Last reviewed: 16 Sep 2021
Last updated: 21 Sep 2021

Summary

Definition

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
  • 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

Diagnostic investigations

Treatment algorithm

Contributors

Authors

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

Baltimore

MD

Disclosures

MAG has received a contract grant from Freespira, Inc. and travel expenses from the Cornelia deLange Syndrome Foundation.

Acknowledgements

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

Newcastle-upon-Tyne

UK

Disclosures

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

Rochester

NY

Disclosures

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

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