Last reviewed: November 2017
Last updated: August  2016



History and exam

Key diagnostic factors

  • presence of risk factors
  • early childhood onset
  • abnormal movements
  • vocal sounds
  • premonitory sensation or 'urge'
  • otherwise normal neurological examination

Other diagnostic factors

  • improvement of symptoms when focused on other tasks
  • worsening of symptoms under stress
  • ritualistic behaviours

Risk factors

  • male sex
  • age 3 to 8 years
  • FHx of TS or tics
  • hx of OCD or ADHD
  • FHx of OCD or ADHD
  • maternal antenatal smoking
  • first trimester maternal stress and severe nausea/vomiting
  • low birth weight

Diagnostic investigations

Investigations to consider

  • brain MRI
  • EEG
  • premonitory urge for tics scale (PUTS)
Full details

Treatment algorithm


Authors VIEW ALL

Research Psychiatrist

Tics and Tourette's Clinical and Research Program

Icahn School of Medicine at Mount Sinai

New York City


Department of Child and Adolescent Psychiatry and Psychology

Institute of Neurosciences

Hospital Clínic Universitari




BG-D has received a research grant from the Alicia Koplowitz Foundation.


Tics and Tourette’s Clinical and Research Program

Division of Tics, OCD and Related Problems

Icahn School of Medicine at Mount Sinai


Department of Psychiatry

Research Psychiatrist

Nathan Kline Institute for Psychiatric Research

Mount Sinai Behavioral Science Unit

New York City



BJC has received honoraria from the American Academy of Child and Adolescent Psychiatry and research support from Astra Zeneca, Auspex/Teva, Catalyst, Neurocrine, NIMH, and Shire. BJC has received funding from The Tourette Association of America for the Center of Excellence at Icahn School of Medicine at Mount Sinai.

Dr Blanca Garcia-Delgar and Dr Barbara J. Coffey would like to gratefully acknowledge Dr Victoria Chang and Dr Steven Frucht, the previous contributors to this monograph, as well as Zoey Shaw for her assistance in review and preparation of the manuscript. VC and SF declare that they have no competing interests.

Peer reviewers VIEW ALL

Specialised Registrar

Paediatric Neurology

Honorary Clinical Lecturer

Newcastle General Hospital




AB declares that she has no competing interests.

Professor of Neurology, Neurobiology, Anatomy and Pediatrics

Chief Child Neurology

University of Rochester




JM is an author of a number of references cited in this monograph.

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