Summary
Definition
History and exam
Key diagnostic factors
- male sex and early childhood onset
- positive past psychiatric history
- positive family history
- 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 sex
- age 3 to 8 years
- family history of TS or tics
- history of OCD or ADHD
- family history of OCD or ADHD
- maternal prenatal smoking
- first trimester maternal stress and severe nausea/vomiting
- low birth weight
Diagnostic tests
1st tests to order
- clinical diagnosis
Tests to consider
- brain MRI
- EEG
- premonitory urge for tics scale (PUTS)
Treatment algorithm
without ADHD or OCD
with ADHD
with OCD
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 declares that he has no competing interests.
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.
Differentials
- Provisional tic disorder
- Persistent (chronic) motor or vocal tic disorder
- Stereotypies
More DifferentialsGuidelines
- Practice guideline recommendations summary: the treatment of tics in people with Tourette syndrome and chronic tic disorders
- Canadian guidelines for the evidence-based treatment of tic disorders: pharmacotherapy
More GuidelinesPatient information
Obsessive-compulsive disorder
ADHD: what is it?
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