Mortimer's Tic Inventory – Dale Mortimer, M.D.

Tics are abrupt, sudden, brief, rapid, recurrent, repetitive, non–rhythmic involuntary movements, gestures, and/or utterances/vocalizations that typically occur in bouts at irregular intervals (“remitting/relapsing” course), and mimic some aspect of a normal behavioral repertoire. Tics are usually of brief duration, with individual tics rarely last more than a second or two. Around 20% of children experience transient and benign tic disorders (– which are more likely to occur during the winter months). In the minority of those with chronic tics, by age 10-11 years, many of these children report premonitory experiences that precede the tics, and are relieved with the performance of the tic. These sensory experiences, which may be intrinsic to the phenomenology of the tic, typically consist of a feeling of tightness, tension, increased sensitivity, or a mounting discomfort/ anxiety located in a specific part of the body. The sensory prodrome ( – which is likened to the expectation that precedes a hiccup, sneeze or an itch) is felt as requiring some type of vigorous, quick, tic–like action for its attenuation. Although the performance of a tic may lead to short–term relief, the child/adolescent (or adult) soon feels the mounting of renewed tension to which he or she will inevitably and perhaps shamefully capitulate. Sometimes those with tics feel that an effective action to relieve the building pressure (or prodromal sensation) must include a dangerous or aggressive behavior, as an essential constituent of the tic experience. Tics may be difficult to distinguish between normal behavior – although the tics are frequently contextually odd or inappropriate behaviors. Early–onset tic symptoms may be misdiagnosed and mistaken for other medical conditions (– for example, throat clearing, sniffing, coughing, snorting, hissing, and noisy breathing are often mistaken for allergy symptoms) and it often requires a trained eye (or ear) to correctly identify tics.

Simple motor tics (many of these tics are difficult to adequately describe in words):

Complex motor tics involve more than one muscle group, and moving in a certain stereotyped sequence. The motor tics may appear dance–like. They can also be obscene in character or they may appear self-injurious. While the complex motor tics may appear intentional, they serve no purpose for the person who performs them.

Phonic tics are non–word utterances/ sounds involving the passage of air in some capacity (phonic tics may be difficult to distinguish from normal – although contexually odd or inappropriate – behavior).

Verbal or vocal tics are stereotypical use of words or a series of words or word phrases. Again, verbal tics may be difficult to distinguish from normal (although contexually odd or inappropriate) behavior.

Sensory tics are localized, uncomfortable sensations that occur in a repetitive fashion, often relieved by performing a motor or vocal tic. Descriptions will vary, but may include a feeling of pressure, tension, anxiety, an ache, tingling, energy, burning, or even a feeling that things are “just not right.” Alas, squeezing the affected muscles brings only temporary relief.

Mental play is pleasurable and intentional visual, auditory, and cognitive number and word games (e.g., making up new words by breaking up or changing old ones, playing mental arithmetic games purely for entertainment, changing the appearance of images by squinting or moving one’s eyes in different ways).

References/Recommended Reading or Viewing:

  1. “Gilles de la Tourette Syndrome and Tic Disorders” - Elaine Shapiro, Ph.D. and Arthur K. Shapiro, M.D., Harvard Mental Health Newsletter (published in about 1989)
  2. Yale Global Tic Severity Scale – James Leckman, M.D., Yale Child Study Center (1992)
  3. “I Have Tourette’s, but Tourette’s Doesn’t Have Me,” HBO Special, directed and produced by Ellen Goosenberg Kent (2005)
  4. A Mind of Its Own - Ruth Dowling Bruun, M.D. and Bertel Brunn, M.D. (1994)
  5. Budman CL, Bruun RD, Park KS, Olsen MD, “Rage attacks in children and adolescents with Tourette’s disorder: a pilot study,” Journal of Clinical Psychiatry. 1998;59:576-580
  6. Cohen DJ and Leckman JF, “Developmental psychopathology and neurobiology of Tourette’s syndrome,” Journal of the American Academy of Child & Adolescent Psychiatry, 1994, 33 (1):2-15
  7. Darrow SM, Grados M, Sandor P, et al, “Autism spectrum symptoms in a Tourette’s disorder sample,” Journal of the American Academy of Child & Adolescent Psychiatry. 2017;56(7):610-617
  8. da Silva Prado H, da Rosario MC, et al, “Sensory phenomena in obsessive–compulsive disorder and tic disorders: a review of the literature,” CNS Spectrums.2008; 13(5):425-432
  9. Treatment and Management of Youth with Tourette Syndrome and Tic Disorders – Joseph McGuire, Tanya Murphy, John Piacentini, Eric Storch (editors) (2018)
  10. Anything from the Tourette’s Association of America [formerly Tourette’s Syndrome of America]