European Society for the study of Tourette syndrome 2022 criteria for clinical diagnosis of functional tic-like behaviours: international consensus from experts in tic disorders
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Background and purpose: In 2020, health professionals witnessed a dramatic increase in referrals of young people with rapid onset of severe tic‐like behaviours. We assembled a working group to develop criteria for the clinical diagnosis of functional tic‐like behaviours (FTLBs) to help neurologists, pediatricians, psychiatrists, and psychologists recognize and diagnose this condition. Methods: We used a formal consensus development process, using a multiround, web‐based Delphi survey. The survey was based on an in‐person discussion at the European Society for the Study of Tourette Syndrome (ESSTS) meeting in Lausanne in June 2022. Members of an invited group with extensive clinical experience working with patients with Tourette syndrome and FTLBs discussed potential clinical criteria for diagnosis of FTLBs. An initial set of criteria were developed based on common clinical experiences and review of the literature on FTLBs and revised through iterative discussions, resulting in the survey items for voting. Results: In total, 24 members of the working group were invited to participate in the Delphi process. We propose that there are three major criteria and two minor criteria to support the clinical diagnosis of FTLBs. A clinically definite diagnosis of FTLBs can be confirmed by the presence of all three major criteria. A clinically probable diagnosis of FTLBs can be confirmed by the presence of two major criteria and one minor criterion. Conclusions: Distinguishing FTLBs from primary tics is important due to the distinct treatment paths required for these two conditions. A limitation of the ESSTS 2022 criteria is that they lack prospective testing of their sensitivity and specificity.
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The role of stress and anxiety in precipitating and maintaining complex tic presentations has been previously reported.
“The role of stress and anxiety in precipitating and maintaining complex tic presentations has been previously reported (12, 20, 21).”
From Integrated cognitive behavioral intervention for functional tics (I-CBiT): case reports and treatment formulation (2023) · cites this paper as [12]
The Introduction (page unavailable) describes anxiety and depression as possible triggers of rapid-onset functional tic-like behaviours. The Discussion (page unavailable) says treating these comorbidities appears important for symptom improvement, but it does not establish that stress and anxiety maintain complex tic presentations generally. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAll cases met criteria for FTLBs based on current guidelines.
“All cases presented to our clinic between 2019 and 2023 and met criteria for FTLBs based on current guidelines (12).”
From Integrated cognitive behavioral intervention for functional tics (I-CBiT): case reports and treatment formulation (2023) · cites this paper as [12]
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Hartmann, A., Andrén, P., Atkinson-Clément, C., Czernecki, V., Delorme, C., Morand‐Beaulieu, S., Debes, N. M., Müller‐Vahl, K., Paschou, P., Szejko, N., et al. (2025) · F1000Research · doi:10.12688/f1000research.164800.3
Self-citationFunktionelle neurologische Bewegungsstörungen
Weissbach, A., Hamami, F., Münchau, A. M., & Ganos, C. (2025) · Neurologie up2date · doi:10.1055/a-2678-2191
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- Authors
- Pringsheim, T., Ganos, C., Nilles, C., Cavanna, A. E., Gilbert, D. L., Greenberg, E., Hartmann, A., Hedderly, T., Heyman, I., Liang, H., Malaty, I., Malik, O., Debes, N. M., Vahl, K. M., Munchau, A., Murphy, T., Nagy, P., Owen, T., Rizzo, R., Skov, L., Stern, J., Szejko, N., Worbe, Y., & Martino, D.
- Affiliations
- University of Calgary (CA)
- Charité – Universitätsmedizin Berlin (DE)
- National Health Service (GB)
- Cincinnati Children's Hospital Medical Center (US)
- Massachusetts General Hospital (US)
- Assistance Publique – Hôpitaux de Paris (FR)
- King's College London (GB)
- University College London (GB)
- University of Florida Health (US)
- University of Copenhagen (DK)
- Department of Psychiatry, Social Psychiatry, and Psychotherapy Hanover Medical School Hanover Germany
- Institute of Systems Motor Science University of Lübeck Lübeck Germany
- Division of Neurodevelopmental Disorders Bethesda Children's Hospital Budapest Hungary
- University of Catania (IT)
- Herlev Hospital (DK)
- University of London (GB)
- Medical University of Warsaw (PL)
- Sorbonne Université (FR)
- Corresponding author
- Pringsheim, Tamara
- ORCID
- Pringsheim, Tamara
- Ganos, Christos
- Nilles, Christelle
- Cavanna, Andrea E.
- Gilbert, Donald L.
- Greenberg, Erica
- Hartmann, Andreas
- Hedderly, Tammy
- Heyman, Isobel
- Liang, Holan
- Malaty, Irene
- Malik, Osman
- Debes, Nanette Mol
- Murphy, Tara
- Owen, Tamsin
- Rizzo, Renata
- Skov, Liselotte
- Stern, Jeremy
- Szejko, Natalia
- Worbe, Yulia
- Martino, Davide
- Venue
- European Journal of Neurology
- Publisher
- Wiley
- Published
- 2023-01-13
- Volume
- 30
- Issue
- 4
- Pages
- 902-910
- ISSN
- 1351-5101 (ISSN-L)
- 1468-1331
- OpenAlex
- W4313379902
- Semantic Scholar
- 0edbb6117a04e4c7139847f52bbae0d34e57313e
- Cited by
- 72
- References
- 28
- Citations by year
- 2026: 19 · 2025: 18 · 2024: 20 · 2023: 15
- FWCI
- 14.66
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- European Journal of Neurology (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Funders
- American Brain Foundation
- Tourette Association of America
- Public Health Agency of Canada
- Public Health Agency
- Warszawski Uniwersytet Medyczny
- Uniwersytet Warszawski
- Ministerstwo Zdrowia
- Parkinsonfonden
- Alberta Children's Hospital Research Institute
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Clinical Psychology › Stuttering Research and Treatment
- Keywords
- clinical criteria, tic disorders, Tourette syndrome, diagnostic criteria, Delphi consensus, youth
- MeSH terms
- Adolescent, Tourette Syndrome, Humans, Prospective Studies, Tic Disorders, Tics, Consensus
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