What are the common symptoms of Tourette Syndrome?

Tourette Syndrome is marked by motor and vocal tics, including sudden blinking, throat clearing, grunting, or shouting inappropriate words.

What types of tics are associated with Tourette Syndrome?

Tics can be simple or complex. Simple tics involve quick, repetitive movements, while complex tics involve coordinated motions. Tics can also be motor or vocal.

When do Tourette symptoms usually start?

Tics typically begin between the ages of 2 and 15, making early evaluation and care essential during childhood or adolescence.

What are some common signs and symptoms of Tics and Tourette Syndrome?

The most common signs of Tourette syndrome are the tics themselves. For example: Simple Tics – Sudden, brief, and repetitive tics that typically involve only a few muscle groups, such as in the fingers or the eyes. Complex Tics – More complex tics are distinct, coordinated movements involving multiple large muscle groups. Motor Tics – Motor tics are physical, such as simple or complex tics. Vocal Tics – Vocal tics include grunting, coughing, throat clearing, barking, or shouting obscene language.

How is it Determined that Someone has Tics and Tourette Syndrome?

There are no specific tests used to diagnose Tourette syndrome. Instead, diagnosis is based on the signs and symptoms presented. The criteria include: The presence of both motor and vocal tics Tics occur multiple times per day, every day, for over a year Tics begin by age 18 Tics are not caused by medication

How is Tics and Tourette Syndrome being handled or treated in today’s society?

Unfortunately, there remains a stigma surrounding Tourette syndrome in the country. Many jokes and viral videos focus on those suffering from Tourette syndrome, and are made for others to laugh at. However, individuals with Tourette syndrome typically have more options for treatment than ever before. Seeking a doctor or therapist is as easy as making a phone call.

How is Tourette Syndrome treated at Prime Behavioral Health?

Prime Behavioral Health offers treatment in Southlake, TX, for those experiencing tics or Tourette Syndrome, including access to compassionate psychiatric care and therapy.

Tics and Tourette Syndrome Treatment in Southlake, TX and the Surrounding Areas

Q: How is Tourette Syndrome diagnosed?

Tourette Syndrome is diagnosed based on symptoms. Criteria include both motor and vocal tics occurring daily for over a year, beginning before age 18, and not caused by medication.

Prime Behavioral Health is a licensed psychiatric practice providing evaluation and treatment for tics and Tourette syndrome for children, teens, and adults in Southlake, TX and the surrounding areas. Our practice is led by Dr. Vishal Shah, MD, Board Certified in Adult and Child/Adolescent Psychiatry with over five years of experience serving North Texas, alongside four certified psychiatric mental health nurse practitioners. Care includes a thorough diagnostic evaluation, referrals for Comprehensive Behavioral Intervention for Tics (CBIT), medication management when tics cause significant impairment, and treatment for co-occurring conditions such as ADHD, OCD, and anxiety. We accept most major insurance plans including Aetna, BlueCross BlueShield PPO, Optum, United Healthcare, and Cigna, offer telemedicine appointments for eligible follow-up care, and have verified patient reviews on Google. Call 817-778-8884 or schedule your new patient appointment online to begin.

Tics and Tourette Syndrome Treatment in Southlake, TX

What Are Tics and Tourette Syndrome?

Tics are sudden, rapid, repetitive movements or sounds that are difficult to control. Tourette syndrome is a neurodevelopmental condition defined by multiple motor tics and at least one vocal tic that have lasted more than a year, with onset before age 18. According to the CDC, tics usually begin in childhood, with an average starting age of about 6 and a range from about 2 to 15, and Tourette syndrome is more common in boys than in girls.

Tics are not a choice, and they are not a sign of poor parenting or a behavior problem. Many people feel a building urge before a tic that eases briefly afterward, and they can hold tics back for a short time with effort, which is tiring. Tics wax and wane, often becoming more noticeable with stress, excitement, or fatigue, and many people see them ease in late adolescence or early adulthood, although the course varies.

Movies and viral clips often show involuntary swearing, but that symptom, called coprolalia, affects only a minority of people with Tourette syndrome. Most tics are everyday movements and sounds such as blinking, shrugging, throat clearing, and sniffing. The National Institute of Neurological Disorders and Stroke offers a plain-language overview of the condition.

Types of Tics

Type	Simple tics	Complex tics
Motor	Eye blinking, nose twitching, facial grimacing, head jerking, shoulder shrugging	Hopping, twirling, touching objects or people, a coordinated sequence of movements, copying others' movements
Vocal	Throat clearing, sniffing, coughing, grunting, humming	Repeating words or phrases, repeating one's own words, and in a minority of people, involuntary inappropriate words

Tic Disorders Compared

Diagnosis	Key features (DSM-5)
Provisional tic disorder	One or more motor and/or vocal tics present for less than one year since the first tic appeared
Persistent (chronic) motor or vocal tic disorder	Motor tics only, or vocal tics only, present for more than one year
Tourette's disorder	Multiple motor tics and at least one vocal tic (not necessarily at the same time), present for more than one year

All three diagnoses require onset before age 18 and tics that are not better explained by a medication, a substance, or another medical condition. There is no blood test or brain scan for Tourette syndrome, so an experienced clinician makes the diagnosis from history and observation.

Signs It May Be Time for an Evaluation

Not every tic needs treatment, and many brief tics fade on their own. Consider an evaluation when:

Tics have lasted longer than a few months, or have become more frequent, intense, or complex
Tics cause pain, strain, or injury, such as neck or shoulder soreness
Tics interfere with schoolwork, sleep, friendships, or family life
Your child is teased, withdraws, or shows anxiety, low mood, or low confidence
Tics come with intrusive thoughts, rituals, or attention problems that suggest OCD or ADHD
You are unsure whether a movement or sound is a tic

Tics that begin abruptly, especially alongside sudden obsessive thoughts or major changes in mood or behavior, deserve a prompt evaluation. A psychiatric evaluation can sort tics from habits, stereotypies, anxiety, and other causes, and can identify related conditions that need attention.

Co-Occurring Conditions

Most people with Tourette syndrome have at least one other condition, and these often affect daily life as much as the tics themselves. The most common are ADHD and OCD, followed by anxiety and depression. Sleep problems, learning differences, and impulsive or disruptive behavior also appear. Our overview of neurodevelopmental conditions in children explains how these conditions can overlap.

Tic and Tourette Treatment at Prime Behavioral Health

Treatment focuses on function, comfort, and quality of life rather than eliminating every tic. Care plans are individualized and may combine the following.

Diagnostic Evaluation and Education

Care starts with a comprehensive psychiatric evaluation and a clear explanation of what tics are and are not. Families often find that understanding urges, waxing and waning, and triggers lowers stress for everyone. Many tics need education and monitoring rather than treatment.

Behavioral Therapy Referrals (CBIT)

Comprehensive Behavioral Intervention for Tics (CBIT) teaches patients to notice the urge before a tic, practice a competing response, and change situations that make tics worse. Clinical guidelines list CBIT among first-line treatments. It is delivered by a trained therapist, and we coordinate referrals and stay in touch with your therapist. The Tourette Association of America offers additional family resources.

Medication Management

When tics cause pain, injury, or significant interference, medication can help reduce their severity. Options a psychiatrist may consider include alpha-2 adrenergic agonists and certain antipsychotic medications, among others. Your provider reviews benefits and side effects, starts with careful dosing, and adjusts the plan over time, and results vary. See how medication management works at our practice. GeneSight DNA testing is available to help guide medication choices for co-occurring conditions.

Treatment for Co-Occurring Conditions

Treating ADHD, OCD, anxiety, and depression often improves day-to-day life more than treating tics alone. When ADHD and tics occur together, treatment choices are made carefully and monitored closely. OCD is typically treated with Exposure and Response Prevention therapy, medication, or both.

School Coordination and Accommodations

Federal special education law lists Tourette syndrome as an example of an “other health impairment,” and Section 504 can provide accommodations when tics limit learning. The U.S. Department of Education explains how IDEA special education services work. In Texas, the IEP team is called the ARD committee. We provide documentation from your evaluation, and our guide on becoming an effective advocate for your child helps families prepare for school meetings.

Family Support and Parent Guidance

Parents learn how to respond calmly to tics, support sleep and routines, and help teachers and classmates understand tics when the child agrees. Read about the role of family support in psychiatric treatment and how therapy and psychiatry work together for adolescent mental health.

Telemedicine Follow-Up

Initial evaluations take place in person at our Southlake office. Eligible patients can use telemedicine follow-up visits for check-ins and medication reviews, which fits around school and work schedules.

Where TMS Therapy Fits

NeuroStar TMS therapy is not an FDA-approved treatment for tics or Tourette syndrome. Patients who also have treatment-resistant depression (ages 15 and older) or, as an adult adjunct, OCD may be evaluated separately for those conditions. Learn more about NeuroStar TMS therapy and TMS therapy for OCD.

Home Support vs. Professional Care

What families can do at home	When to bring in a professional
Stay calm and avoid commenting on or asking a child to stop tics	Tics cause pain or injury, or disrupt school and friendships
Keep sleep, meals, and routines consistent, with downtime built in	Anxiety, OCD symptoms, low mood, or major behavior changes appear alongside tics
Help teachers and classmates understand tics, with the child's agreement	The school asks for documentation or you want formal accommodations
Offer low-pressure outlets such as exercise and hobbies	Tics are getting worse, or you are not sure whether movements are tics

A professional evaluation matters because other conditions can mimic tics, co-occurring conditions often cause more impairment than the tics, CBIT requires a trained therapist, and medication needs careful monitoring.

Our Process for Tic and Tourette Evaluations

Call 817-778-8884 or schedule online. No referral is required.
Our team reviews your insurance benefits before treatment begins.
Your first visit is a comprehensive evaluation of about 60 to 90 minutes with the patient and family, covering tic history, medical, developmental, and family history, and current medications.
Your provider observes tics and may use diagnosis-specific rating scales, with input from schools, pediatricians, or neurologists when appropriate and with your consent.
You receive a clear explanation of the diagnosis and a personalized plan, which may include education, CBIT referral, medication management, school documentation, and treatment of co-occurring conditions.
Follow-up visits track progress and adjust care, in the office or by telemedicine for eligible patients.

Tourette and Tic Care in Southlake and the DFW Area

CDC data suggest that roughly 3 to 6 of every 1,000 school-age children have been diagnosed with Tourette syndrome, and brief tics are more common. For families in districts such as Carroll ISD, Keller ISD, Grapevine-Colleyville ISD, and Northwest ISD, school supports are available under federal law, and Texas parents may request a special education evaluation from their district in writing.

Families reach our Southlake office from Grapevine, Colleyville, Keller, Trophy Club, Roanoke, Fort Worth, and communities across the metroplex, and eligible follow-ups can use telemedicine to reduce travel.

Meet Our Providers

Dr. Vishal Shah, MD - Psychiatrist and Medical Director

Dr. Vishal Shah is a board-certified psychiatrist and Medical Director of Prime Behavioral Health. He earned undergraduate degrees in Genetics and Computer Science from Rutgers University and his Medical Doctorate from Saba University of Medicine, graduating with honors. Dr. Shah completed a three-year Adult Psychiatry Residency at Howard University Hospital and a two-year Child and Adolescent Psychiatry Fellowship at Akron Children’s Hospital. He is Board Certified in both Adult Psychiatry and Child/Adolescent Psychiatry and brings expertise in Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Interpersonal Therapy (IPT), Motivational Interviewing, and crisis management.

Barbara Schoen Johnson, PhD, APRN, PMHNP - Psychiatric Mental Health Nurse Practitioner

Dr. Barbara Schoen Johnson holds a PhD in Nursing from Texas Woman’s University and is board certified in Child and Adolescent Psychiatric Nursing by the American Nurses Credentialing Center. She completed her PMHNP certification at the University of Texas at Arlington and served 16 years as a Child and Adolescent Psychiatric Nurse Practitioner at Cook Children’s Behavioral Health Outpatient Clinic. She has authored two nationally recognized psychiatric nursing textbooks, earned the AJN Book of the Year Award, and was named among the Great 100 Nurses of Dallas-Fort Worth.

Mariah Mathews, MSN, APRN, PMHNP-BC - Psychiatric Mental Health Nurse Practitioner

Mariah Mathews is board certified in Child, Adolescent, and Adult Psychiatric Nursing by the American Nurses Credentialing Center. She holds a Master of Science in Nursing from Eastern Kentucky University and a Bachelor of Science in Nursing from the University of Missouri-Columbia. She brings seven years of pediatric RN experience from Children’s Health Dallas and completed clinical rotations at UT Southwestern Outpatient Adult Psychiatry and Children’s Health Plano.

Keri Kendall, MSN, APRN, PMHNP-BC - Psychiatric Mental Health Nurse Practitioner

Keri Kendall is board certified in Child, Adolescent, and Adult Psychiatric Nursing by the American Nurses Credentialing Center and holds a Master of Science in Nursing from the University of Texas at Arlington. Prior to her psychiatric specialization, she practiced as a cardiac nurse and a school nurse. She is committed to helping each patient develop a clear path toward long-term mental health and daily wellness.

Pragya Pathak, MSN, APRN, PMHNP-C - Psychiatric Mental Health Nurse Practitioner

Pragya Pathak is a Certified Psychiatric Mental Health Nurse Practitioner by both the American Academy of Nurse Practitioners and the State of Texas. She holds a Master of Science in Nursing from the University of Texas at Arlington (2025) and a Bachelor of Science in Nursing from Texas Woman’s University (2016). She brings over eight years of psychiatric inpatient nursing experience from UT Southwestern Medical Center and completed clinical rotations in outpatient psychiatry and the ECT Service.

View full provider credentials and bios.

Why Choose Prime Behavioral Health for Tic and Tourette Care

What We Offer	What It Means for You
Evaluation of tics and co-occurring conditions	ADHD, OCD, anxiety, and sleep problems are assessed together so the plan fits the whole picture
CBIT referrals and school documentation	Coordinated care across therapy, school, and family
Board-certified psychiatrist (Dr. Shah, MD)	Physician-led care with dual board certification in adult and child/adolescent psychiatry
4 licensed psychiatric nurse practitioners	Broader availability across all age groups, including child and adolescent psychiatric nursing experience
Major insurance accepted	Aetna, BlueCross BlueShield PPO, Optum, United Healthcare, and Cigna; benefits verified before treatment begins
Verified patient reviews on Google	Read what patients say before you book
Telemedicine appointments	Eligible follow-ups from home reduce travel for busy families and professionals
New patient appointments	No referral required. Schedule online or call 817-778-8884
GeneSight DNA testing available	Genetic insight to help guide medication choices and reduce trial and error
5+ years serving DFW	Established practice with deep North Texas community roots

Frequently Asked Questions About Tics and Tourette Syndrome Treatment in Southlake, TX

What is Tourette syndrome?

Tourette syndrome is a neurodevelopmental condition marked by tics, which are sudden, repetitive movements or sounds that a person cannot fully control. A diagnosis requires multiple motor tics and at least one vocal tic that have been present for more than a year, with onset before age 18. Tics often change in type and frequency over time, and many people live full, active lives with the right support.

What is the difference between tics and Tourette syndrome?

Tics are sudden, repetitive movements or sounds, and many children have a brief tic at some point that fades within months. Tourette syndrome is the diagnosis when both motor and vocal tics have lasted more than a year. Persistent motor or vocal tic disorder describes tics of only one kind lasting more than a year. A clinical evaluation determines which diagnosis fits.

What are the most common motor tics?

Common motor tics include eye blinking, nose twitching, facial grimacing, head jerking, and shoulder shrugging. More complex motor tics can involve hopping, twirling, touching objects, or a coordinated sequence of movements. Tics vary from person to person and often change over time.

What are the most common vocal tics?

Common vocal tics include throat clearing, sniffing, coughing, grunting, and humming. Complex vocal tics can include repeating words or phrases, repeating one’s own words, or sounds that seem to come out of context. Many vocal tics are mistaken for allergies or a cold at first.

Do all people with Tourette syndrome swear involuntarily?

No. Involuntary swearing or inappropriate words, called coprolalia, occurs in only a minority of people with Tourette syndrome. Most people have more common tics such as blinking, shrugging, throat clearing, or sniffing. Media portrayals often overstate how common coprolalia is.

At what age do tics usually start?

Tics usually begin in childhood, with an average starting age of about 6 and a range from about 2 to 15, according to the CDC. Severity often peaks in the early teen years, and many people see tics ease afterward. Because of this timing, early evaluation helps families plan supports at home and school.

What causes Tourette syndrome?

Researchers believe Tourette syndrome results from a combination of genetic and brain-related factors, particularly differences in the circuits that help control movement and behavior. It is not caused by poor parenting, a lack of discipline, or a character flaw. Stress and excitement can make tics more noticeable but do not cause the condition.

Is Tourette syndrome hereditary?

Tourette syndrome often runs in families, and genetics play a meaningful role, although no single gene explains it. Having a parent with tics raises the chance that a child will have tics, but many children with a family history never develop them, and many children with tics have no known family history.

How is Tourette syndrome diagnosed?

Diagnosis is clinical. A provider reviews when tics began, what types are present, how long they have lasted, family and medical history, and current medications, and observes the tics. DSM-5 criteria require multiple motor tics and at least one vocal tic for more than a year, with onset before age 18 and no better explanation such as a medication or another medical condition.

Is there a test, blood work, or brain scan for Tourette syndrome?

No blood test or brain scan diagnoses Tourette syndrome. Testing is sometimes ordered to rule out other causes when the picture is unclear, such as a different movement disorder or a medication effect. Most diagnoses rest on a careful history and observation by an experienced clinician.

What is a premonitory urge?

A premonitory urge is an uncomfortable feeling that builds before a tic, such as an itch, tension, or pressure, and eases briefly after the tic occurs. Many people with Tourette syndrome, especially older children and adults, notice these urges. Awareness of the urge is a key skill taught in behavioral therapy for tics.

Can a person control or hold back tics?

Many people can hold back tics for short periods, but doing so takes effort and attention and is often followed by a stronger release of tics later. Suppression is not a long-term solution and can be exhausting at school or work. Behavioral therapy teaches healthier ways to respond to the urge.

What makes tics better or worse?

Stress, excitement, anxiety, tiredness, and illness can make tics more frequent or noticeable, while calm, focused activities often reduce them. Tics typically wax and wane, with better and worse stretches that have no clear cause. Keeping routines, sleep, and stress levels steady supports overall comfort.

Do tics go away with age?

The course varies. Tics often peak in the early teen years, and many people notice improvement in late adolescence or early adulthood, while others continue to have tics into adulthood. Ongoing follow-up allows treatment to be adjusted as tics change.

Does every child with tics need treatment?

No. Mild tics that do not cause pain, injury, distress, or problems at school or with friends often need only education and reassurance. Treatment is considered when tics interfere with daily life, cause discomfort, or come with other concerns such as anxiety or ADHD. Your provider helps weigh the options with you.

What tic and Tourette treatments are available at Prime Behavioral Health?

Prime Behavioral Health provides a comprehensive diagnostic evaluation, education for patients and families, referrals for CBIT, medication management when tics cause significant impairment, treatment of co-occurring conditions such as ADHD, OCD, and anxiety, school coordination, and telemedicine follow-up for eligible patients. Care plans are individualized and adjusted over time.

What is CBIT, and who provides it?

Comprehensive Behavioral Intervention for Tics (CBIT) is a structured behavioral therapy that helps people notice the urge before a tic and practice a competing response, along with strategies to change situations that make tics worse. Clinical guidelines list CBIT among first-line treatments. A therapist trained in CBIT delivers it, and Prime Behavioral Health coordinates referrals as part of the care plan.

Can medication help with tics?

Yes, when tics are painful, injurious, or significantly disruptive, medication can reduce tic severity for many patients. Options evaluated by a psychiatrist include alpha-2 adrenergic agonists and certain antipsychotic medications, among others. Decisions are individualized, start with a careful review of benefits and side effects, and are revisited over time. Results vary.

What are the side effects of tic medications?

Side effects depend on the medication class and may include drowsiness, dizziness, changes in appetite or weight, or movement-related effects. Your provider reviews the risks of each option, starts with careful dosing, and monitors you at follow-up visits. Report any new symptoms promptly so the plan can be adjusted.

Can ADHD and Tourette syndrome occur together?

Yes. ADHD is one of the most common conditions seen alongside Tourette syndrome, and many children have both. Evaluation looks at attention, impulsivity, and tics together so treatment choices are made carefully and monitored closely.

How are OCD and Tourette syndrome related?

OCD is another common companion of Tourette syndrome, and the two can look similar because both involve repetitive behaviors. Tics are typically driven by a physical urge, while compulsions are usually driven by an obsessive thought or fear. A careful evaluation separates them, since treatment differs, and Exposure and Response Prevention therapy and medication are standard approaches for OCD.

Can anxiety or stress make tics worse?

Yes. Anxiety and stress often make tics more noticeable, and living with tics can increase anxiety in return. Treating anxiety with therapy, skills training, or medication when appropriate may help tics feel more manageable. Sleep, exercise, and predictable routines also help.

Is TMS therapy a treatment for tics or Tourette syndrome?

No. NeuroStar TMS therapy is FDA-approved for major depressive disorder and, for adults, as an adjunct treatment for OCD, but it is not an approved treatment for tics or Tourette syndrome. Patients with Tourette syndrome who also have treatment-resistant depression or OCD may be evaluated for TMS separately for those conditions.

How can Tourette syndrome affect school?

Tics can distract students, and holding tics back at school can be tiring. Co-occurring ADHD, anxiety, or OCD can add challenges, and teasing can affect confidence. With understanding teachers and the right supports, many students do well academically.

What school accommodations help students with tics?

Helpful accommodations include permission to step out briefly when tics are intense, extra time or a separate room for tests, a quiet space to release tics, flexibility with handwriting-heavy tasks if tics affect writing, and educating teachers and classmates about tics when the student agrees. Needs vary, and accommodations are tailored to the individual student.

Does Tourette syndrome qualify for a 504 Plan or an IEP?

Possibly. Federal special education law lists Tourette syndrome among the conditions that can qualify under the other health impairment category, and Section 504 can provide accommodations when a condition limits learning. In Texas, an ARD committee makes IEP decisions. Schools determine eligibility, and documentation from an evaluation can support the request.

How should parents respond to tics at home?

Stay calm, avoid asking your child to stop or commenting on each tic, and keep routines and sleep consistent. Praise effort and strengths, support friendships, and give low-pressure ways to unwind, such as exercise or hobbies. Educate family members and, with your child’s agreement, teachers, so tics are understood rather than punished.

Can adults be diagnosed with Tourette syndrome?

Tourette syndrome by definition begins before age 18, but adults with long-standing tics can be evaluated and treated, and some adults are first diagnosed later because earlier tics were mild or unrecognized. New tics that begin in adulthood deserve a medical evaluation to look for other causes.

Does Prime Behavioral Health treat children and teens with tics?

Yes. Dr. Vishal Shah is board certified in Adult and Child/Adolescent Psychiatry, and Barbara Schoen Johnson, PhD, APRN, PMHNP brings 16 years of child and adolescent psychiatric nursing experience at Cook Children’s. The practice evaluates and treats children, teens, and adults, and involves parents throughout the process for minors.

How do I schedule an evaluation, and is a referral required?

Call 817-778-8884 or complete the online new patient form. No referral is required. Prime Behavioral Health accepts Aetna, BlueCross BlueShield PPO, Optum, United Healthcare, and Cigna. Initial evaluations take place in person at the Southlake office, and eligible follow-up visits can use telemedicine. Bring a list of medications, prior records, and a short phone video of typical tics if you can.

Areas We Serve

Prime Behavioral Health serves patients from Southlake and throughout the greater Dallas-Fort Worth region, including:

Get Tic and Tourette Care at Prime Behavioral Health

If your child, teen, or you are dealing with tics, Prime Behavioral Health provides a clear diagnosis and a practical plan. Our board-certified psychiatrist Dr. Vishal Shah, MD, and licensed psychiatric team have over five years of experience, accept Aetna, BlueCross BlueShield PPO, Optum, United Healthcare, and Cigna, and offer telemedicine follow-ups for added convenience. Read our verified patient reviews on Google, then schedule your evaluation online or call Prime Behavioral Health at 817-778-8884.