Tics and Tourettes in Children (Paediatric Guidelines)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Audience

  • North NHS Highland only
  • Primary and Secondary care 
  • Paediatrics only

Tics are sudden recurrent individually recognisable vocalisations, intermittent movements or movement fragments that are almost always briefly suppressible and are usually associated with awareness of an urge to perform the movement. They are very common in children aged 5 years and older (peak 10 to 13years). Characteristic features of tics are predictability of movement, predictability of onset and triggered by suggestion, sensory cues, stress, excitement or demonstration.

  • Tics usually increase with stress, tiredness and boredom and are often prominent when watching television, there are triggers individual for each person.
  • Tics usually decrease with concentration, exercise and distraction. They decrease in frequency during sleep but do not go away completely.
  • Tics are often accompanied by other associated disorders such as ADHD, OCD, ASD, mood disorders and problems in relation to conduct. If there are concerns around a neuro developmental condition then an NDAS referral can be initiated by education and the family.

Tourette’s syndrome is the presence of motor and vocal tics for at least a year.

Referral

Referral to medical / community paediatrics is not required and the parents can be directed to the self-help information below.

Information to include in the referral

Please include the following points from history in the referral letter

  • Current and any previous motor or vocal tics
  • Duration of symptoms
  • Any associated neurological or psychiatric conditions
  • Other neurodevelopmental symptoms i.e. ADHD, ASD, sensory issues
  • History of repetitive behaviour, coprolalia, echolalia.
  • Any relevant social history, including school attended
  • Psychosocial impairment, impact on activities of daily living, pain or injury
  • Family history of tics, neurodevelopmental disorder and psychiatric illness

Information to include on examination

  • Any neurological abnormalities

Who to refer to medical paediatrics

  • If diagnosis is in doubt or uncertain (Please ask the families to take videos and get in touch with Paediatrics via Clinical dialogue, so we can ask the family to share these via a confidential video platform, Vcreate, and get back to you)
  • Developmental regression
  • Neurological abnormality on examination.
  • Features of autoimmune encephalitis: an obvious and sudden change in the child’s health over a short period of time which include altered mental state, behavioural changes and agitation. They can have seizures or fits, abnormal movements, hallucinations, sleep disturbance and decreased consciousness and speech changes.

If the diagnosis is uncertain with concerns as above kindly discuss this with medical paediatrics via SCI gateway.

Who and when to refer to CAMHS

  • Significant associated mental health concerns (eg. OCD, low mood, anxiety)
  • If invasive tics are impacting on school and sleep despite the following interventions:
    • Non-pharmacological / Behavioural interventions trialled with input from Primary mental health work (PMHW)
    • Learning and Classroom support* (as below)

*Home, learning and classroom support strategies

  • Advise to ignore tics and do not bring attention to them which might exacerbate the tics
  • Do not ask the child to stop the tics
  • Advise parents and education to ensure young people have movement breaks
  • Encourage parents to discuss situation with Education for Support with recommendations as highlighted below * alongside support from Guidance Counsellor.
  • Psychoeducation of young person, family, teachers and peers
  • Provide proactive (not reactive) support and predictable routines
  • Provide breaks, with opportunities for physical movement
  • Designate a safe place to go to when tics are severe, with a pre-agreed pass or signal for time out
  • Preferential seating (eg, front of the class, close to the door)
  • A buddy for learning and social support (may help prevent bullying)
  • Planning / managing communication about tics (to school, peers/friends, employer) and self-advocacy (how to respond if asked about tics)
  • Allow scribe / computer if writing is affected; special provisions for examinations i.e. seating in a separate room, allowing extra time
  • Identify and avoid triggers; manage stress, anxiety, or boredom
  • Encourage relaxing activities and foster strengths and hobbies to boost self-esteem
  • Join support groups to share experiences and attend activities or events such as camps

Other behavioural therapies

Behaviour therapies in TS

Where tics have a significant impact on a child or young person's functioning and there are concerns about their mental health, a referral can be made to Child and Adolescent Mental Health Services (CAMHS) within NHS Highland: https://www.camhs-nhshighland.com/professionals

Young people with milder tics and mental health concerns who do not meet Tier 3 CAMHS criteria might also be able to access the PMHW service for consultation and advice or direct work (e.g. anxiety management).

Patient information

Information for teachers: 1583409432_tourettes-action-key-facts-for-teachers_Feb2020.pdf 

Further information for healthcare professionals

Abbreviations

  • ADHD: attention deficit hyperactivity disorder 
  • ASD: autism spectrum disorder 
  • CAMHS: child and adolescence mental health services
  • NDAS: neuro developmental assessment service
  • OCD: obsessive compulsive disorder
  • PMHW: Primary mental health work

Editorial Information

Last reviewed: 11/12/2025

Next review date: 11/12/2028

Author(s): Paediatrics and CAMHS.

Version: 1

Approved By: TAM Subgroup of the ADTC

Reviewer name(s): A Majethia, Consultant Paediatrician, A Barr, Clinical child Psychologist, J Hosie, Clinical child Psychologist.

Document Id: TAM737

References