A thorough evaluation for comorbidity is called for when symptoms and impairment warrant, and careful assessment of people with TS includes comprehensive screening for these conditions.Comorbid conditions such as OCD and ADHD can be more impairing than tics, and cause greater impact on overall functioning. Disruptive behaviors, impaired functioning, or cognitive impairment in individuals with comorbid Tourettes and ADHD may be accounted for by the ADHD, highlighting the importance of identifying comorbid conditions. Children and adolescents with TS who have learning difficulties are candidates for psychoeducational testing, particularly if the child also has ADHD. Management
There is no cure for Tourettes. There is no single most effective medication, and no one medication effectively treats all symptoms. Most medications prescribed for tics have not been approved for that use, and no medication is without the risk of significant adverse effects. Treatment is focused on identifying the most troubling or impairing symptoms and helping the individual manage them. Because comorbid conditions are often a larger source of impairment than tics, they are a priority in treatment. The management of Tourettes is individualized and involves shared decision-making between the clinician, patient, family and caregivers. Practice guidelines for the treatment of tics were published by the American Academy of Neurology in 2019.Education, reassurance and psychobehavioral therapy are often sufficient for the majority of cases. In particular, psychoeducation targeting the patient and their family and surrounding community is a key management strategy. Watchful waiting "is an acceptable approach" for those who are not functionally impaired.
Hence, other medical conditions that include tics or tic-like movements—for example, autism or other causes of tics—must be ruled out.Patients referred for a tic disorder are assessed based on their family history of tics, vulnerability to ADHD, obsessive–compulsive symptoms, and a number of other chronic medical, psychiatric and neurological conditions. In individuals with a typical onset and a family history of tics or OCD, a basic physical and neurological examination may be sufficient. There are no specific medical or screening tests that can be used to diagnose Tourettes; the diagnosis is usually made based on observation of the individuals symptoms and family history, and after ruling out secondary causes of tic disorders (tourettism).Delayed diagnosis often occurs because professionals mistakenly believe that TS is rare, always involves coprolalia, or must be severely impairing. The DSM has recognized since 2000 that many individuals with Tourettes do not have significant impairment; diagnosis does not require the presence of coprolalia or a comorbid condition, such as ADHD or OCD. Tourettes may be misdiagnosed because of the wide expression of severity, ranging from mild (in the majority of cases) or moderate, to severe (the rare but more widely recognized and publicized cases). About 20% of people with Tourette syndrome do not realize that they have tics.Tics that appear early in the course of TS are often confused with allergies, asthma, vision problems, and other conditions.