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Tourette Syndrome - Ongoing Assessment
Screening
No screening test exists for Tourette syndrome (TS). Consider asking about symptoms in children presenting with conditions commonly associated with TS, such as attention deficit hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD). For children with TS, consider screening for associated behavioral and neurodevelopmental disorders.Diagnostic Criteria
There is no diagnostic test to confirm TS. The following diagnostic criteria from the DSM-IV-TR ([American: 2000]) must be met for a diagnosis of TS:- both multiple motor tics and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently; (A tic is a sudden rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization.)
- the tics occur many times a day (usually in bouts) nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months;
- the onset is before age 18 years; and
- the disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington disease or post-viral encephalitis).
History And Examination
Interim History
Tic frequency should be monitored in ongoing visits. If the patient is taking medications for tics, effectiveness and side effects should be followed.Developmental and Educational Progress
Social, academic, mood-based, and other functional symptoms should be part of routine surveillance for children with TS. Open-ended questions about academic, social, organizational, and family functioning may uncover new concerns in these or other areas, warranting more detailed investigation.Social and Family Functioning
TS and associated conditions may contribute to problems in social and family functioning. Ask about success with friends and in school, and about behavior at school and within the family.Physical Exam
General
Watch for subtle signs of tics during the history-taking and exam. Watch for sedation if the child is on medication for TS (including antipsychotics and alpha-adrenergic agonists).Growth Parameters
Watch for excess weight gain (particularly associated with antipsychotic medication).Testing
Subspecialist Collaborations and Other Resources
For the child with severe TS and/or associated problems, co-management with a TS expert may be helpful. The pediatric specialties with the most expertise in TS and associated conditions may vary by community among child neurology, child psychiatry, or developmental pediatrics. If you have chosen a state's resources to be displayed, that region's local experts will be shown below. In addition, children with TS often need assessment by related professionals such as occupational therapy and psychology. Other services, as well as local and national organizations focused on TS, may be found in the Resources section.
Developmental Pediatrics (see Services below for relevant providers)
Often focused on younger children, but may have clinical experience and be helpful in evaluating children with TS and accessing other resources.
Child Psychiatry (see Services below for relevant providers)
May have considerable clinical experience with TS; particularly helpful when behavioral, learning, or mental health problems are also a concern.
Pediatric Neurology (see Services below for relevant providers)
May have considerable clinical experience with TS; particularly helpful if differentiating TS from other movement disorders or seizures is needed.
Comorbid Conditions
Most patients with TS (>90%) have one or more associated behavioral or neurodevelopmental conditions. These conditions may include:- ADHD (in approximately 50%);
- OCD (in approximately 30%);
- Learning problems (in approximately 20%);
- Anxiety (in approximately 30%);
- Sleep problems;
- Depression;
- Anger dysregulation; and
- Pervasive developmental disorders, including autism and Asperger syndrome.
Resources
Information & Support
For Professionals
Tourette Syndrome Association
The only national organization serving children, individuals, and families affected by Tourette Syndrome (TS). Includes six
online CME/CNE programs, programs on Recognition, Diagnosis and Treatment, as well as training for Allied Professionals and
Educators. The website also contains resources for patients and families.
For Parents and Patients
Tourette Syndrome Association, Utah Chapter
Utah chapter of the TSA offering educational advocacy; family support and get togethers; and educational materials.
Tourette Syndrome Association
The only national organization serving children, individuals, and families affected by Tourette Syndrome (TS). Includes six
online CME/CNE programs, programs on Recognition, Diagnosis and Treatment, as well as training for Allied Professionals and
Educators. The website also contains resources for patients and families.
Tourette syndrome (Genetics Home Reference)
Information for patients/families about Tourette syndrome from Genetics Home Reference, sponsored by the National Library
of Medicine
Practice Guidelines
Scahill L, Erenberg G, Berlin CM Jr, Budman C, Coffey BJ, Jankovic J, Kiessling L, King RA, Kurlan R, Lang A, Mink J, Murphy
T, Zinner S, Walkup J.
Contemporary assessment and pharmacotherapy of Tourette syndrome.
NeuroRx.
2006;3(2):192-206.
PubMed abstract
These guidelines are from the Tourette Syndrome Association Medical Advisory Board: Practice Committee.
Services
For other services related to this condition, browse our Services categories or search our database.
Helpful Articles
PubMed search on Tourette syndrome: review articles over
Zinner, SH.
Tourette syndrome - much more than tics; First of two parts, Moving beyond misconceptions to diagnosis.
Contemporary Pediatrics.
2004;21(8):22-36.
/ Full Text
First of a two part article; diagnosis of TS and associated questions are covered in this first section.
Zinner, SH.
Tourette syndrome - much more than tics; Second of two parts, Management tailored to the entire patient.
Contemporary Pediatrics.
2004;21(8):38-49.
/ Full Text
Second of a two part article, including the management of TS as part of management of the patient with possible associated
conditions.
Authors
| Authors: | Samuel H. Zinner M.D., 5/2008 Lynne M Kerr MD, PhD, 5/2008 |
| Reviewing Author: | Francis Filloux M.D., 7/2008 |
| Content Last Updated: | 8/2008 |