The provided UK guidelines do not explicitly detail the specific diagnostic criteria for Tourette Syndrome in children and adolescents. However, for related neurodevelopmental conditions such as autism and attention deficit hyperactivity disorder (ADHD), the National Institute for Health and Care Excellence (NICE) guidelines refer to the diagnostic criteria outlined in the DSM-5 or ICD-11 NICE CG128,NICE NG87. It is generally understood that the diagnosis of Tourette Syndrome also relies on these international classification systems, which are used in clinical trials involving children and adolescents with the condition (Jankovic et al. 2021; Andrén et al. 2022).
Based on the UK guidelines, key considerations for tic disorders, including Tourette Syndrome, involve:
- Presence of Tics: Tics are involuntary movements NICE NG127. While simple motor tics that are not troublesome to the child do not routinely require referral, a tic disorder that significantly impacts a child's quality of life warrants specialist assessment NICE NG127.
- Referral Pathways: For children with a tic disorder that has a significant impact on their quality of life, referral should be considered according to local pathways NICE NG127. This may include referral to mental health services if associated with anxiety or obsessive-compulsive behaviour, to the neurodevelopmental team if associated with symptoms suggestive of autism or ADHD, or for neurological assessment if the tic disorder is severe NICE NG127. Tics and stereotypies are also noted to be more common in children with autism or a learning disability NICE NG127.
- Coexisting Conditions: When assessing for neurodevelopmental conditions like autism, tics or Tourette Syndrome are considered as potential coexisting conditions, alongside ADHD, anxiety disorders, and obsessive-compulsive disorder (OCD) NICE CG128.
International expert consensus also contributes to the understanding and diagnosis of tic disorders, including the differentiation of functional tic-like behaviours from Tourette Syndrome (Pringsheim et al. 2023).
Key References
- NG127 - Suspected neurological conditions: recognition and referral
- CG128 - Autism spectrum disorder in under 19s: recognition, referral and diagnosis
- NG87 - Attention deficit hyperactivity disorder: diagnosis and management
- (Jankovic et al., 2021): Safety and Efficacy of Flexible-Dose Deutetrabenazine in Children and Adolescents With Tourette Syndrome: A Randomized Clinical Trial.
- (Andrén et al., 2022): Therapist-Supported Internet-Delivered Exposure and Response Prevention for Children and Adolescents With Tourette Syndrome: A Randomized Clinical Trial.
- (Pringsheim et al., 2023): European Society for the Study of Tourette Syndrome 2022 criteria for clinical diagnosis of functional tic-like behaviours: International consensus from experts in tic disorders.