Functional Tics Diagnostic Inventory

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• Tic History and Motor–Vocal Assessment
• Tic Diagnostic Criteria and Uncertainty
• Measuring Tic Symptoms and Everyday Function

Evidence update: The ESSTS entry describes the original consensus publication. Later selected-criterion specificity research is discussed in criteria and uncertainty; the original inventory wording remains intact.

Developmental and onset history

Motor and vocal phenomenology

The assessment describes movements, sounds and phrases, their complexity and evolution. Observational cohorts identify group differences, but individual overlap with Tourette syndrome is substantial. Coprolalia or a complex phrase alone cannot establish functional symptoms. [3][6]

Context dependence and variability

Symptoms are compared across ordinary settings and tasks using history and respectful observation. Context sensitivity occurs in both functional and primary tics, so changes with attention or an audience are not independently diagnostic. [2][3]

Suppressibility

The clinician asks about temporary ability to delay symptoms rather than demanding a prolonged demonstration. Both diagnoses can include suppressibility or difficulty suppressing. This is a history feature with limited individual discriminative value. [2][3]

Premonitory sensations

An urge or sensation before movement or sound is documented in the person’s own words. Its presence or absence contributes context but does not reliably divide functional from primary tic disorders, particularly across ages. [2][3]

Suggestibility

Symptoms may change when discussed or observed. This can occur in both functional and primary tics and is not proof of deliberate imitation. Avoid provoking symptoms to demonstrate it; use the history when discussion itself is difficult. [2][3]

ESSTS consensus criteria

The framework combines clinical history and phenomenology rather than relying on a single sign. Its original publication was expert consensus, not prospective diagnostic-accuracy validation. Apply alongside the published critique and an assessment for coexistence. [2][3]

Longitudinal reassessment

Follow-up, childhood records and consensual collateral information can clarify mixed or uncertain presentations. A changing formulation is preferable to forcing a binary classification. This is a clinical process, not an independently validated positive sign. [3][7]

Neurophysiology and other investigations

EEG–EMG may address a differential with jerks, but premovement potentials also occur in primary tics. There is no established high-accuracy laboratory test that independently separates functional tic-like symptoms from Tourette syndrome. Other tests answer specific differential questions. [8][9]

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Research and Sources

Citation	Full citation and evidence limit
[1]	Malaty IA, Anderson S, Bennett SM, et al. Diagnosis and management of functional tic-like phenomena. Journal of Clinical Medicine. 2022;11(21):6470. FND-CIT-0110. Source. Expert review; diagnostic formulation and individualized management. The review reported no controlled treatment studies specific to functional tic-like symptoms.
[2]	Pringsheim T, Ganos C, McGuire JF, et al. European Society for the Study of Tourette Syndrome 2022 criteria for clinical diagnosis of functional tic-like behaviours: international consensus from experts in tic disorders. European Journal of Neurology. 2023;30(4):902–910. FND-CIT-0111. Source. Expert Delphi consensus. The publication explicitly states that prospective sensitivity and specificity testing was lacking; not a validated self-diagnostic checklist.
[3]	Andersen K, Cavanna AE, Szejko N, et al. A critical examination of the clinical diagnosis of functional tic-like behaviors. Movement Disorders Clinical Practice. 2024;11(9):1065–1071. FND-CIT-0112. Source. Critical review of diagnostic reasoning, clinical benchmarks and coexistence. Supports transparent uncertainty, not dismissal of symptoms.
[4]	Maxwell A, Zouki JJ, Eapen V. Integrated cognitive behavioral intervention for functional tics (I-CBiT): case reports and treatment formulation. Frontiers in Pediatrics. 2023;11:1265123. FND-CIT-0113. Source. Uncontrolled case series of eight young people. Reported improvement cannot establish causal efficacy, comparative benefit or generalizability to other populations.
[5]	Szejko N, Robinson S, Hartmann A, et al. European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part I: assessment. European Child & Adolescent Psychiatry. 2022;31:383–402. FND-CIT-0114. Source. Primary tic-disorder assessment guideline; adjacent evidence for terminology and differential diagnosis, not functional-tic treatment evidence.
[6]	Pringsheim T, Ganos C, McGuire JF, et al. Rapid Onset Functional Tic-Like Behaviors in Young Females During the COVID-19 Pandemic. Movement disorders : official journal of the Movement Disorder Society. 2021;36(12):2707-2713. DOI. PMID: 34387394. FND-CIT-0173.
[7]	Cavanna AE, Caimi V, Capriolo E, et al. Neurodevelopmental Tics with Co-Morbid Functional Tic-like Behaviors: Diagnostic Challenges of a Complex Tourette Syndrome Phenotype. Brain sciences. 2025;15(5):435. DOI. PMID: 40426606. FND-CIT-0172.
[8]	van der Salm SM, Tijssen MA, Koelman JH, van Rootselaar AF. The bereitschaftspotential in jerky movement disorders. Journal of neurology, neurosurgery, and psychiatry. 2012;83(12):1162-1167. DOI. PMID: 22952323. FND-CIT-0125.
[9]	Edwards MJ, Koens LH, Liepert J, et al. Clinical neurophysiology of functional motor disorders: IFCN Handbook Chapter. Clinical neurophysiology practice. 2024;9:69-77. DOI. PMID: 38352251. FND-CIT-0022.

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