Recognizing Neuropsychiatric Manifestations of TSC

Nearly all individuals with TSC experience at least one behavioral, psychiatric, intellectual, academic, neuropsychological or psychosocial concern. And these difficulties are not limited to patients with intellectual disability. As Jamie Capal, MD, director of Cincinnati Children’s Tuberous Sclerosis Complex-Associated Neuropsychiatric Disorders (TAND) Clinic, explains, “A patient does not need to have an intellectual disability for these disorders to affect their daily life. Difficulties with attention, flexibility, executive functioning or multitasking can create meaningful challenges even when overall intellectual functioning is otherwise normal.”

Neuropsychiatric concerns may be difficult to address during visits focused on epilepsy and other physical symptoms of TSC. Concerns involving behavior, school performance, attention, executive functioning, anxiety, depression, autism, development or learning may need more attention.

“When families or clinicians are noticing problems with behavior, school performance, attention, anxiety, autism, development or mental health, those concerns deserve to be evaluated individually rather than being assumed to be simply part of having a complex medical condition,” Capal says.

Focused evaluation can help characterize a patient’s challenges, distinguish among overlapping neuropsychiatric concerns and guide appropriate management and support.

Considering Neuropsychiatric Health Across the Lifespan

Neuropsychiatric manifestations of TSC can change with age and developmental stage. New demands may reveal difficulties that were less apparent earlier, particularly in executive functioning, independence, school or work performance, mental health and transition to adult care.

Periodic screening can help identify emerging concerns and determine when targeted neuropsychiatric, developmental or psychological evaluation may be appropriate.

Accessing Focused TAND Evaluation

When more focused assessment is indicated, patients may benefit from evaluation by clinicians experienced in the neuropsychiatric manifestations of TSC. Cincinnati Children’s Tuberous Sclerosis Complex-Associated Neuropsychiatric Disorders (TAND) Clinic is one option for pediatric and adult patients who need evaluation or management of behavioral, developmental, psychiatric or neuropsychological concerns.

Depending on individual needs, evaluation may include developmental and autism assessment and mental health screening, with psychiatry, psychology, speech-language pathology and social work involved as appropriate.

Patients referred for a focused TAND evaluation can continue their broader TSC care with their existing provider or center. In-person and telehealth appointments are available.

When to Refer

Consider referral for focused evaluation when a patient with TSC has unresolved or emerging concerns involving behavior, attention or executive functioning, school performance, anxiety, autism, development, mental health or transition to adult care.

(Published October 2026)

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