Tics and Tourette syndrome: Viva

A 10-year-old boy is referred by his general practitioner for tics. Over the last two years he has had eye-blinking, facial grimacing, shoulder-shrugging, and throat-clearing that come and go over weeks, shift from one body part to another, and are preceded by a mounting urge relieved only by performing the movement. He can suppress them briefly at school but they burst back afterwards. He is inattentive and restless in class and is falling behind, and his mother describes nightly checking rituals that distress him. His father had childhood tics. His examination is normal. The examiner asks how you make the diagnosis, how you separate these movements from mimics, how you would manage him, and what you would tell the family about the future.