European Child & Adolescent Psychiatry

, Volume 22, Supplement 1, pp 55–60 | Cite as

Tic disorders and Tourette’s syndrome

  • Kerstin J. Plessen


Diagnostic categories of tic disorders include both transient and chronic tic disorders and Tourette’s disorder. Changes for this group of disorders proposed for the forthcoming DSM-5 system include: (1) The term “stereotyped” will be eliminated in the definition of tics and the new definition will be applied consistently across all entities of tic disorders; (2) the diagnosis “Transient Tic Disorder” will change its name to “Provisional Tic Disorder”; (3) introduction of two new categories in individuals whose tics are triggered by illicit drugs or by a medical condition; (4) specification of chronic tic disorders into those with motor tics or with vocal tics only; (5) specification of the absence of a period longer than 3 months without tics will disappear for Tourette’s Disorder. This overview discusses a number of implications resulting from these diagnostic modifications of the diagnostic classifications for use in the clinics. European guidelines for “Tourette’s syndrome and other Tic disorders” were published in 2011 in the ECAP by the “European Society for the Study of Tourette Syndrome”. The guidelines emphasize the complexity of these neuropsychiatric disorders that require interdisciplinary cooperation between medical professionals, but also patients, parents and teachers for planning of treatment. The main conclusion derived from the guideline for pharmacological treatment is the urgent need for rigorous studies that address the effectiveness of anti-tic medications. The guidelines also emphasize the importance of facilitating the dissemination of several behavioral treatment approaches, such as “Exposure Response Prevention”, yet the most well documented being “Habit Reversal Training”.


Tics Tourette  Guidelines  Diagnostic system 



This work was supported by the Capital Region Psychiatry, Denmarkand the Research Council of Norway (grant nr. 544/H10).

Conflict of interest

The corresponding author states that there are no conflicts of interest. This article is part of the supplement “The Future of Child and Adolescent Psychiatry and Psychology: The Impact of DSM 5 and of Guidelines for Assessment and Treatment”. This supplement was not sponsored by outside commercial interests.


  1. 1.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th ednGoogle Scholar
  2. 2.
    Bloch MH, Panza KE, Landeros-Weisenberger A, Leckman JF (2009) Meta-analysis: treatment of attention-deficit/hyperactivity disorder in children with comorbid tic disorders. J Am Acad Child Adolesc Psychiatry 48:884–893PubMedCrossRefGoogle Scholar
  3. 3.
    Bloch MH, Peterson BS, Scahill L, Otka J, Katsovich L, Zhang H, Leckman JF (2006) Adulthood outcome of tic and obsessive-compulsive symptom severity in children with Tourette syndrome. Arch Pediatr Adolesc Med 160:65–69PubMedCrossRefGoogle Scholar
  4. 4.
    Castellanos FX, Giedd JN, Elia J, Marsh WL, Ritchie GF, Hamburger SD, Rapoport JL (1997) Controlled stimulant treatment of ADHD and comorbid Tourette’s syndrome: effects of stimulant and dose. J Am Acad Child Adolesc Psychiatry 36:589–596PubMedCrossRefGoogle Scholar
  5. 5.
    Cath DC, Hedderly T, Ludolph AG, Stern JS, Murphy T, Hartmann A, Czernecki V, Robertson MM, Martino D, Munchau A, Rizzo R (2011) European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment. Eur Child Adolesc Psychiatry 20:155–171PubMedCrossRefGoogle Scholar
  6. 6.
    Curtis A, Clarke C, Rickards H (2009) Cannabinoids for Tourette’s Syndrome. Cochrane Database Syst Rev CD006565Google Scholar
  7. 7.
    Denckla M, Bemporad J, MacKay M (1976) Tics following methylphenidate administration. A report of 20 cases. JAMA 235:1349Y1351Google Scholar
  8. 8.
    Gogtay N, Giedd JN, Lusk L, Hayashi KM, Greenstein D, Vaituzis AC, Nugent TF 3rd, Herman DH, Clasen LS, Toga AW, Rapoport JL, Thompson PM (2004) Dynamic mapping of human cortical development during childhood through early adulthood. Proc Natl Acad Sci USA 101:8174–8179PubMedCrossRefGoogle Scholar
  9. 9.
    Himle MB, Woods DW, Bunaciu L (2008) Evaluating the role of contingency in differentially reinforced tic suppression. J Appl Behav Anal 41:285–289PubMedCrossRefGoogle Scholar
  10. 10.
    Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988PubMedCrossRefGoogle Scholar
  11. 11.
    Khalifa N, von Knorring A (2005) Tourette syndrome and other tic disorders in a total population of children: clinical assessment and background. Acta Paediatr 94:1608–1614PubMedCrossRefGoogle Scholar
  12. 12.
    Kompoliti K, Goetz C (1997) Tourette syndrome. Clinical rating and quantitative assessment of tics. Neurol Clin 15:239–254PubMedCrossRefGoogle Scholar
  13. 13.
    Leckman J, Riddle M, Hardin M, Ort S, Swartz K, Stevenson J, Cohen D (1989) The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 28:566–573PubMedCrossRefGoogle Scholar
  14. 14.
    Leckman JF (2012) Tic disorders. BMJ 344:d7659PubMedCrossRefGoogle Scholar
  15. 15.
    Leckman JF (2002) Tourette’s syndrome. Lancet 360:1577–1586PubMedCrossRefGoogle Scholar
  16. 16.
    Leckman JF, Walker DE, Cohen DJ (1993) Premonitory urges in Tourette’s syndrome. Am J Psychiatry 150:98–102PubMedGoogle Scholar
  17. 17.
    Muller-Vahl KR, Cath DC, Cavanna AE, Dehning S, Porta M, Robertson MM, Visser-Vandewalle V (2011) European clinical guidelines for Tourette syndrome and other tic disorders. Part IV: deep brain stimulation. Eur Child Adolesc Psychiatry 20:209–217PubMedCrossRefGoogle Scholar
  18. 18.
    Pierce A, Rickards H (2011) Atypical Antipsychotics for Tourette’s Syndrome. Cochrane Database Syst RevGoogle Scholar
  19. 19.
    Pringsheim T, Marras C (2009) Pimozide for tics in Tourette’s syndrome. Cochrane Database Syst Rev CD006996Google Scholar
  20. 20.
    Robertson M, Eapen V, Cavanna A (2009) The international prevalence, epidemiology, and clinical phenomenology of Tourette syndrome: a cross-cultural perspective. J Psychosom Res 67:475–483PubMedCrossRefGoogle Scholar
  21. 21.
    Roessner V, Hoekstra PJ, Rothenberger A (2011) Tourette’s disorder and other tic disorders in DSM-5: a comment. Eur Child Adolesc Psychiatry 20:71–74PubMedCrossRefGoogle Scholar
  22. 22.
    Roessner V, Plessen KJ, Rothenberger A, Ludolph AG, Rizzo R, Skov L, Strand G, Stern JS, Termine C, Hoekstra PJ (2011) European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment. Eur Child Adolesc Psychiatry 20:173–196PubMedCrossRefGoogle Scholar
  23. 23.
    Roessner V, Rothenberger A, Rickards H, Hoekstra PJ (2011) European clinical guidelines for Tourette syndrome and other tic disorders. Eur Child Adolesc Psychiatry 20:153–154PubMedCrossRefGoogle Scholar
  24. 24.
    Shapiro A, Shapiro E, Young J, Feinberg T (1988) Gilles de la Tourette syndrome. Raven Press, New YorkGoogle Scholar
  25. 25.
    Verdellen C, van de Griendt J, Hartmann A, Murphy T (2011) European clinical guidelines for Tourette syndrome and other tic disorders. Part III: behavioural and psychosocial interventions. Eur Child Adolesc Psychiatry 20:197–207PubMedCrossRefGoogle Scholar
  26. 26.
    Walkup JT, Ferrao Y, Leckman JF, Stein DJ, Singer H (2010) Tic disorders: some key issues for DSM-V. Depress Anxiety 27:600–610PubMedCrossRefGoogle Scholar
  27. 27.
    WHO (1992) ICD-10: The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostical guideline. World Health Organization, GenevaGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Centre for Child and Adolescent Psychiatry BispebjergCapital Region PsychiatryCopenhagen NVDenmark
  2. 2.Institute for Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
  3. 3.Department of Clinical Medicine, Faculty of Medicine and DentistryUniversity of BergenBergenNorway

Personalised recommendations