Mental Health: Tic and Tourette Disorders: Course, Prognosis and Approach for Pediatric Practice

Tic disorders, including Tourette syndrome (TS), are common childhood neurodevelopmental conditions. Tics are sudden, rapid, recurrent, nonrhythmic movements or vocalizations. When multiple motor tics and at least one vocal tic persist for more than a year, the diagnosis meets criteria for TS. TS typically emerges between ages 4 and 6 and peaks in preadolescence. Most children develop simple motor tics, such as eye blinking or facial grimacing, that often spread from the face and head to the shoulders and limbs. The tics become more complex over time.¹ Vocal tics usually begin one to two years later with simple sounds such as throat clearing or sniffing that may progress to words or phrases. Around age 10, many children report premonitory urges, which are brief sensations relieved by performing the tic.

Tics characteristically wax and wane, and tend to worsen with stress, anxiety, emotional excitement and fatigue, and lessen during focused, goal‑directed activities such as sports or music. It is helpful to explain to teachers that tics are not volitional misbehavior, even if children can sometimes postpone them.

Comorbidities: Often the Main Driver of Impairment
Attention-deficit/hyperactivity disorder and obsessive-compulsive disorder are very common in youth with tic disorders and often cause more day‑to‑day problems than the tics themselves.² Many children also struggle with emotional dysregulation and executive dysfunction.³ Caregivers describe “big feelings” that escalate quickly, “rage episodes,” meltdowns or shutdowns that seem out of proportion to the trigger with a slow return to baseline. Kids may have trouble filtering sensory input and managing internal tension, which can worsen both tics and behavior. Executive challenges (working memory, organization, planning, shifting between tasks) can hurt school performance and make daily routines difficult. Adults may misinterpret these problems as defiance rather than neurodevelopmental vulnerability.

Treatment: Who Needs It and Where to Start

Treatment starts with education and reassurance that tics are neurological and often improve. Intervention is needed if tics cause pain, distress or impairment. Mild tics may need only monitoring. First‑line treatment is behavioral therapy, particularly Comprehensive Behavioral Intervention for Tics (CBIT).⁴ Medication is reserved for moderate or severe impairment.

Information from Quezada J, Coffman KA¹

When to Refer and How to Support
General pediatricians can manage most mild tic presentations, but referral is warranted if the diagnosis is unclear, tics significantly impair function or comorbidities need specialized treatment. Referral to child psychiatry or neurology is especially important for abrupt, complex or atypical onset, such as mid‑adolescent onset, or functional tic‑like behaviors that can resemble Tourette syndrome.

Counseling should emphasize the following: tics almost always begin in childhood, peak in preadolescence and improve in adolescence; comorbid conditions often drive long‑term impairment and need active management; and promoting self‑esteem, strong peer relationships and school support is central to positive outcomes. With accurate diagnosis, education and collaborative care, most children with tics or Tourette syndrome grow up to lead healthy, well‑adjusted lives.

References:

1. Quezada J, Coffman KA. Current approaches and new developments in the pharmacological management of Tourette syndrome. CNS Drugs. 2018;32(1):33-45. doi:1007/s40263-017-0486-0
2. Tourette syndrome: an overview. Tourette Association of America. Accessed February 9, 2026. https://tourette.org/about-tourette/overview/
3. Set KK, Warner JN. Tourette syndrome in children: an update. Curr Probl Pediatr Adolesc Health Care. 2021;51(7):101032. doi:10.1016/j.cppeds.2021.101032
4. Kohler K, Rosen N, Piacentini, J. Description, implementation, and efficacy of the comprehensive behavioral intervention for tics as first-line treatment for Tourette and other tic disorders. J Child Adolesc Psychopharmacol. 2025;35(3):126-134. doi:10.1089/cap.2024.0023