The Tic Disorder Service

The Tic Disorder Service at Great Ormond Street Hospital (GOSH) is a multi-disciplinary clinic headed by Dr Holan Liang (Child and Adolescent Psychiatrist), Dr Sara Shavel-Jessop (Consultant Paediatric Neuropsychologist) and Dr Tara Murphy (Consultant Paediatric Neuropsychologist).

The Tourette syndrome clinic is a national specialist service that cares for children and young people up to 17 years of age. We have a specialist multi-disciplinary team that works closely with other departments within GOSH, and with neurology, in particular. The care of children is always shared between local services and the specialist service here at GOSH.

There is a strong research collaboration between GOSH and the other Tourette syndrome clinics in the UK, and we have an international reputation for clinical research into psychological treatments for Tourette syndrome, including cognitive (learning) profiles as well as studies of the genetics of tic disorders and the role of infection.

What is Tourette syndrome?

Tourette syndrome is a neurological problem characterised by involuntary movements (motor tics) and sounds (vocal tics). Individuals with Tourette syndrome may also have neurodevelopmental, emotional and behavioural problems such as obsessive-compulsive disorder, attention deficit hyperactivity disorder, difficult behaviour or learning problems.

What is the Tourette syndrome clinic?

The GOSH clinic is a national specialist clinic for young people with Tourette syndrome. We see children and adolescents from all over the country.

It is a Tier 4 level clinic, which means that written referrals need to come from the consultant paediatrician or child and adolescent psychiatrist already looking after a child in their own area. We do not take-over the care of children referred to us, but work in partnership with the referring doctor.

Who we see and what we offer

  • We see young people up to age 17 years of age
  • We assess young people with suspected Tourette syndrome, where the diagnosis is in doubt or is complex
  • We assess young people with problematic Tourette syndrome (e.g. with associated mental health problems or troublesome tics), and advise on management
  • We offer flexible packages of management, individually tailored to the needs of the child and family
  • We use evidence-based treatments
  • We give advice on medication and psychological treatment
  • We can provide monitoring/prescribing of medication in conjunction with local services
  • We can offer short packages of psychological treatment
  • Where appropriate we offer diagnostic assessment of other commonly co-occurring conditions
  • We have programmes of child and parent group treatments and interventions

Current referral acceptance criteria

We are currently only able to accept referrals which meet the three following criteria:

  1. The patient must be open to and referral made by the patient’s local Child and Mental Health Service (CAMHS), and it must be sent by a CAMHS Consultant Child Psychiatrist, Consultant Clinical Psychologist or a Consultant Community Paediatrician.
  2. The patient must be presenting with tics in the moderate-to-severe range of severity. We require a detailed description of how the child’s tics impact their life socially, physically, educationally and / or emotionally.
  3. The patient must have already received an intervention for tics within local CAMHS, with difficulties persisting despite this intervention and / or a clinician from the referring team is available to join the initial assessment with the Tic Disorder Service. We are able to offer these initial assessments via telemedicine.

What happens if you come to clinic?

We are working towards adherence to national guidelines for maximum wait times, but try to see patients as quickly as possible, taking clinical urgency into account.

Before the appointment we will ask the family, child and school to fill in some questionnaires online, which help us make the best use of time in the clinic. The young person and family will meet members of the team and feedback is given on the day, and a written report will be sent to the referrer and the family.

Please allow 1- 2 ½ hours at the clinic for new patients.

Who else can help with Tourette syndrome?

Most people with Tourette syndrome can be successfully helped by their local specialist team. Most child specialists will know about the medications that are sometime used in Tourette syndrome, and the sort of help that children with Tourette syndrome may need psychologically or at school.