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Tics matter because they are a distinct movement category that must be separated from habits, compulsionsA repetitive action or mental act carried out to relieve the anxiety caused by an obsession.Read more →, and other movement disorders before naming a diagnosis. A tic is a sudden, repetitive, stereotyped movement or vocalisation that the person can suppress for a while, usually only with mounting inner tension. For example, imagine a boy who blinks repeatedly and clears his throat, and who says the urge to do it builds up like an itch beforehand. In practice, that preceding urge, called a premonitory urge, is one of the clues marking a movement out as a tic rather than another type of abnormal movement.

Motor tics are movements, e.g. blinking, shrugging, or jerking the head; vocal tics are sounds, e.g. throat-clearing, sniffing, or grunting. Tourette syndrome (a tic disorder) is diagnosed when a person has multiple motor tics plus at least one vocal tic, both present at some point, persisting for more than one year, with onset in childhood. Coprolalia, the involuntary uttering of obscene words, is a well-known but actually uncommon feature, present in only a minority of patients. ADHDAttention-deficit hyperactivity disorder, a condition of inattention, impulsivity and sometimes hyperactivity.Read more → (attention deficit hyperactivity disorder) and OCDObsessive-compulsive disorder, a condition of unwanted repeated thoughts and the actions done to relieve them.Read more → (obsessive-compulsive disorder, a condition of intrusive thoughts and repetitive rituals) are common comorbidities and can be more impairing than the tics themselves. Take a child referred for 'behavioural problems' at school who, on closer history, also has throat-clearing tics stretching back over a year. Actively asking about tics is worthwhile even when the presenting complaint is inattention or rituals, since this comorbid pattern is common.

• How common is swearing as a symptom in Tourette syndrome?
• For how long must tics have been present before Tourette syndrome can be diagnosed?
• Which medication is used first when tics need drug treatment after behavioural therapy?

• Tics, sudden, repetitive, suppressible movements preceded by a premonitory urge, unlike stereotypies, which are rhythmic and not preceded by an urge.
• Chorea, irregular, unpredictable, flowing movements, rather than the stereotyped, repeatable pattern of a tic.
• Compulsions, purposeful acts performed to reduce anxiety from an obsessionAn unwanted, intrusive thought, image, or urge that keeps returning and causes distress.Read more →, whereas tics are not driven by a specific intrusive thought.
• Coprolalia, an uncommon feature of Tourette syndrome, unlike the multiple motor plus vocal tics required for the diagnosis itself.

• Most children with Tourette syndrome do not develop it.
• Treatment depends on impairment rather than on this symptom.
• It is neither universal nor a diagnostic requirement.
• Tics are the defining feature of the disorder.
• A week is far too short and would capture transient tics.

• Extract the defining phenomenology, duration, severity and functional-impact clues.
• Match the pattern to the most specific diagnostic or assessment construct.
• Actively test the closest look-alike against the missing or contradictory clue.
• Choose the precise term rather than a broader category that is merely compatible.