Tics or Tourette Syndrome – Primary Care, Outpatient Specialty Care and Emergency Department

Co-Morbid Conditions

Screen for the following conditions that commonly occur along with tics, especially with chronic tics.

Condition	Screening and Additional Guidance
Attention-Deficit/Hyperactivity Disorder (ADHD)	Vanderbilt Assessment Scales May send the parent questionnaires in myCHOP Tics and ADHD are often diagnosed around the same age ADHD Clinical Pathway
Obsessive Compulsive Disorder (OCD)	Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) Anxiety Disorder and OCD Clinical Pathway
Anxiety	8 yrs – 18 yrs: SCARED 11 yrs – 17 yrs: GAD-7 May be sent as a myCHOP questionnaire Anxiety Disorder and OCD Clinical Pathway
Learning Disability	If learning concerns, request IEP evaluation with child’s school
Autism Spectrum Disorder (ASD)	Autism Screening, Referral and Management Clinical Pathway

Role of PANDAS/PANS

Prospective studies published after establishment of the Pediatric Autoimmune Neuropsychiatric Disorders (PANDAS) criteria have failed to show an association between onset or exacerbations of tics with group A streptococcal infections
Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) criteria no longer includes tics as a core symptom
Autoimmune or infectious evaluation is not indicated for tics
The following therapies are not recommended for the management of tics
- Antibiotics
- Corticosteroids
- IVIG
- NSAIDs
- Plasmapheresis

Reference

The American Academy of Pediatrics PANS Clinical Report

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Tics or Tourette Syndrome – Primary Care, Outpatient Specialty Care and Emergency Department

Co-Morbid Conditions

Role of PANDAS/PANS

Reference

Find a research study

Innovation and your child

Find research studies

Tics or Tourette Syndrome – Primary Care, Outpatient Specialty Care and Emergency Department – Co-Morbid Conditions

Tics or Tourette Syndrome – Primary Care, Outpatient Specialty Care and Emergency Department

Co-Morbid Conditions

Role of PANDAS/PANS

Reference