Our Neurosciences Center recently developed a standard of care for tic disorders/Tourette syndrome to assist referring providers (see below). It offers a provider checklist with helpful resources, including a list of local therapy resources in Western Washington and Yakima.

Tic Disorders/Tourette Syndrome Policy


  • Gilles de la Tourette syndrome (Tourette syndrome) is an early childhood-onset neurodevelopmental disorder marked by the appearance of multiple involuntary movements and vocalizations, referred to as “tics.”
  • Tourette syndrome is commonly associated with comorbid conditions such as attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, anxiety disorder and other behavioral problems.
  • According to some reports, 80% to 90% of patients with Tourette syndrome have both tics and psychiatric manifestations.
  • These comorbid disorders can cause significant functional impairment and poor self-esteem and can affect the quality of life of patients with Tourette syndrome.


  • Behavioral treatment can reduce the frequency of tics and increase functioning, adaptation and coping skills.
  • Behavioral therapy specific for tics:
    • Comprehensive behavioral intervention for tics (CBIT)
    • Habit reversal training (HRT)
    • Exposure and response prevention therapy (ERP)
  • There is no cure for tics, and while pharmacologic agents can reduce tic frequency, there are potential significant side effects from medications, and they rarely eradicate tics completely.
  • The pharmacologic treatments for tics include alpha agonists, anticonvulsants, dopamine depletors and antipsychotics.

Provider checklist

  • Provide patient with the handout Tics and Tic Disorders.
  • Direct patient to Tourette Association of America website to find “Tools for Parents,” “Parent and Family Resources,” “Tourette in the Classroom – Helpful Resources” and a Resource Library. The Centers for Disease Control (CDC) offers Information about Tourette Syndrome for Families.
  • Refer a patient for a psychological evaluation to screen for co-morbid conditions and to provide cognitive behavioral therapy. Families can call the Washington Mental Health Referral Service for Children and Teens at 833-303-5437 for assistance finding qualified therapists who have access and take their insurance. Alternatively, you can use the Partnership Access Line (PAL) to request to connect your patient with a qualified therapist (PAL will transfer the request to the Washington Mental Health Referral Service for Children and Teens, who will reach out to the family directly and notify you when a referral is made).
  • Refer patient for specific behavioral therapies such as CBIT, HRT or ERP, if available (see earlier).
  • Consider daily preventive medications for patients with pain or impairment in social functioning as a result of the tics.
    • First line:
      • Clonidine: 0.05 mg per day; maximum 0.1 to 0.3 mg per day, divided one to three times per day, or
      • Guanfacine:5 mg per day; maximum 4 mg per day, divided one to two times per day
    • Second line:
      • Topiramate: 1 to 9 mg/kg/day; maximum 200 mg per day, divided one to two times per day