TIC DISORDER/ TOURETTE SYNDROME ASSESSMENT FOR CHILDREN AND TEENS

At Possibilities, physicians with expertise in neuroscience and development offer Tic Disorder/Tourette Syndrome Assessments to children and teens. With this assessment, physicians can determine whether a Tic Disorder—like Tourette Syndrome (TS)—is present and whether it explains the repetitive behaviours you’ve noticed from your child or teen. Here are questions we are often asked about our specialized Tic Disorder/Tourette Syndrome Assessment, along with our answers.

What are tics?
Tics are repetitive, involuntary movements or vocalizations such as blinking, nose twitching, throat clearing, or sniffing. You might have heard that tics are all about swearing or using inappropriate language, especially in Tourette Syndrome (TS). Science says that assumption is wrong! In Tourette Syndrome most tics do not involve swearing at all.
What is Tourette Syndrome (TS)?
Tourette Syndrome (TS) is a neurobiological brain difference—which means it is a neurodevelopmental condition—where tics are a symptom. Tourette Syndrome occurs when a child or teen has had both movement and vocal tics for more than a year.
Will the tics stop by making my child more aware of them and by just saying, “stop”?
No. Tics, by definition, are involuntary. Some children and teens may have some control over their tics, but not 24/7. And saying “stop!” or providing rewards and consequences will not be effective either. In fact, the more people talk about tics or point them out, the more likely the tics will get worse! Treating tics requires a highly specialized treatment plan. It also requires a therapist with highly specialized training in treating tics. A clinician who does more general forms of therapy will not be effective when it comes to reducing tics that are stressful for your child or teen.
What treatments are available if Tourette Syndrome is diagnosed?
If your child or teen wants to reduce specific tics, then there are options, such as specialized behaviour therapy called CBIT, or medication. 
Can you tell me more about the drug-free therapy for tics called CBIT?
Yes! At Possibilities, we have clinicians trained in CBIT, which stands for Comprehensive Behavioural Intervention for Tics. CBIT is an exciting, well-researched, and scientifically-supported behaviour therapy designed specifically to help individuals with Tic Disorders lessen their tics. CBIT is a drug-free option for tic management done with a therapist trained in this technique. At Possibilities, our trained clinicians offer CBIT to children and adolescents. We do not offer services for Tic Disorders and Tourette Syndrome for adults at this time.

    Are tics the only symptom or concern that might need treatment in Tic Disorders or Tourette Syndrome?
    No. In people with persistent tics, there is a very high chance (86%!) that other difficulties are present, too. These added challenges can include ADD/ADHD, Learning Disabilities, Anxiety, Obsessive-Compulsive Disorder (OCD) and self-regulation difficulties that can affect thoughts, feelings, and actions. Often, these coexisting conditions can cause more difficulties for people with Tic Disorders than the tics themselves! If treatment is focused on tics only, other concerns could be missed and get worse over time. It’s important to have an integrated treatment plan for all conditions that may be present along with the tics.
    How can I figure out if my child or teen has a Tic Disorder like Tourette Syndrome?
    A detailed assessment of tics can help you figure that out. And no, this is not something you need to figure out on your own. We can help! We have assessed thousands of children and teens at the Possibilities Clinic. We are specialists, not generalists. That means we have expertise in Tic Disorders, like Tourette Syndrome, and in the conditions that often go along with tics. We stay up-to-date with the latest research and follow current guidelines for assessing and treating these disorders.
    What if I hear about a great treatment for Tourette Syndrome, or for any condition that exists along with it, but you do not offer it at Possibilities?
    We only offer treatments that are supported by science. If you’ve heard about a treatment and we don’t offer it, ask us why. Most likely, the science is not strong enough for us to offer it to our patients. A treatment might sound scientific, but that doesn’t mean it is. Scient-iffy  is our word for science-sounding claims and treatments that have minimal to no scientific support to back them up. The absence of real data makes many claims and treatments  “iffy”—meaning unproven and full of uncertainty. We stand by science and all things scientific. We never settle for “scientiffy” and neither should you!
    What do Tourette Syndrome Assessments look like at the Possibilities Clinic?
    At Possibilities we offer an OHIP-covered appointment with a physician who has expertise in the diagnosis of Tic Disorders and Tourette Syndrome. The physician will review all background information you provide prior to the appointment. In a comprehensive clinical interview, the physician will take a detailed medical and developmental history, ask you about the length, nature, and severity of tics, and explore whether other conditions, like learning and attention problems, might be present. The physician will then advise you on the next steps you and your family can take. 
    Does my child need to be present with me for the assessment?
    Yes. At least one parent must be present for the assessment interview. Your child must also be available. Younger children might be present for only part of the interview, while teens may wish to stay for the duration. The physician can receive information about tics from both you and your child with this arrangement. Chances are your child or teen will display tics in the interview, too, and those tics are important for the physician to see. Speaking with your child can also help the physician determine whether CBIT might be a good treatment option. CBIT requires clients to be aware of their tics, frustrated and bothered by them, and motivated to change them—so motivated that they are diligent in performing weekly exercises when tics emerge to try and lessen them. Ages 8 or 9 is often a good starting point for CBIT.
    How are your Tic Disorders/ Tourette Syndrome Assessments at the Possibilities Clinic different from others?
    Our physicians have deep expertise in Tic Disorders, including Tourette Syndrome. But their expertise extends beyond tics, with specialized knowledge in disorders that often go along with tics like ADHD and Learning Disabilities. If the physician has concerns that other conditions might be occurring along with a Tic Disorder, a specialized assessment will be suggested. Our comprehensive assessment exploring whether ADD/ADHD is present is called a Focus Forward 360 Assessment. A more extensive assessment looking at whether ADHD and any Learning Disabilities are present together is called a Signature Assessment. These assessments are done by Multidisciplinary Teams which include physicians and  health professionals from psychology and psychometry. 
    At what age should I consider obtaining a Tic Disorder Assessment for my child?
    At any age! Good outcomes can happen with the right Treatment Plan, but a comprehensive assessment comes first. Currently, Possibilities only offers Tic Disorders/Tourette Syndrome assessment and treatments for children and adolescents up to the age of 17 years. We can, however, assess and treat commonly co-occurring ADD and ADHD in adults.
    Will the assessment help the physician develop the right Treatment Plan?
    Yes! Recommendations cannot be general, and they cannot be vague. Recommendations must be targeted, specific, and supported by science, and they must be personalized for your child or teen. If the physician suspects other challenges are impeding your child’s success based on the Tic Disorder Assessment interview, further investigation with a comprehensive Multidisciplinary Team assessment will be suggested, like a Focus Forward 360 Assessment or Signature Assessment. Information gathered from these assessments—including any diagnoses that might be made—can be used to craft more recommendations that target all the areas where your child needs support.
    What is the cost of the assessment?
    The Tic Disorder/Tourette Syndrome Assessment is an appointment with a physician that is covered by OHIP. If the physician recommends a Comprehensive Multidisciplinary Team Assessment like Focus Forward 360 Assessment to examine attention further, or a Signature Assessment to see if a Learning Disability explains challenges at school, there is a cost since OHIP does not cover the work and testing materials of health professionals from psychometry and psychology on the Assessment Team. The cost of these assessments is often covered by private insurance plans. Therapies such as CBIT are provided by non-medical professionals and are also not covered by OHIP. CBIT treatment costs may be covered by your private insurance plan. 
    I see your main office is in Toronto. Do you provide services in other parts of Ontario?
    Yes! Our Tic Disorder/Tourette Syndrome Assessment is now available throughout Ontario over secure video sessions. If you have a computer and a high-speed internet connection, you and your child can attend the appointment from the comfort of your home. 
    Do I need to be in Ontario for the assessment?
    Yes. All our physicians are licensed to see people in Ontario only. If you live anywhere in Ontario, you can be accessed remotely. You and your child must be physically present in Ontario at the time of your video appointment.
    Do I need a doctor’s referral to start the assessment?
    Yes. A specialized physician is involved in the Tic Disorder/Tourette Syndrome Assessment, so a doctor’s referral is required. 
    How do I get started?
    Please complete the intake form on our website at https://possibilitiesclinic.com/age-3-17/ for children and teens. Once we have this form and the physician referral, our Coordinator will call you to set up an appointment.
    For any questions, email us at info@possibilitiesclinic.com or call 1-833-482-5558 to speak to one of our Clinical Coordinators.