Last reviewed: 5 Nov 2021
Last updated: 08 Nov 2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • observed tics
  • premonitory sensation
  • ability to suppress tics
  • symptoms may improve when distracted
  • otherwise normal neurological examination

Other diagnostic factors

  • symptoms worse with stress, anxiety, or excitement
  • variable severity over time
  • symptoms of comorbid psychiatric disorder

Risk factors

  • onset at age <18 years
  • male sex
  • family history of tics
  • family history of obsessive-compulsive disorder (OCD), ADHD, or depression
  • antenatal maternal smoking
  • history of OCD or ADHD
  • history of autism spectrum disorder (ASD)

Diagnostic investigations

Investigations to consider

  • MRI brain with and without contrast
  • electroencephalogram
  • cerebrospinal fluid analysis (lumbar puncture)

Treatment algorithm



Tanya K. Murphy, MD, MS

JHMACH & USF Maurice A. and Thelma P. Rothman Chair of Developmental Pediatrics

Director, Rothman Center for Neuropsychiatry

Vice-Chair, University of South Florida Pediatrics

Professor, Departments of Pediatrics and Psychiatry

University of South Florida

Johns Hopkins All Children’s Hospital

St. Petersburg



TKM has received research grants from Auspex Pharmaceuticals, the National Institute of Mental Health, Shire Pharmaceuticals, Pfizer Inc., F. Hoffman-La Roche Ltd., AstraZeneca Pharmaceuticals, Centers for Disease Control and Prevention, Massachusetts General Hospital, Sunovion Pharmaceuticals, Neurocrine Bioscience, Psyadon Pharmaceuticals, and PANDAS Network. She is on the advisory board for the International Obsessive Compulsive Foundation. She is also an author of several references cited in this topic.

Fatima Masumova, DO

Forensic Psychiatry Fellowship, PGY-6

Rutgers Robert Wood Johnson Medical School

New Brunswick



FM declares that she has no competing interests.

Cathy L. Budman, MD


National Tourette Centre of Excellence at Northwell Health


Movement Disorders Program in Psychiatry


Hofstra Northwell School of Medicine

Northwell Health




CLB has received research funding from Otsuka, Psyadon, Auspex, Teva, Neurocrine, and Synchroneuron Pharmaceuticals. She is a consultant for Bracket and a paid speaker for the Centers for Disease Control and Prevention (CDC) - National Tourette Syndrome Association Partnership. She is an author of several references cited in this topic.


Dr Tanya K. Murphy, Dr Fatima Masumova, and Dr Cathy L. Budman would like to gratefully acknowledge Dr Amber Stocco, Dr Migvis Monduy, and Dr Bobbi Hopkins, previous contributors to this topic. AS, MM, and BH declare that they have no competing interests.

Peer reviewers

Francis Filloux, MD


Division of Pediatric Neurology

University of Utah School of Medicine

Salt Lake City



FF declares that he has no competing interests.

Use of this content is subject to our disclaimer