When is it appropriate to refer a patient with Tourette Syndrome to a specialist for further evaluation?

Referral to a specialist for a patient with Tourette Syndrome (a tic disorder) is appropriate under specific circumstances, varying slightly between children and adults ¹.

• For children:
  • Do not routinely refer children with simple motor tics that are not troublesome to the child ¹.
  • Consider referral if the tic disorder has a significant impact on their quality of life ¹. This may include:
    • Referral to mental health services if the tic disorder is associated with symptoms of anxiety or obsessive compulsive behaviour ¹.
    • Referral to the neurodevelopmental team if the tic disorder is associated with symptoms suggestive of autism or attention deficit hyperactivity disorder (ADHD) ¹.
    • Referral for neurological assessment if the tic disorder is severe ¹.
  • Specialist referral and advice are required before offering medicine for motor tics ¹.
• For adults:
  • Do not routinely refer adults with tics unless the tics are troublesome or accompanied by additional progressive neurological symptoms ¹.
  • Consider referring adults with a tic disorder for psychological therapy if the disorder distresses them ¹.
  • Consider referring adults for neurological assessment if their symptoms are severe and the disorder continues to distress them after completing psychological therapy ¹. It should be noted that there are limited medicines available, and they may not always be effective or can have serious side effects ¹.