission errors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhonic tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSleep duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCPT reaction time variability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMotor tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSleep anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGo/no-go reaction time variability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMotor tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSleep anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCPT reaction time variability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhonic tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eParasomnias\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCPT mean reaction time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhonic tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSleep disordered breathing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGo/no-go mean reaction time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhonic tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSleep disordered breathing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCPT error rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhonic tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDaytime sleepiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCPT reaction time variability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMotor tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCSHQ total scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCPT error rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhonic tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCSHQ total scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCPT mean reaction time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhonic tics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCSHQ total scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCPT mean reaction time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYGTSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCSHQ total scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study investigated whether sleep problems moderate the relationship between tic severity and cognitive performance in children and adolescents with tic disorders. Several key findings emerged. First, specific dimensions of sleep problems significantly moderated the associations between tic severity and multiple domains of neurocognitive functioning, including sustained attention, inhibitory control, and response inhibition. Importantly, these moderating effects remained robust even after controlling for ADHD symptoms, underscoring the independent role of sleep in shaping the interplay between tics and cognition. Although no direct correlations were observed between tic severity and sleep problems, the moderation results suggest that sleep may act as a contextual factor determining whether tic symptoms translate into cognitive impairments.\u003c/p\u003e \u003cp\u003eInterestingly, tic severity was positively correlated with CPT accuracy and negatively correlated with omission errors. At first glance, this pattern may seem counterintuitive, as tic disorders are often assumed to involve attentional deficits. One possible explanation is that children with more severe tics may exert increased cognitive effort or adopt compensatory strategies during structured laboratory tasks, thereby maintaining higher accuracy. Alternatively, the CPT may not fully capture everyday attentional challenges, and task-specific vigilance could contribute to better accuracy scores. This association should not be interpreted as enhanced attentional efficiency, since other indices such as reaction time or variability may still reflect subtle deficits.\u003c/p\u003e \u003cp\u003ePrevious literature on cognition in tic disorders has been mixed: while several studies and reviews report deficits in inhibitory control and attentional regulation in some patients with Tourette syndrome or chronic tic disorders[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], other investigations \u0026mdash; particularly those controlling for comorbidities or testing \u0026ldquo;pure\u0026rdquo; TD samples \u0026mdash; have observed largely intact or even compensatory performance on tasks such as Go/No-Go and stop-signal paradigms[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], highlighting substantial heterogeneity across individuals and methodologies. Concurrently, a substantial body of work demonstrates that inadequate or fragmented sleep reliably impairs core neurocognitive domains relevant to our outcome measures \u0026mdash; including sustained attention, response inhibition, processing speed, and executive control \u0026mdash; across experimental, longitudinal, and population studies in children and adults[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Meta-analytic and review evidence links sleep restriction/poor sleep quality to worse attention and executive functioning[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], and experimental sleep-restriction/fragmentation studies show causal decrements in inhibitory control and increased reaction-time variability[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eImportantly, experimental work also indicates that sleep can act as a moderator of cognitive performance: acute sleep restriction or fragmentation amplifies deficits in response inhibition and self-regulation in vulnerable individuals, implying that sleep problems may not only exert main effects but also change the strength or direction of relationships between clinical symptoms and cognition[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Taken together, these streams of evidence help explain why prior studies of tic\u0026ndash;cognition associations have been inconsistent: differences in sample composition (presence/absence of comorbid ADHD), variability in sleep status across samples, and heterogeneity in cognitive paradigms can all produce divergent results. Our finding that specific sleep dimensions moderate the tic\u0026ndash;cognition link therefore dovetails with and extends the existing literature by showing that sleep may be one of the contextual factors that accounts for heterogeneity in cognitive outcomes among youth with tic disorders.\u003c/p\u003e \u003cp\u003eMechanistically, the moderating role of sleep on the tic\u0026ndash;cognition relationship may be understood through multiple, interrelated pathways. First, inadequate sleep and fragmented sleep patterns have been shown to impair multiple cognitive domains, particularly sustained attention, executive function, and inhibitory control \u0026mdash; domains that overlap with those often challenged in tic disorders[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. For example, a meta-analytic review of 61 studies found significant negative effects of sleep restriction on executive functioning (g = \u0026minus;\u0026thinsp;0.324, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and sustained attention (g = \u0026minus;\u0026thinsp;0.409, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Second, sleep disruption may reduce frontal-cortical resource availability and increase daytime fatigue, thereby limiting the cognitive reserve available to manage both tic impulses and task demands[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Third, in children with tic disorders, high tic severity may already place added demands on attentional and inhibitory systems; when sleep is compromised, these systems may be less capable of compensating, thereby magnifying tic-related cognitive deficits. In this way, sleep functions not merely as a coexisting problem but as a contextual amplifier of tic\u0026ndash;cognition associations.\u003c/p\u003e \u003cp\u003eThe findings of the present study have important clinical and research implications. Clinically, the demonstration that specific sleep-disturbance dimensions moderate the relationship between tic severity and cognitive performance suggests that sleep assessment and targeted sleep interventions should be integrated into the routine management of children and adolescents with tic disorders. Given that all moderating effects remained significant even after controlling for ADHD symptoms, it indicates that sleep problems represent an independent treatment target rather than merely a by-product of comorbid ADHD or tic severity. Recent evidence from large-scale meta-analyses supports the value of sleep screening in tic disorders (pooled prevalence 34%)[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and shows that co-occurring psychiatric symptoms such as ADHD and anxiety increase the likelihood of sleep problems in this population. From a research perspective, these results highlight the value of longitudinal designs and intervention trials to determine whether improving sleep (for example via behavioral sleep hygiene, structured bedtime routines, or chronotherapy) can attenuate tic-related cognitive impairments. In addition, future studies should explore whether sleep functions not only as a moderator but potentially as a mediator in the tic\u0026ndash;cognition pathway, and whether interventions focused on sleep produce downstream improvements in executive function, attentional control, and overall academic/behavioral outcomes. Finally, given the emerging evidence implicating cortico-striato-thalamo-cortical (CSTC) circuitry in tics, sleep, and cognition alike[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], translational studies integrating neuroimaging, actigraphy, and neuropsychological testing may provide a mechanistic basis for sleep-focused interventions in tic disorders.\u003c/p\u003e \u003cp\u003eSeveral limitations of the present study should be acknowledged. First, the cross-sectional design precludes causal inference regarding the directional relationships among tic severity, sleep disturbances, and cognitive outcomes. Longitudinal or interventional studies are needed to determine whether improving sleep leads to downstream benefits in cognitive performance or tic control. Second, sleep characteristics were assessed by parent-reported questionnaires (CSHQ), which may be subject to recall or perception bias; future research should incorporate objective measures such as actigraphy or polysomnography. Third, although ADHD symptom severity was statistically controlled (SNAP-IV total scores), other comorbidities\u0026mdash;such as anxiety, obsessive\u0026ndash;compulsive symptoms, or medication use\u0026mdash;were not systematically accounted for, which might have influenced both sleep and cognition. Importantly, although multiple moderation effects reached nominal significance, these associations did not survive false discovery rate (FDR) correction. Therefore, the findings should be interpreted as preliminary and hypothesis-generating rather than conclusive. The pattern of results nevertheless suggests meaningful trends worthy of further investigation in larger samples with greater statistical power. Finally, our sample consisted of outpatients within a limited age range (6\u0026ndash;14 years), which may restrict generalizability to younger children, adults, or community populations. Future studies should adopt longitudinal and multimodal approaches to clarify the causal pathways linking tics, sleep, and cognition, and to explore whether targeted sleep interventions could mitigate cognitive dysfunction in this population.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, this study provides novel evidence that specific dimensions of sleep problems—such as sleep onset delay, bedtime resistance, sleep duration, and overall sleep problems—moderate the relationship between tic severity and cognitive performance in children and adolescents with tic disorders. These moderating effects remained significant even after controlling for ADHD symptoms, demonstrating that sleep independently influences how tic symptoms translate into attentional and executive function impairments. Importantly, the findings suggest that sleep problems act as a contextual factor rather than a mere comorbid condition, shaping the cognitive outcomes of affected individuals. These results underscore the importance of assessing and addressing sleep problems in clinical management, as interventions targeting sleep may help mitigate the cognitive consequences of tic disorders. Future longitudinal and interventional studies are warranted to establish causality and explore the therapeutic potential of sleep optimization in this population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eContributors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYonghua Cui and Na Li developed the research question and study design. Na Li, Xu Hong, Chang Xu and Ruijie Chen conducted the data collection. Na Li took the data\u0026nbsp;analysis under the supervision of Yonghua Cui. Na Li contributed to data interpretation and writing of the report. Yonghua Cui\u0026nbsp;oversaw the data analysis. Yonghua Cui and Junjuan Yan revised the report. All authors revised and approved the final report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of conflicting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the grant from National Natural Science Foundation of China (NSFC) under Grant No. 82171538 and the Beijing High Level Public Health Technology Talent Construction Project No.2022-2-007.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data collected in this study is based on the children\u0026apos;s mental intelligence digital system Version 1.0 jointly developed and designed by Ying Li, Xu Hong and Yonghua Cui. Thanks to the three personnel who designed the system.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAssociation AP (2013) Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Publishing\u003c/li\u003e\n \u003cli\u003eCubo E (2012) Review of prevalence studies of tic disorders: methodological caveats. Tremor Other Hyperkinet Mov (N Y) 210.7916/d8445k68\u003c/li\u003e\n \u003cli\u003eScahill L, Specht M, Page C (2014) The Prevalence of Tic Disorders and Clinical Characteristics in Children. J Obsessive Compuls Relat Disord 3:394-400.10.1016/j.jocrd.2014.06.002\u003c/li\u003e\n \u003cli\u003eRobertson MM (2015) A personal 35 year perspective on Gilles de la Tourette syndrome: prevalence, phenomenology, comorbidities, and coexistent psychopathologies. 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JAMA Psychiatry 72:325-333.10.1001/jamapsychiatry.2014.2650\u003c/li\u003e\n \u003cli\u003eLeckman JF, Riddle MA, Hardin MT, Ort SI, Swartz KL, Stevenson J, Cohen DJ (1989) The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. Journal of the American Academy of Child and Adolescent Psychiatry 28:566-573.\u003c/li\u003e\n \u003cli\u003eWen F, Gu Y, Yan J, Liu J, Wang F, Yu L, Li Y, Cui Y (2021) Revisiting the structure of the Yale Global Tic Severity Scale (YGTSS) in a sample of Chinese children with tic disorders. BMC Psychiatry 21:394.10.1186/s12888-021-03399-5\u003c/li\u003e\n \u003cli\u003eLi N, Hong X, Cui Y, Li Y (2024) Clinical tics and quality of life in children and adolescents with tic disorders: The mediating role of sleep. Sleep Med 124:217-222.10.1016/j.sleep.2024.09.030\u003c/li\u003e\n \u003cli\u003eOwens JA, Spirito A, McGuinn M (2000) The Children\u0026apos;s Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep 23:1043-1051.\u003c/li\u003e\n \u003cli\u003eBonuck KA, Goodlin-Jones BL, Schechter C, Owens J (2017) Modified Children\u0026apos;s sleep habits questionnaire for behavioral sleep problems: A validation study. Sleep Health 3:136-141.10.1016/j.sleh.2017.03.009\u003c/li\u003e\n \u003cli\u003eHall CL, Guo B, Valentine AZ, Groom MJ, Daley D, Sayal K, Hollis C (2020) The Validity of the SNAP-IV in Children Displaying ADHD Symptoms. Assessment 27:1258-1271.10.1177/1073191119842255\u003c/li\u003e\n \u003cli\u003eBussing R, Fernandez M, Harwood M, Wei H, Garvan CW, Eyberg SM, Swanson JM (2008) Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: psychometric properties and normative ratings from a school district sample. Assessment 15:317-328.10.1177/1073191107313888\u003c/li\u003e\n \u003cli\u003eD\u0026apos;Aiello B, Menghini D, Di Vara S, De Rossi P, Vicari S (2024) Predictors of Methylphenidate response in children and adolescents with ADHD: the role of sleep disturbances. Eur Arch Psychiatry Clin Neurosci10.1007/s00406-024-01932-7\u003c/li\u003e\n \u003cli\u003eSoreni N, Crosbie J, Ickowicz A, Schachar R (2009) Stop signal and Conners\u0026apos; continuous performance tasks: test--retest reliability of two inhibition measures in ADHD children. 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Sleep Sci 14:107-118.10.5935/1984-0063.20200049\u003c/li\u003e\n \u003cli\u003eSchumacher AM, Miller AL, Watamura SE, Kurth S, Lassonde JM, LeBourgeois MK (2017) Sleep Moderates the Association Between Response Inhibition and Self-Regulation in Early Childhood. Journal of Clinical Child and Adolescent Psychology : the Official Journal For the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 46:222-235.10.1080/15374416.2016.1204921\u003c/li\u003e\n \u003cli\u003eNofzinger EA, Buysse DJ, Germain A, Price JC, Miewald JM, Kupfer DJ (2004) Functional neuroimaging evidence for hyperarousal in insomnia. Am J Psychiatry 161:2126-2128.10.1176/appi.ajp.161.11.2126\u003c/li\u003e\n \u003cli\u003eBenkirane O, Delwiche B, Mairesse O, Peigneux P (2022) Impact of Sleep Fragmentation on Cognition and Fatigue. Int J Environ Res Public Health 1910.3390/ijerph192315485\u003c/li\u003e\n \u003cli\u003eHall MD, Gipson KS, Gipson SYT, Colvin MK, Nguyen STT, Greenberg E (2025) Disrupted Cortico-Striato-Thalamo-Cortical Circuitry and Sleep Disturbances in Obsessive-Compulsive Spectrum, Chronic Tic, and Attention-Deficit/Hyperactivity Disorders. Harv Rev Psychiatry 33:114-126.10.1097/hrp.0000000000000429\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"tic disorders, sleep, cognitive function, moderate analysis","lastPublishedDoi":"10.21203/rs.3.rs-8488651/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8488651/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTic disorders are common neurodevelopmental conditions in children and adolescents, often accompanied by cognitive difficulties and sleep disturbances. Sleep problems may influence the extent to which tic severity affects cognitive performance, yet this potential moderating role remains largely unexplored. Understanding these interactions is critical for optimizing clinical management.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA total of 101 children and adolescents (ages 6\u0026ndash;14) with tic disorders were recruited. Tic severity was assessed using the Yale Global Tic Severity Scale (YGTSS), and sleep was measured via the Children\u0026rsquo;s Sleep Habits Questionnaire (CSHQ). Cognitive performance was evaluated using a battery including the Continuous Performance Test (CPT) and Go/No-Go tasks. Moderation analyses were conducted in R to examine whether sleep dimensions moderated the relationship between tic severity and cognition, and whether these effects persisted after controlling for Attention-deficit/hyperactivity disorder (ADHD) symptoms.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAcross 23 significant moderation models, specific sleep dimensions\u0026mdash;including sleep onset delay, bedtime resistance, sleep duration and other sleep aspects\u0026mdash;significantly moderated the associations between tic severity and cognitive performance. These effects remained significant after controlling for ADHD symptoms. No direct correlations were observed between tic severity and sleep, highlighting the contextual role of sleep in cognitive performance.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSleep problems independently shape the impact of tic severity on cognition. Assessment and management of sleep problems may mitigate cognitive deficits, suggesting that targeted sleep interventions could be an important component of comprehensive care for children and adolescents with tic disorders.\u003c/p\u003e","manuscriptTitle":"Sleep Problems Moderate the Association Between Tic Severity and Cognitive Function in Children: Effects Beyond ADHD Symptoms","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-21 10:05:41","doi":"10.21203/rs.3.rs-8488651/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"38f565ea-295c-47e0-b1fd-647268d24bf8","owner":[],"postedDate":"January 21st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-16T19:24:57+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-21 10:05:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8488651","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8488651","identity":"rs-8488651","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}