Page 1 of 1
Q.1
Does your child demonstrate repeated sudden twitches or jerks of the extremities? These can include eye blinking, neck twisting, muscle tightening, shoulder shrugging, or any similar movement.
*
Yes – frequently
Sometimes
No – never
Q.2
Does your child utter involuntary sounds, like grunts, yelps, squeaks, or throat clears?
*
Yes – frequently
Sometimes
No – never
Q.3
Does your child mimic the motions or words of others, in a manner that appears involuntary?
*
Yes – frequently
Sometimes
No – never
Q.4
Does your child involuntarily carry out known gestures, like waving, reaching or vulgar actions (like giving “the finger”)?
*
Yes – frequently
Sometimes
No – never
Q.5
For any relevant tics from above, how long have they lasted?
*
More than 4 weeks
Less than 4 weeks
Not applicable
Q.6
If tics have lasted for longer than 4 weeks, have they been present for more than a year?
*
Yes, more than one year
No, between four weeks and a year
Not applicable
Q.7
Is your child demonstrating more than one type of tic (motor or vocal)?
*
Yes, motor and vocal at the same time
Yes, more than one motor tic OR more than one vocal tic — but not motor and vocal at the same time
No, single tic only
Not applicable
Q.8
Do these tics ever cause severe emotional or social distress for your child?
*
Yes – frequently
Sometimes
No – never
Q.9
[OPTIONAL] Would you like to receive ADDitude's free newsletter for parents of children with ADHD and related conditions? If so, enter your email address below. You can unsubscribe at any time.
Email
Page 1 of 1