My child has started blinking excessively and making throat-clearing sounds. Is this Tourette syndrome?

Possibly — but it is very common for children to develop one or more tics without meeting criteria for Tourette syndrome. Provisional tic disorder (tics present for less than one year) is extremely common in primary school children. Tourette syndrome requires both motor tics AND vocal tics for more than one year, starting before age 18. Most isolated tics in children are benign, wax and wane over weeks or months, and resolve without treatment. It is worth seeing your GP to confirm the diagnosis, screen for associated ADHD or anxiety, and discuss what to watch for — but reassurance that most tics improve significantly with time is warranted in the first instance.

Is my child doing this on purpose? Can they control the tics?

Tics are involuntary — your child cannot stop them the same way you cannot stop a sneeze. Many children can suppress tics briefly, often at the cost of a building inner tension that releases when they stop trying — similar to resisting a yawn. The urge that builds before a tic (called the premonitory urge) is often described as more distressing than the tic itself. It is important that schools, family members, and teachers understand this: telling a child to 'just stop' is ineffective and counterproductive. Tics are typically much worse under stress, excitement, fatigue, or illness, and better during absorbing activities such as sport or gaming.

What is CBIT and how does it help tics?

CBIT — Comprehensive Behavioural Intervention for Tics — is a structured behavioural therapy that is the recommended first-line treatment for moderate-to-severe tics in children aged nine and above. It combines habit reversal training (learning to recognise the premonitory urge and perform a competing movement instead), relaxation training, and identification of situations that worsen tics. In clinical trials, over 50% of children achieve significant and durable tic reduction with CBIT, with effects equal to or exceeding medication and without side effects. It is available through clinical psychologists trained in the approach; the Tourette Syndrome Association of Australia can help locate practitioners in your state.

My son has both tics and ADHD — can he take ADHD medication without making tics worse?

Yes. Older concerns that stimulant medications (methylphenidate, dexamphetamine, lisdexamfetamine) worsen tics have been largely refuted by current evidence. The 2019 American Academy of Neurology guideline confirms that stimulants are generally safe in children with both Tourette syndrome and ADHD, and may even improve tics in some children. The ADHD often causes far more impairment at school and at home than the tics themselves, and treating it appropriately is important. Your child's paediatrician or psychiatrist will monitor tic severity closely when starting ADHD medication, but this should not be a reason to avoid treating the ADHD.

My child's tics suddenly got much worse after a strep throat — what should I check?

Sudden or dramatic worsening of tics following a streptococcal infection — sore throat, scarlet fever, skin infection — can be a feature of PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) or Sydenham chorea. These are distinct from typical Tourette syndrome and warrant prompt medical review. Your GP should take a throat swab, check anti-streptolysin O (ASO) and anti-DNase B antibody levels, and consider referral to a paediatrician or paediatric neurologist for further evaluation. Sudden onset of tics or a completely new neurological picture — weakness, regression of milestones, personality change — is a red flag requiring urgent specialist assessment.

Tics and Tourette syndrome

Tics and Tourette syndrome: the AU general practice guide for families

By Dr HB Lo, FACRRM Reviewed 28 September 2026 8 min read

Tics — brief, repetitive, involuntary movements or sounds — are common in school-age children, with 10–25% affected at some point. Tourette syndrome is the combination of both motor and vocal tics persisting over a year, affecting around 0.3–1% of children.

The key message is that most tics improve by adulthood, and comorbid conditions — ADHD (≈50%) and OCD (≈30%) — are usually more disabling than the tics themselves. First-line treatment for moderate-to-severe tics is Comprehensive Behavioural Intervention for Tics (CBIT), not medication. Medication is added only if CBIT is unavailable or insufficient.

Tics are among the most common neurodevelopmental presentations in Australian general practice. Transient motor tics — eye blinking, facial grimacing, shoulder shrugging — affect approximately 10–25% of primary school children at some point, while persistent tic disorders affect around 1%, and Tourette syndrome around 0.3–1% of the childhood population.

Despite their frequency, tics generate substantial parental distress, teacher concern, and peer confusion. Most of this distress can be resolved by understanding three things: tics are involuntary and not a behavioural choice; most improve or resolve by adulthood; and the comorbid conditions that accompany tics — particularly ADHD and OCD — are often far more impairing than the tics themselves and have highly effective treatments.

A. Core clinical — the AU general-practice framework

Classifying tics

The DSM-5-TR and ICD-11 classify tic disorders into three categories:

Provisional tic disorder — motor and/or vocal tics present for less than one year. Very common in primary school age; often resolves spontaneously.

Persistent (chronic) motor or vocal tic disorder — a single class of tic (motor only, or vocal only) persisting for one year or longer.

Tourette syndrome — both motor tics AND phonic (vocal) tics, each present for at least one year, with onset before age 18. Therapeutic Guidelines (eTG) and the AAN 2019 guideline both emphasise that coprolalia (involuntary obscene vocalisations) is present in only 10–15% of people with Tourette syndrome and is NOT a diagnostic requirement — it is the most misunderstood feature of the condition.

Motor tics range from simple single-muscle jerks (blinking, grimacing, head jerk) to complex coordinated sequences (hopping, touching objects). Phonic tics range from simple sounds (throat clearing, sniffing, grunting) to complex vocalisations (words, echolalia). The natural history involves waxing and waning — symptoms intensify and diminish over weeks, are worse with stress and fatigue, and tend to peak in severity around ages 10–12.

Why comorbidities matter most

Per eTG and the AAN 2019 guideline, approximately:

50% of children with Tourette syndrome have ADHD — the most common and functionally important comorbidity
30% have OCD — obsessions and compulsions, or “just right” OCD-spectrum phenomena
Anxiety, depression, learning difficulties, sleep disturbance, and ASD overlap are all more common than in the general population

This means that for many children, the ADHD causes the most difficulty at school, the anxiety causes the most difficulty socially, and the tics are actually the least disabling element of the clinical picture. Comprehensive assessment must evaluate all comorbidities, and their treatment is often more impactful than tic-focused intervention.

Clinical assessment

History should characterise: onset age; type (motor, vocal, or both); frequency, intensity, and complexity; distribution; waxing-waning pattern; premonitory urge; triggers (stress, excitement, illness, fatigue); suppressibility; and functional impact at school, home, and socially. The premonitory urge — a sense of building discomfort or tension before the tic that is briefly relieved by it — is a distinctive feature that helps distinguish tics from other movement disorders.

Comorbidity screening should systematically cover ADHD (inattention, impulsivity, hyperactivity), OCD (obsessions, compulsions, checking behaviours), anxiety, depression, learning difficulties, and sleep quality.

Red flag history requiring urgent assessment: sudden or subacute onset of tics (days to weeks), particularly following recent streptococcal infection — raises concern for Sydenham chorea, PANDAS (paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection), or anti-NMDA receptor encephalitis. Regression of developmental milestones, focal neurological signs, or personality change alongside tic onset are urgent referral indicators.

Examination should confirm the neurological examination is normal — cranial nerves, tone, power, reflexes, coordination, gait must all be intact in typical Tourette syndrome. Soft neurological signs (dystonia, choreoathetosis, primitive reflexes) suggest an alternative or additional diagnosis. A brief mental state and cognitive screen is appropriate.

Investigations

Investigations are not required in typical Tourette syndrome — this is a clinical diagnosis. Targeted investigations are reserved for atypical presentations:

ASO titre and anti-DNase B if acute or subacute onset following known or possible streptococcal infection
Wilson’s disease screen (caeruloplasmin, 24-hour urinary copper) if young onset with atypical movements, hepatic features, or Kayser-Fleischer rings on slit-lamp examination
TFTs — hyperthyroidism can cause movement resembling tics
EEG only if seizure is suspected
Brain MRI only if focal neurology, late-onset, or atypical presentation

B. Treatment — the CBIT-first approach

Behavioural therapy: CBIT

The AAN 2019 guideline places CBIT — Comprehensive Behavioural Intervention for Tics — as the first-line intervention for moderate-to-severe tic disorder in children aged nine and above. The Tourette Association of America’s CBIT overview summarises the core components:

Habit reversal training (HRT) — the child learns to recognise the premonitory urge and perform a competing movement (one that is physiologically incompatible with the tic) during the urge window
Functional analysis — identifying situations, activities, and emotions that reliably worsen tics and modifying the environment accordingly
Relaxation training — reducing the autonomic arousal that amplifies tic frequency

CBIT produces clinically significant tic reduction in over 50% of participants, with sustained benefits at 12-month follow-up. It carries no pharmacological side effects. Telehealth delivery is increasingly available in Australia, reducing the access barrier for rural and regional families. Practitioners trained in CBIT can be located through the Tourette Syndrome Association of Australia.

When to add medication

Medication is considered when CBIT is unavailable, when tics are causing significant functional impairment (school exclusion, self-injurious behaviour, severe social impact), or when CBIT alone has been insufficient.

Alpha-2 agonists — preferred first medication class:

Per eTG and AMH, clonidine (25–200 micrograms per day, titrated) is the preferred first-choice medication for tics, particularly when comorbid ADHD is present. It is on PBS general schedule (off-label for tics). Guanfacine has a similar profile but has more limited PBS availability in Australia. Alpha-2 agonists have the advantage of simultaneously benefiting both tic frequency and ADHD symptoms with a more favourable safety profile than antipsychotics.

Antipsychotics — for severe or refractory tics:

Risperidone and aripiprazole are the most commonly used options. Both require PBS Authority. Aripiprazole is increasingly preferred due to lower rates of metabolic side effects and extrapyramidal symptoms — though risperidone has more historical evidence. Both are prescribed at low doses for tics, well below those used for psychotic disorders. Haloperidol is largely historical for this indication given its side-effect profile.

Managing comorbid ADHD

Stimulant medications (methylphenidate, dexamphetamine, lisdexamfetamine) are safe in children with Tourette syndrome and ADHD. The older clinical belief that stimulants inevitably worsen tics has been refuted by controlled trial evidence reviewed in the AAN 2019 guideline. Methylphenidate was non-inferior to placebo in tic worsening while producing meaningful ADHD improvement. Individual responses vary — close monitoring of tic frequency when initiating ADHD medication is appropriate — but the presence of tics is not a contraindication to treating ADHD appropriately.

Atomoxetine (PBS Authority) is a non-stimulant alternative for ADHD with tics.

School accommodation is a major general practice responsibility for children with Tourette syndrome. The Disability Standards for Education 2005 (federal legislation) requires Australian schools to make reasonable adjustments.

Useful accommodations include: discreet seating away from the front; access to a quiet area when tics are particularly intrusive; extended time during examinations; reduced-distraction assessment environments; and staff briefing (with parental consent) so teachers respond to tics with understanding rather than disciplinary action.

GP letters to schools should specify the diagnosis, the involuntary nature of tics, the specific accommodations requested with rationale, and contact details for questions. Clear documentation reduces the friction between families and school administration.

For children with significant functional impairment, NDIS access may be appropriate. The NDIS Early Childhood Approach covers children under nine; standard NDIS access is available from age 7 for Tourette syndrome with documented functional impact.

D. Australian operations

MBS items: Standard GP consultations (items 23, 36, 44) with Level C/D typical for complex neurodevelopmental presentations. Healthy Kids Check (item 709) is an opportunistic point of detection. Mental Health Care Plan (items 2715/2717) for comorbid anxiety or OCD. GP Chronic Condition Management Plan (items 965/967) for chronic neurodevelopmental coordination including allied health. Telehealth items 91890/91891 support follow-up for rural and remote families.

PBS: Clonidine — PBS general schedule (off-label for tics; on-schedule for hypertension). Risperidone — PBS Authority Required for severe behaviour disturbance with specific paediatric criteria. Aripiprazole — PBS Authority Required for autism with irritability and tics in selected patients. ADHD medications (methylphenidate, dexamphetamine, lisdexamfetamine, atomoxetine) — PBS Authority Required, specialist-initiated.

SafeScript: Stimulant medications for ADHD are Schedule 8 in all states; real-time prescription monitoring (SafeScript) applies. Specialist initiation (paediatrician or psychiatrist) is required for PBS funding.

E. Special populations

Females: Tourette syndrome has a male predominance of approximately 3–4:1 in clinical samples, but females are under-diagnosed — partly because tics in girls may present with different comorbidity profiles (more anxiety and OCD, less obvious hyperactivity) that lead to alternative diagnoses. A heightened index of suspicion in girls with OCD-spectrum presentations and a history of transient tics in childhood is appropriate.

Aboriginal and Torres Strait Islander children: Cultural safety in neurodevelopmental consultations is important. Coordination with ACCHOs (Aboriginal Community Controlled Health Organisations) and culturally safe CYMHS pathways is appropriate. The Closing the Gap PBS co-payment applies to eligible medications.

Adolescents and functional tic-like behaviours: A cluster of adolescents — predominantly females — developed sudden-onset complex tic-like movements following social media exposure (particularly TikTok) from 2020 onwards. These “functional tic-like behaviours” differ from Tourette syndrome: sudden onset in adolescence, complex from the start, typically lacking premonitory urge, and often with identifiable social exposure. Management is distinct and requires specialist input. Misclassification as Tourette syndrome leads to inappropriate pharmacological treatment.

When to escalate

Refer to paediatrician or paediatric neurologist for:

Diagnosis confirmation and treatment planning at initial diagnosis
Severe or disabling tics not responding to CBIT
Complex comorbidity management (severe ADHD, OCD, anxiety)
Atypical presentation or diagnostic uncertainty

Refer urgently if:

Acute or subacute onset — concern for Sydenham chorea, PANDAS, or anti-NMDA encephalitis
Regression of developmental milestones
Focal neurological signs
Severe self-injurious behaviour

What this article is and is not

This article draws on Therapeutic Guidelines (eTG), the AMH, the AAN 2019 guideline, and the Tourette Syndrome Association of Australia. It is general health information for educational purposes and does not constitute personal medical advice or create a doctor–patient relationship.

For Australian families: Tourette Syndrome Association of Australia, Raising Children Network, HealthDirect, and Better Health Channel.

Sources cited

Frequently asked questions

My child has started blinking excessively and making throat-clearing sounds. Is this Tourette syndrome?

Possibly — but it is very common for children to develop one or more tics without meeting criteria for Tourette syndrome. Provisional tic disorder (tics present for less than one year) is extremely common in primary school children. Tourette syndrome requires both motor tics AND vocal tics for more than one year, starting before age 18. Most isolated tics in children are benign, wax and wane over weeks or months, and resolve without treatment. It is worth seeing your GP to confirm the diagnosis, screen for associated ADHD or anxiety, and discuss what to watch for — but reassurance that most tics improve significantly with time is warranted in the first instance.
Is my child doing this on purpose? Can they control the tics?

Tics are involuntary — your child cannot stop them the same way you cannot stop a sneeze. Many children can suppress tics briefly, often at the cost of a building inner tension that releases when they stop trying — similar to resisting a yawn. The urge that builds before a tic (called the premonitory urge) is often described as more distressing than the tic itself. It is important that schools, family members, and teachers understand this: telling a child to 'just stop' is ineffective and counterproductive. Tics are typically much worse under stress, excitement, fatigue, or illness, and better during absorbing activities such as sport or gaming.
What is CBIT and how does it help tics?

CBIT — Comprehensive Behavioural Intervention for Tics — is a structured behavioural therapy that is the recommended first-line treatment for moderate-to-severe tics in children aged nine and above. It combines habit reversal training (learning to recognise the premonitory urge and perform a competing movement instead), relaxation training, and identification of situations that worsen tics. In clinical trials, over 50% of children achieve significant and durable tic reduction with CBIT, with effects equal to or exceeding medication and without side effects. It is available through clinical psychologists trained in the approach; the Tourette Syndrome Association of Australia can help locate practitioners in your state.
My son has both tics and ADHD — can he take ADHD medication without making tics worse?

Yes. Older concerns that stimulant medications (methylphenidate, dexamphetamine, lisdexamfetamine) worsen tics have been largely refuted by current evidence. The 2019 American Academy of Neurology guideline confirms that stimulants are generally safe in children with both Tourette syndrome and ADHD, and may even improve tics in some children. The ADHD often causes far more impairment at school and at home than the tics themselves, and treating it appropriately is important. Your child's paediatrician or psychiatrist will monitor tic severity closely when starting ADHD medication, but this should not be a reason to avoid treating the ADHD.
My child's tics suddenly got much worse after a strep throat — what should I check?

Sudden or dramatic worsening of tics following a streptococcal infection — sore throat, scarlet fever, skin infection — can be a feature of PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) or Sydenham chorea. These are distinct from typical Tourette syndrome and warrant prompt medical review. Your GP should take a throat swab, check anti-streptolysin O (ASO) and anti-DNase B antibody levels, and consider referral to a paediatrician or paediatric neurologist for further evaluation. Sudden onset of tics or a completely new neurological picture — weakness, regression of milestones, personality change — is a red flag requiring urgent specialist assessment.

Source quality

Sources grouped by evidence tier. AU primary tier first; international where AU is silent or lagging; named-author reconstruction where guidelines have not yet caught up. How tiers work.