Comprehensive Assessment Strategies

Abstract

Abstract In the assessment of a potential new or established case of tic disorder, the clinician has several goals that extend beyond confirming or clarifying the presence and severity of tics and the diagnosis of tic disorder. These include assessing the impact of the disorder on the patient and family, identifying the factors that exacerbate or mitigate the symptoms, determining the extent of comorbid conditions, clarifying the patient’s and the family’s understanding of the disorder, and developing an alliance and shared perspective on the patient’s problems in order to pursue the treatment goals and priorities that emerge from the assessment. Clinicians, teachers, parents, and peers should be educated regarding the key phenomenological features and natural course of Tourette syndrome and related disorders. For children, the clinician needs to place the tics into the context of overall development so that the child’s development is kept on track. This often involves refocusing the family’s attention away from the tics and helping them find ways to build on the child’s strengths and abilities. Social, emotional, and academic outcomes in adulthood do not always reflect tic outcomes given the chronic course, the negative impact on peer and family relationships, and the variable number of co-occurring conditions. Helping a child or an adult become a “self-advocate” rather than being ashamed of their tics is often a helpful approach. A comprehensive assessment of each of these domains will ensure that a consensus can be reached concerning treatment priorities.