Summary
Definition
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
Investigations to consider
- brain MRI
- EEG
- premonitory urge for tics scale (PUTS)
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 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.
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 monograph.
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 monograph.
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