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Difficulty: MediumChildhood and Neurodevelopmental Disorders

An 8-year-old boy is brought to the clinic by his parents due to uncontrollable movements. Over the past 14 months, he has been frequently blinking his eyes forcefully, shrugging his shoulders, and occasionally making loud grunting and throat-clearing noises. These behaviors worsen when he is anxious about school assignments. His parents report that he met all early childhood developmental milestones appropriately. Neurological examination is otherwise unremarkable. Which of the following diagnostic criteria MUST be met to formally diagnose this patient's most likely condition? (Select all that apply)

  1. Presence of both multiple motor tics and one or more vocal tics at some time during the illness.Answer
  2. The tics have persisted for more than 1 year since the onset of the first tic.Answer
  3. Onset of the tics must occur prior to 18 years of age.Answer
  4. D
    A documented delay in acquiring early age-appropriate motor or language milestones.
  5. E
    The tics must be continuously present for at least 6 months without any tic-free periods.

Answer

The condition is Tourette syndrome, which requires the presence of multiple motor tics and at least one vocal tic, persistence of tics for more than 1 year, and symptom onset prior to 18 years of age.
The diagnosis of Tourette syndrome formally requires the presence of multiple motor tics and at least one vocal tic (though they do not have to occur concurrently). Furthermore, these tics must persist for more than 1 year from the onset of the first tic, although they are allowed to wax and wane in severity. Finally, because it is classified as a neurodevelopmental disorder, the onset of symptoms must be documented prior to 18 years of age.

Step-by-Step Solution

1
Analyze the clinical vignette to identify the core symptoms and timeline.
The patient is an 8-year-old presenting with multiple motor tics (eye blinking, shoulder shrugging) and vocal tics (grunting, throat-clearing) that have been present for 14 months.
Establishing the specific types of tics and their duration is critical for differentiating tic disorders.
2
Determine the most likely diagnosis.
The combination of multiple motor tics, vocal tics, and a duration longer than one year indicates Tourette syndrome.
This specific clinical profile perfectly matches the pathognomonic presentation of Tourette syndrome.
3
Evaluate each answer choice against formal DSM-5 criteria for Tourette syndrome.
Multiple motor and vocal tics, persistence for >1 year, and onset before age 18 are required. Milestone delays and continuous 6-month symptoms without tic-free periods are not criteria.
To identify the exact multidomain diagnostic criteria required while eliminating plausible distractor requirements.

Key Concept

DSM-5 diagnostic criteria for Tourette syndrome
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Topics

Childhood and Neurodevelopmental Disorders

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