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Practice Parameter for the Assessment and Treatment of Children and Adolescents With Tic Disorders

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Tic disorders, including Tourette’s disorder, present with a wide range of symptom severity and associated comorbidity. This Practice Parameter reviews the evidence from research and clinical experience in the evaluation and treatment of pediatric tic disorders. Recommendations are provided for a comprehensive evaluation to include common comorbid disorders and for a hierarchical approach to multimodal interventions.

Key Words

tic disorders
Tourette’s disorder
treatment
Practice Parameter

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This article can be used to obtain continuing medical education (CME) at www.jaacap.org

This Parameter was developed by Tanya K. Murphy, M.D., Adam B. Lewin, Ph.D., Eric A. Storch, Ph.D., Saundra Stock, M.D., and the American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI): Oscar G. Bukstein, M.D., M.P.H. and Heather J. Walter, M.D., M.P.H., Co-Chairs, and Christopher Bellonci, M.D., R. Scott Benson, M.D., Regina Bussing, M.D., Allan Chrisman, M.D., Tiffany R. Farchione, M.D., John Hamilton, M.D., Munya Hayek, M.D., Helene Keable, M.D., Joan Kinlan, M.D., Nicole Quiterio, M.D., Carol Rockhill, M.D., Ulrich Schoettle, M.D., Matthew Siegel, M.D., and Saundra Stock, M.D.

AACAP Practice Parameters are developed by the AACAP CQI in accordance with American Medical Association policy. Parameter development is an iterative process between the primary author(s), the CQI, topic experts, and representatives from multiple constituent groups, including AACAP membership, relevant AACAP Committees, the AACAP Assembly of Regional Organizations, and the AACAP Council. Details of the Parameter development process can be accessed on the AACAP website. Responsibility for Parameter content and review rests with the author(s), the CQI, the CQI Consensus Group, and the AACAP Council.

The AACAP develops both patient-oriented and clinician-oriented Practice Parameters. Patient-oriented Parameters provide recommendations to guide clinicians toward best assessment and treatment practices. Recommendations are based on the critical appraisal of empirical evidence (when available) and clinical consensus (when not), and are graded according to the strength of the empirical and clinical support. Clinician-oriented Parameters provide clinicians with the information (stated as principles) needed to develop practice-based skills. Although empirical evidence may be available to support certain principles, principles are primarily based on clinical consensus. This Parameter is a patient-oriented Parameter.

The primary intended audience for the AACAP Practice Parameters is child and adolescent psychiatrists; however, the information contained therein may also be useful for other mental health clinicians.

The authors acknowledge the following experts for their contributions to this Parameter Barbara Coffey, M.D., M.S., Carol Mathews, M.D., Cathy Budman, M.D., James Leckman, M.D., Michael Bloch, M.D. and Jonathan W. Mink, M.D., Ph.D.

Kristin Kroeger Ptakowski and Jennifer Medicus served as the AACAP staff liaisons for the CQI.

This Parameter was reviewed at the Member Forum at the AACAP Annual Meeting in October 2011.

From December 2012 to January 2013, this Parameter was reviewed by a Consensus Group convened by the CQI. Consensus Group members and their constituent groups were as follows: Oscar Bukstein, M.D., M.P.H., Saundra Stock, M.D., Regina Bussing, M.D., and Allan Chrisman, M.D. (CQI); Barbara Coffey, M.D., James Leckman, M.D., (Topic Experts); Melissa DelBello, M.D. (AACAP Committee on Research); Debra Koss, M.D., Felissa Goldstein, M.D. (AACAP Assembly of Regional Organizations); and David DeMaso, M.D., Jenna Saul, M.D. (AACAP Council).

This Practice Parameter was approved by the AACAP Council on July 29, 2013.

This Practice Parameter is available on the internet (www.aacap.org).

Correspondence to the AACAP Communications Department, 3615 Wisconsin Ave., NW, Washington, D.C. 20016.

Disclosures: Tanya K. Murphy, M.D. receives research funding from NIH/NIMH, CDC, Otsuka Pharmaceuticals, NARSAD, IOCDF, Ortho-McNeil Janssen Pharmaceuticals, Shire Pharmaceuticals, Pfizer, Inc. and Indevus Pharmaceuticals. She has received travel support from the Tourette Syndrome Association and honorarium from grand rounds lectures. Adam B. Lewin, Ph.D. serves as a consultant for Otsuka America Pharmaceutical and ProPhase, Inc. He receives grant support from International Obsessive Compulsive Disorder Foundation; National Alliance for Research on Schizophrenia and Depression; University of South Florida Research Foundation, Inc. He has received travel support from University of South Florida Research Foundation, Inc. Eric A. Storch, Ph.D., serves on the advisory board for the International Obsessive Compulsive Disorder Foundation. He serves as a consultant for Otsuka America Pharmaceutical, Inc. and ProPhase Inc. He receives grant support from Centers for Disease Control; National Institutes of Health; Ortho-McNeil Neurologics; Transportation Security Administration. He has intellectual property with Springer and Taylor and Francis. He serves on the speakers bureau for International Obsessive Compulsive Disorder Foundation. Saundra Stock, M.D. has received research funding from GlaxoSmithKline and served as a sub-investigator n studies funding by Forest Research Institute, Merck/Schering-Plough, Supernus, Bristol-Myers Squibb, AstraZeneca and Boehringer-Ingelheim. She also has served on the expert panel consulting to the Florida Medicaid Drug Therapy Management Program for Behavioral Health. Oscar Bukstein, M.D., M.P.H., co-chair, has served as a consultant with PRIME CME and EZRA Inovations, and has intellectual property with Routledge Press. Heather Walter, M.D., M.P.H., co-chair, has no financial relationships to disclose. Disclosures of potential conflicts of interest for all other individuals named above are provided on the AACAP website on the Practice Information page.