Last reviewed: 13 Apr 2021
Last updated: 19 Jan 2018



History and exam

Key diagnostic factors

  • male gender and early childhood onset
  • positive past psychiatric hx
  • positive FHx
  • abnormal movements
  • vocal sounds
  • premonitory sensation or "urge"
  • otherwise normal neurological exam

Other diagnostic factors

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

Risk factors

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

Diagnostic investigations

Treatment algorithm


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 is a member of the Medical Advisory Board and has received grant support from Cornelia de Lange Syndrome Foundation. MAG has a contract with Palo Alto Health Sciences Inc. for a biofeedback device trial.

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 monograph.

Peer reviewersVIEW 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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