Hi, this is Tom, and in this episode, I'm going to be going through Tourette's and Ticks.

And you can find notes at 0.0.5.com and in the 0 to Finals Pediatrics book.

And you can find flashcards and questions at members.02finals.com.

So let's jump straight in.

Ticks are sudden, rapid, recurrent movements or vocalizations that the child feels a strong urge to perform.

Tics often present around 5 to 7 years of age.

They can be associated with OCD and ADHD.

Tourette's syndrome involves multiple motor and vocal ticks present for at least a year and starting

before aged 18. Ticks become more prominent when the child is under pressure or

excited. They may describe an overwhelming urge to perform the tick. This urge increases the more

they suppress it. They feel the need to complete the tick, often several times to get relief from that urge.

These feelings are called pre-monitory sensations.

Examples of simple ticks include clearing the throat, blinking, head jerking, sniffing, grunting,

and eye-rolling.

Examples of complex ticks include physical movements such as twirling on the spot or touching objects,

copropraxia, which involves making obscene gestures, coprolalia, which involves saying obscene words, and echolalia, which involves repeating other people's words.

Finally, let's go through management. Ticks will usually improve over time. Mild cases, with no signs of underlying disease, may only require reassurance and

monitoring. Taking measures to reduce stress, anxiety and triggers can be helpful. More severe or

troublesome ticks may be referred to a specialist. They may benefit from habit reversal therapy, or HRT,

comprehensive behavioral intervention for ticks, or CBIT, or medications may be tried in very

severe cases, for example, antipsychotic medications or clonidine.

Comorbid conditions such as OCD or ADHD may benefit from treatment.

...