Pediatric Movement Disorders - Tics

Examination

The examination of a child with tics or other habitual disorders consists primarily of observation. A videotape of the child performing the movements at home may be very helpful. A full neurological examination is essential in order to ensure the absence of other symptoms. Appropriate classification depends on the movements made spontaneously by the child. In some cases, movements may be provoked by intense concentration or by stress, such as a request to perform mathematics problems. The child may be able to describe the sense of build-up of the need to tic, followed by a transient release after the movement. In some cases, tics may be incorporated into apparently voluntary movements, such as when touching the face is transformed into a brief brush of the hair in an attempt to cover up the movement.

Classification as a tic relies on the repetitive and stereotyped nature of the movement. Compulsions can usually be distinguished from tics by the lack of stereotyped details of the movement. In addition, with compulsions, the child typically describes a sense of worry about the consequences if the movement is not made. The feeling of a build-up or of worry is usually not present in stereotypies, mannerisms, or habits. However, these may be difficult to distinguish, especially if the child is not able to provide a good description of how the movement feels. Akathisia may be difficult to distinguish from chorea unless the sense of restlessness can be described. The sensation of the need to move in restless legs syndrome is different from other types of motor restlessness, although it can be confused with akathisia and similar symptoms may occur if the child is nervous or stressed.