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Tourette Syndrome Symptom Survey

One of the problems in diagnosing Tourette Syndrome is the lack of common symptoms. But is this as true as we think it is? The purpose of this survey is to determine if there are any symptoms common to all children in the earliest stages of Tourette Syndrome. Your help in finding out would be greatly appreciated.

Please answer all of the questions.

Age of child when symptoms first appeared:
Age of child when diagnosed:
Sex of child: Male Female

In the beginning, did the child:

  1. Do an unusual amount of sniffing? Yes No

  2. Do an unusual amount of touching things? Yes No

  3. Do an unusual amount of touching people? Yes No

  4. Do an unusual amount of eye blinking? Yes No

  5. Do an unusual amount of eye movements? Yes No

  6. Do an unusual amount of head jerking? Yes No

  7. Do an unusual amount of teeth grinding? Yes No

  8. Do an unusual amount of throat clearing? Yes No

  9. Make a lot of hand movements? Yes No

  10. Make a lot of leg or foot movements? Yes No

  11. Spin around while walking? Yes No

  12. Show a lot of oppositional behavior? Yes No

  13. Have self-injurious behavior? Yes No

  14. Have coprolalia? Yes No

  15. Have difficulty sleeping? Yes No

If your child exhibited any initial symptoms that were not listed above, please describe them below:

Your name:

Your e-mail:

Additional comments?