Primary Care, Outpatient Specialty Care and ED Clinical Pathway for Management of Children with Tics or Tourette Syndrome
Team Assessment
- History and Physical
- Determine age of onset of tic-like behavior
- Review any available video of behavior
- Differential Diagnosis
- Screen for co-morbid conditions
- Review common phenomenology and diagnostic criteria of tics
- Refer to ED or Neurology as indicated
- Concern for seizure
- Risk of injury
- Explosive onset
Undetermined
Screen for co-morbid conditions, especially if duration ≥ 1 yr
- Review differential diagnosis
- Refer to Neurology
- Instruct family to obtain video of movement
Not bothersome
Bothersome
Affecting school or daily life
Affecting school or daily life
- Family Education
- Follow up as clinically indicated
- Family Education
- Treatment Considerations
- Consider CBIT referral
- Pharmacologic Treatments
- Consider referral to Neurology
- Self-injurious tics
- Whiplash tics
- Complex co-occurring conditions
Evidence
- Practice Guideline Recommendations Summary: Treatment of Tics in People with Tourette Syndrome and Chronic Tic Disorders
- Comprehensive Systematic Review Summary: Treatment of Tics in People with Tourette Syndrome and Chronic Tic Disorders
- Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Clinical Report
- European Clinical Guidelines for Tourette Syndrome and Other Tic Disorders—Version 2.0. Part I: Assessment
- Lifetime Prevalence, Age of Risk, and Etiology of Comorbid Psychiatric Disorders in Tourette Syndrome
- European Society for the Study of Tourette Syndrome 2022 Criteria for Clinical Diagnosis of Functional Tic-Like Behaviours: International Consensus from Experts in Tic Disorders