Objective: To investigate the balance between goal-directed and habitual control in adolescents with Tourette syndrome (TS) and to determine how longitudinal changes in this balance relate to tic severity evolution and cortico-basal ganglia functional connectivity.

Background: Tics and habits are context-dependent motor patterns relying on cortico-basal ganglia circuitry and dopamine. Enhanced habitual control has been reported in unmedicated adults with TS. However, the balance between goal-directed and habitual control remains unexplored in adolescents–a critical developmental window for understanding of clinical outcome.

Method: 51 TS (15.83±1.82 y) and 59 healthy controls (HC; 16.68±1.92 y) completed a ‘slip-of-action’ task at baseline (V1), assessing habitual versus goal-directed control via response rates to rewarded (‘Go’) and secondary devalued (‘No-go’) outcomes. 42 TS were retested 18 months later (V2). Tic severity was assessed using the YGTSS/50. Resting-state functional connectivity was examined between basal ganglia and cortical regions involved in both behavioral systems. Mixed-effects models included age and change in tic severity (ΔYGTSS/50) as covariates.

Results: At V1, no differences in habitual control were observed between HC, medicated and unmedicated TS patients. Longitudinally, older age (p = 0.011) and tic improvement (p = 0.027) predicted better goal-directed performance. ΔYGTSS/50 correlated with change in No-go response rate (r = 0.322, p = 0.038): worsening tics were associated with increased habitual responding. Age-performance trajectories did not differ between TS and HC, indicating disease-specific ΔYGTSS/50 effects beyond normal maturation. Increased habitual control at V2 correlated with strengthened connectivity between nucleus accumbens (NAcc)-putamen (r = 0.321, p = 0.046), SMA-caudate (r = 0.376, p = 0.019) and NAcc-medial prefrontal cortex (r = 0.387, p = 0.015) and weakened SMA-M1 connectivity (r = -0.333, p = 0.038).

Conclusion: Adolescents with TS showed no baseline habitual control abnormalities. However, longitudinal increases in habitual responding track tic severity progression, independent of brain maturation and correlate with cortico-striatal circuits connectivity changes. Habitual control shifts dynamically with tic severity during adolescence and connectivity changes in habit-supporting circuits.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/longitudinal-shifts-in-goal-directed-and-habitual-control-relate-to-tic-severity-and-cortico-striatal-connectivity-in-adolescents-with-tourette-syndrome/