Tic disorders and Tourette syndrome

Meet the patient

An 11-year-old boy is referred because he "can't stop blinking and sniffing." His teacher thinks he is being defiant. He blinks in bursts, clears his throat every few sentences, and describes a building "itch" in his eyes and throat that the movement briefly relieves. He also can't sit still, loses his homework, and has been told for years that he has "just ADHD."[5][19]

The blink and the sniff are tics. The itch that the tic relieves is the premonitory urge — the single feature that tells you this is a tic disorder and not defiance. And the ADHD sitting next to it is the comorbidity that will decide his function far more than the tics do.[6][9]

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