Information
Prevalence
- 5% lifetime prevalence of provisional tic disorder2
- 0.77% overall prevalence of Gilles de la Tourette’s syndrome4
- More common in children than adults, in boys than girls, and in special education populations4
- More than half of children with Tourette’s syndrome may have Attention Deficit Hyperactivity Disorder (ADHD)3
DSM-5 Definition and Diagnostic Criteria1
- Tics: Sudden, rapid, recurrent, non-rhythmic motor movements or vocalisations
- Vocalisations can be simple sounds (e.g. sniffing, throat clearing or coughing), or complex vocalisations (e.g. coprolalia); also includes speech blocking or stuttering-like symptoms
| Provisional tic disorder | Persistent (chronic) motor or vocal tic disorder | Tourette’s disorder |
| ≥1 motor or vocal tics | ≥1 motor or vocal tics present during the illness, but not both | ≥2 motor and ≥1 vocal tics present at some time during the illness, although not necessarily concurrently |
| Tics present for <1y since first tic onset | Tics persisted for >1y since first tic onset (frequency may wax and wane) | Tics persisted for >1y since first tic onset (frequency may wax and wane) |
| First tic onset <18y | | |
| Not attributable to substance* or medical condition† | | |
| Criteria for Tourette’s disorder or persistent (chronic) motor or vocal tic disorder not met | Criteria for Tourette’s disorder not met |
*Medication, cocaine †Huntington’s disease, post-viral encephalitis
Diagnosis
- Diagnosis is made clinically from history and examination
- No role for investigation if diagnosis is certain
Referral Guidelines:
- No referral required if diagnosis of tic disorder certain
- Refer to General Paediatrics in the first instance if diagnosis uncertain
- If diagnosis still uncertain:
- Discuss with Paediatric Neurology (for video review of movements) for a child with no neurodevelopmental co-morbidity
- Discuss with Community Paediatrics for a child already known to CCH with a neurodevelopmental disorder
- Refer to Child and Adolescent Mental Health Service for management of:
- neurodevelopmental/psychological co-morbidities (e.g., depression, anxiety, ADHD, OCD)
- treating these conditions may improve tics
- severe tics impacting activities of daily living or mental health (consider quantifying with Yale Global Tic Severity Scale)
- CBT has best evidence of efficacy; requires high degree of engagement so more suited for older children
- pharmacologic treatments have poor evidence but may be considered
- neurodevelopmental/psychological co-morbidities (e.g., depression, anxiety, ADHD, OCD)
- Reassure
- Tics will completely remit in many children with recent-onset tics or, more likely, will cease to be noticed or to affect quality of life2
- Most children with tics in isolation do not require medication
- Pharmacological treatment has poor evidence of efficacy6,7
- Cognitive behavioural therapy (CBT; e.g., habit reversal training) has good evidence of efficacy5 but requires high degree of engagement
- Support
- Provide information leaflets; e.g., ‘Tic Tips: Strategies to help you manage your Tourette Syndrome‘
- Signpost to Tourette Scotland (lists local support groups) and Tourettes Action website
- Identify co-morbidities (e.g., depression, anxiety, ADHD, Obsessive Compulsive Disorder (OCD)) and manage accordingly
1487860486_TS–the-simple-truth—A-guide-to-TS-for-children-and-young-people.pdf
Tourette Scotland – www.tourettescotland.org/
Tourettes Action – www.tourettes-action.org.uk/
1American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.
2Black KJ, Black ER, Greene DJ, Schlaggar BL. Provisional Tic Disorder: What to tell parents when their child first starts ticcing. F1000Res. 2016;5:696. doi: 10.12688/f1000research.8428.1.
3Khalifa N, von Knorring Al. Psychopathy in a Swedish population of school children with tic disorders. J Am Acad Child Adolesc Psychiatry. 2006;45(11):1346-1353. [PubMed: 17075357]
4Knight T, Steeves T, Day L, Lowerison M, Jette N, Pringsheim T. Prevalence of tic disorders: a systematic review and meta-analysis. Pediatr Neurol. 2012;47:77-90. doi: 10.1016/j.pediatrneurol.2012.05.002.
5Piacentini J, Woods DW, Scahill L, et al. Behavior Therapy for Children With Tourette Disorder: A Randomized Controlled Trial. JAMA. 2010;303(19):1929-1937. doi: 10.1001/jama.2010.607.
6Pringsheim T, Holler-Managan Y, Okun MS, Jankovic J, Piacentini J, Cavanna AE, Martino D, Müller-Vahl K, Woods DW, Robinson M, Jarvie E, Roessner V, Oskoui M. Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology May 2019;92(19):907-915. doi: 10.1212/WNL.0000000000007467.
7Weisman H, Qureshi IA, Leckman JF, Scahill L, Bloch MH. Systematic review: pharmacological treatment of tic disorders—efficacy of antipsychotic and alpha-2 adrenergic agonist agents. Neurosci Biobehav Rev.
