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Tic Checklist
This form is to be used as an aid when seeking assessment and is not a diagnostic tool
Please ensure you tick all the symptoms you have (past) or do (currently) experience.
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Email
*
Your email
Full Name
*
Your answer
Current age
*
Your answer
Age of first motor tic
*
Your answer
Age of first vocal tic
*
Your answer
Tic Exploration - select what fits best for each set of questions - answer as many as needed
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Tics Began Suddenly
Tics Began Gradually
Tics began as a simple movement / sound
Tics began as a complex movement / sound
Tics increased slowly
Tics increased Rapidly
Tics occur without me knowing
Tics occur after an urge (funny feeling)
I can hold my tics in (for a short period of time)
I can not hold my tics in at all
Required
Motor Tic Checklist - (This is not a full list)
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blinking
facial grimacing
eye rolling
squinting
smacking/licking lips
sticking tongue out
sucking thumb/ fingers
flipping hair of face
head turning
arm movements
neck jerk
tensing muscles
chin down
arm flapping
kicking
toe curling
cracking jaw/joints
jaw clenching
grinding teeth
poking
pulling at clothes
hopping
jumping
kissing self/others
bladder/bowel tics
limb thrusting
skin picking
hitting
putting items in ears/nose
hair/lash pulling
inappropriate touching self/others - copropraxia
inappropriate gestures - copropraxia
eyebrow raise
Frowning
head jerk
shoulder shrugging
Hand / finger movements
Pelvic floor/ Rectum tic
Other:
Required
Vocal Tics (This is not a full list)
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sniffing
coughing
throat clearing
spitting
shouting
squeaking
breathing
burping
noises
whistling
gagging
singing
change in pitch/rate/tone of voice
words
phrases
repeating all/part of own words - Palilalia
repeating all/ part others words - Echolalia
stuttering
animal sounds
obscene/ racial/ socially inappropriate words and or phrases - Coprolalia
Air gulping
Squeaking
Other:
Required
Mental/ Other Tic Checklist (This is not a full list)
intrusive thoughts/ images
flashes of unwanted morbid thoughts/ images
thoughts on repeat
song lyrics on repeat
inappropriate writing/ drawing - coprographia
Writing tics
Stimulus dependent tics
Obsessive thoughts / Rituals
rechecking
perfectionism
items placed just right
touching items in certain way
deleting/re-writing
pattern hyper focus
doing things in a sequence
worries around health self/ others
Other:
Other Symptoms
rigid in thinking
lacking focus/ attention
poor handwriting
rage/ bad temper
easily triggered (temper)
poor organisation
hyper/hypo senses - touch, taste, sound, smell, taste
impulsive
sense of justice
must have last say
Common Co-Occurring Conditions - Diagnosed
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Anxiety
ADHD - Hyperactive
ADHD - Inattentive
ADHD - Combined
OCD - Obsessive Compulsive Disorder
ODD - Oppositional Defiant Disorder
Autism
Mood disorders
Executive dysfunction
Sleep disorder
Migraines
Social Impairment
Required
Other co-occurring symptoms you may be experiencing
limb locking
paralysis
mutism
falling/ drop attacks
non epileptic seizures
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