Tourette's syndrome

Last reviewed: 26 Feb 2023
Last updated: 17 Jan 2023



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
More key diagnostic factors

Other diagnostic factors

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

Risk factors

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

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • brain MRI
  • EEG
  • premonitory urge for tics scale (PUTS)
More investigations to consider

Treatment algorithm


without ADHD or OCD

with ADHD

with OCD



Marco A. Grados, MD, MPH

Clinical Director

Associate Professor of Psychiatry and Behavioral Sciences

Department of Psychiatry and Behavioral Sciences

Division for Child and Adolescent Psychiatry

Johns Hopkins Medicine




MAG declares that he has no competing interests.


Dr Marco Grados would like to gratefully acknowledge Dr Blanca Garcia-Delgar, Dr Barbara J. Coffey, Dr Victoria Chang and Dr Steven Frucht, the previous contributors to this topic.

Peer reviewers

Anna Basu, BM, BCh, PhD, MA, MRCPCH

Specialised Registrar

Paediatric Neurology

Honorary Clinical Lecturer

Newcastle General Hospital




AB declares that she has no competing interests.

Jonathan Mink, MD, PhD

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 topic.

  • Differentials

    • Provisional tic disorder
    • Persistent (chronic) motor or vocal tic disorder
    • Stereotypies
    More Differentials
  • Guidelines

    • Practice guideline recommendations summary: the treatment of tics in people with Tourette syndrome and chronic tic disorders
    • Attention deficit hyperactivity disorder: diagnosis and management
    More Guidelines
  • Patient leaflets

    Tourette’s syndrome

    ADHD: what is it?

    More Patient leaflets
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