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Ask the Mental Health Expert Archives 2001-2004

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Childhood Tic Disorders

Q. My 9-year-old son has recently been placed on Clonidine for the suppression of multiple tics. He was last taken off this drug in March and has been tic free until now. Recently he began sniffing, blinking and shrugging his shoulders and has been placed back on the Clonidine.

Over the years he has displayed these, as well as throat clearing and possibly others although they have not all been at the same time. I spent years fussing at him until a trip to my pediatrician approximately 6 months ago where he observed his behavior and suggested the medication.

My pediatrician is reluctant to diagnose Tourette's Syndrome (TS) without seeing a Pediatric Neurologist. How does one determine the difference between TS and one of the tic disorders?

A. Your pediatrician is probably wise in seeking a second opinion from a specialist in childhood tic disorders. As you may know, tics are stereotyped, purposeless, and irregularly repetitive movements. They can usually be classified as due to chronic motor or vocal tic disorders; transient tic disorders; or Tourette's Syndrome (TS).

TS involves multiple motor and one or more vocal tics, not necessarily at the same time. These occur many times a day, usually in bouts, nearly every day, over the course of a year or more. During this period, there is never a tic-free period of more than three consecutive months, if the condition is truly TS.

Other tic disorders do not fit all of these criteria. By definition, the tics in TS cannot be explained by the effects of some drug, or of some other neurological disorder--and therein lies part of the diagnostic difficulty. Other neurological disorders, such as Wilson's Disease (a disorder of copper metabolism), may also present with tics or similar involuntary movements in children, and must be ruled out before TS can be diagnosed.

A careful neurological exam with appropriate laboratory tests can usually rule out non-TS causes of tics. For more information about TS and related conditions, you may want to check out the website of the Tourette Syndrome Association (www.tsa-usa.org). However, I think that a pediatric neurologist is precisely the right professional to help you and your pediatrician sort this out. There are also several new treatment approaches besides clonidine that would be important to discuss.

November 2002

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