Chapter 44. Tourette Disorder and Obsessive–Compulsive Disorder in Children and Adolescents

Essentials of Diagnosis

DSM-IV-TR Diagnostic Criteria

Tourette's Disorder

1. Both multiple motor 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.)

2. 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.

3. The onset is before age 18 years.

4. The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington's disease or postviral encephalitis).

Chronic Motor or Vocal Tic Disorder

1. Single or multiple motor or vocal tics (i.e., sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations), but not both, have been present at some time during the illness.

2. The tics occur many times a day 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.

3. The onset is before age 18 years.

4. The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington's disease or postviral encephalitis).

5. Criteria have never been met for Tourettes Disorder.

Transient Tic Disorder

1. Single or multiple motor and/or vocal tics (i.e., sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations)

2. The tics occur many times a day, nearly every day for at least 4 weeks, but for no longer than 12 consecutive months.

3. The onset is before age 18 years.

4. The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington's disease or postviral encephalitis).

5. Criteria have never been met for Tourettes Disorder or Chronic Motor or Vocal Tic Disorder.

Tic Disorder Not Otherwise Specified

This category is for disorders characterized by tics that do not meet criteria for a specific Tic Disorder. Examples include tics lasting less than 4 weeks or tics with an onset after age 18 years.

(Adapted with permission from Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Text Revision. Copyright 2000 American Psychiatric Association.)

General Considerations

Epidemiology

Transient tic behaviors are commonplace among school-age children. Estimates range between 4% and 24% of school-age children experiencing tics. The number of children experiencing chronic motor tic disorders is roughly one-quarter this number. Once thought to be much rarer, the current lifetime prevalence estimates for TS ranges from 0.1% to 1%.

The prevalence of tic disorders peaks during the late first and early second decades of life ...