Assessment of tics
| History | |
| Tic history (salient points) | |
| Age of onset of first tics | To determine type of tic |
| Course and age at worst tic severity | To prognosticate progression |
| Determine most debilitating complaints and symptoms | To determine management |
| Is the movement suppressible? | Identifies if it is indeed a tic |
| Triggers, exacerbating and relieving factors | Identifies if it is indeed a tic |
| Fluctuation of symptoms | Identifies if it is indeed a tic |
| Circadian profile of tic activity (including sleep) | Differentiates from other movement disorders |
| Possible relationship between infections (throat and ear) with tic exacerbation | Consider streptococcal autoimmunity |
| Developmental history | Identify other possible behavioural and neurological conditions, particularly comorbid conditions (eg, ADHD and OCD) |
| Past medical history | |
| Medication—current and past | Identify medication-induced movement disorder |
| Family and social history | |
| Family functioning—parental coping styles, parental conflict, social network, financial and housing situation | Identify potential stressors and triggers |
| Parent and patient rating scales, eg, Strengths and Difficulties Questionnaire | Identify functional difficulties |
| Impact on tics on family, learning, quality of life | Identify potential stressors and triggers |
| Family psychosocial and medical history | Identifies psychiatric and/or neurological conditions in relatives particularly of tics, OCD and ADHD in first-degree family |
| Other | |
| Collaborative data (eg, family members, school, video of tics) | To corroborate information, identifies if it is indeed a tic as may not be observed in clinic |
| Examination | |
| General examination | |
| Dysmorphic features | Identify genetic syndromes particularly in association with learning difficulties/autism spectrum. Consult clinical genetics and consider CGH-array if available. |
| Neurological examination | Exclude severe or progressive neurological disorders |
| Observation of tic | Differentiate from other movement disorders (table 2) |
| Fine motor skills, eg, writing and putting lid on pen | Differentiate from other movement disorders. Tics less pronounced when concentrating. |
| Investigations | |
| EEG, neuroimaging, laboratory studies | These are rarely indicated. They may assist in differential diagnoses when the presentation is not typical or deterioration is severe |
| Neuropsychological evaluation (intellectual function, academic attainments, motor skills, attention, executive function and memory) | If the child has comorbid ADHD or OCD |
| Yale Global Tic Severity Scale18 | Measures likelihood of having TS |
ADHD, attention-deficit hyperactivity disorder; CGH comparative genomic hybridisation; OCD, obsessive-compulsive disorder; TS, Tourette syndrome.