Provisional Tic Disorder is not so transient

What is it about?

When a child has had tics for less than a year, the diagnosis is (almost always) Provisional Tic Disorder (formerly Transient Tic Disorder). The assumption has been that usually tics go away before they last the year needed to diagnose Tourette syndrome or chronic tic disorder. We examined 43 children within the first 6 months after their tics started and invited them back at the 12-month anniversary of their first tic. 39 of them returned. Most of them had improved, and a good number of them thought the tics were completely gone. Many of those showed no tics during a long interview and examination. But all of them still had tics, often seen only by video when they were seated in a room by themselves. So the conclusion is that generally tics get better, but don't completely disappear ... at least, not within the first year after onset. We also found baseline predictors of 12-month outcome, including a higher score on an autism spectrum questionnaire (though none of these children had Autistic Disorder), and the presence of an anxiety disorder.

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Why is it important?

These results clarify the natural history of early tic disorders and suggest a couple of practical clues (anxiety and subsyndromal autism spectrum features) as to whose tics are likely to improve less vs. more within the first 6-12 months after onset.

Perspectives