Symposia
Assessment
Joseph F. McGuire, Ph.D.
Assistant Professor
Johns Hopkins University School of Medicine
Baltimore, Maryland
Tourette Syndrome and other persistent tic disorders (collectively TS) are characterized by the childhood onset of motor and/or vocal tics that cause impairment. However, since the onset of the COVID-19 pandemic, there has been a dramatic increase in the acute-onset of tic-like symptoms in adolescents, which some reports have linked to social media exposure (e.g., TikTok). Youth with this clinical presentation exhibit sudden and explosive complex motor and vocal tics, which cause significant disability and often result in visits to the Emergency Department. While there are some similarities between TS and tic-like behaviors, there are notable distinctions (e.g., differences in tic phenomenology, age of onset, comorbidity patterns, gender ratios). Presently, there is no formal assessment to differentiate tics from “tic-like” behaviors. This barrier impedes clinical research efforts to accurately characterize its clinical presentation, determine optimal treatment approaches, and clarify long-term outcomes.
Given the limited information on the topic and its increasing occurrence in outpatient settings, this presentation highlights current recommendations for an evidence-based assessment to differentiate tics from “functional tic-like behaviors” using existing rating scales, clinical information, and clinical expertise. We review proposed criteria for “functional tic-like behaviors” and discuss the clinical presentation of youth who present with this phenomena. The administration and psychometric properties of evidence-based assessments for TS (i.e., clinician-rated, parent-rated, and self-report scales) are discussed. Through a case-based approach, we highlight the advantages and disadvantages of different evidence-based assessments to accurately capture “functional tic-like behaviors” during a diagnostic assessment and ongoing treatment monitoring. Although evidence-based assessments for TS exist, there is a clear need for a consensus definition and consistent assessment of “functional tic-like behaviors” across mental health professions. Ultimately, this can improve diagnostic classification approaches, provide new insights into optimal treatment approaches, and clarify long-term patient outcomes.