Diagnosis for Tic Disorders

Why diagnosis is important

Although there is no cure for tic disorders, there are treatments available to help manage the tics. Medication and behavioral treatments are available if tics cause pain or injury; interfere with school, work, or social life; or cause stress.

Types of tic disorders

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR)1 is used by health professionals to help diagnose tic disorders.

Three tic disorders are included in the DSM-5-TR:

• Tourette syndrome (TS, sometimes called Tourette disorder)
• Persistent (sometimes called chronic) motor or vocal tic disorder
• Provisional tic disorder

The tic disorders differ from each other in terms of the type of tic present (motor or vocal, or a combination of both), and how long the symptoms have lasted. People with Tourette syndrome have both motor and vocal tics and have had tic symptoms for at least 1 year. People with persistent motor or vocal tic disorders have either motor or vocal tics and have had tic symptoms for at least 1 year. People with provisional tic disorders can have motor or vocal tics, or both, but have had their symptoms less than 1 year.

Tourette syndrome

To be diagnosed with TS, a person must

• Have two or more motor tics (for example, blinking or shrugging the shoulders) and at least one vocal tic (for example, humming, clearing the throat, or yelling out a word or phrase), although they might not always happen at the same time.
• Have had tics for at least a year. The tics can occur many times a day (usually in bouts) nearly every day, or off and on.
• Have tics that begin before age 18 years.
• Have symptoms that are not due to taking medicine or other drugs or due to having another medical condition (for example, seizures, Huntington disease, or postviral encephalitis).

Persistent (chronic) motor or vocal tic disorder

To be diagnosed with a persistent tic disorder, a person must

• Have one or more motor tics (for example, blinking or shrugging the shoulders) or vocal tics (for example, humming, clearing the throat, or yelling out a word or phrase), but not both.
• Have tics that occur many times a day nearly every day or on and off throughout a period of more than a year.
• Have tics that start before age 18 years.
• Have symptoms that are not due to taking medicine or other drugs, or due to having a medical condition that can cause tics (for example, seizures, Huntington disease, or postviral encephalitis).
• Not have been diagnosed with TS.

Provisional tic disorder

To be diagnosed with a provisional tic disorder, a person must

• Have one or more motor tics (for example, blinking or shrugging the shoulders) or vocal tics (for example, humming, clearing the throat, or yelling out a word or phrase).
• Have been present for no longer than 12 months in a row.
• Have tics that start before age 18 years.
• Have symptoms that are not due to taking medicine or other drugs, or due to having a medical condition that can cause tics (for example, Huntington disease or postviral encephalitis).
• Not have been diagnosed with TS or persistent motor or vocal tic disorder.

Sudden onset of tic-like behaviors

Sometimes people have tic-like behaviors that look like tics, but that are distinctly different from those typically seen in Tourette syndrome and other tic disorders. The people who develop these tic-like behaviors are often experiencing movement symptoms for the first time, with no reported history of tics. These types of tic-like behaviors are more common among teenagers and more often seen in girls than boys. Sometimes these tics can happen in groups of children. Many experts believe these sudden onset tic-like behaviors can happen for different reasons, and tic-like behaviors may need different treatment compared to tic disorders including Tourette syndrome. The best first step is usually to talk to a healthcare provider who is familiar with tics and get a thorough assessment.

What to do when your child is diagnosed with Tourette syndrome

Taking an active role, learning about TS, and understanding treatment and ways to manage symptoms can help you make the best possible choices for your child and for your family.

• Talk to a healthcare provider about any questions or concerns.
• Learn as much as you can about TS. You can start by reading our pages on the following topics: Facts, Treatments, and Other Concerns & Conditions.
• Ask your provider about concerns and symptoms beyond tics. Most children with TS also have been diagnosed with at least one additional mental, behavioral, or developmental condition and these conditions often add to stress and difficulty in managing health care. Many children with TS also experience learning difficulties. Getting proper treatment and coordinated care is very important.
• Visit the website of the Tourette Association of America to find information, resources, newsletters, videos, and more. In addition, the Tourette Association can be helpful with finding local healthcare providers.

Finding support

Parenting is often challenging and parenting a child with a chronic condition like TS can add additional stress to the day-to-day challenges. If you are the parent of a child with TS, it might be helpful to talk with other parents who have a child with the same condition, to share concerns and information. Similarly, if you are an adult with TS, talking to other adults with TS might be helpful.

Remember that the choices for another family might not be best for your family, so it's important to understand all options and discuss them with your healthcare providers.

• Your local Tourette Association chapter can help you connect with other families through conferences, support groups and other events.
• Parent-to-Parent Programs provide information and emotional support to families of children who have special needs.

Resources

• Tourette Association of America
• American Academy of Child and Adolescent Psychiatry: Facts for Families – Tic Disorders
• Academy of Child and Adolescent Psychiatry (AACAP) — Practice Parameter
• American Academy of Neurology — Practice Guideline Recommendations