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

Common Phenomenology of Tics

Common Presentation of Tics

Common Vocal Tics	Common Motor Tics
Throat clearing Grunting Sniffling Snorting Coughing Animal noises Syllables, words, phrases Echolalia: repeating vocalizations of others Coprolalia: obscene words Blocking/stuttering	Eye blinking Eye rolling/darting Head jerk Facial grimace Mouth/tongue movements Shoulder shrugs Chest/stomach tightening Pelvic tensing movements Leg/feet movements Arm/hand movements Echopraxia: copying another’s gestures Copropraxia: obscene gestures

Common Characteristics of Tics

< 12 yrs of age at onset
- ≥ 12 yrs of age at onset, consider functional etiology
Presence of urge and relief after the movement or vocalization
- Urge may be itchiness, muscle tightness, feeling of pent-up energy, discomfort
Exacerbated by emotions—excitement, stress
Waxing and waning nature
Mostly happens while awake
Tend to subside when child is actively engaged in a task
Tend to increase when talking about the tic

Diagnostic Criteria for Tic Disorders

Provisional Tic Disorder	< 1 yr duration ≥ 1 motor or vocal tics
Chronic Tic Disorder	Tourette Syndrome Lifetime history of multiple motor tics and at least one vocal tic ≥ 1 yr cumulative duration Chronic motor tic ≥ 1 motor tics ≥ 1 yr duration Chronic vocal tic ≥ 1 vocal tics ≥ 1 yr duration

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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

Common Phenomenology of Tics

Common Presentation of Tics

Common Characteristics of Tics

Diagnostic Criteria for Tic Disorders

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Innovation and your child

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

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

Common Phenomenology of Tics

Common Presentation of Tics

Common Characteristics of Tics

Diagnostic Criteria for Tic Disorders