A teaching tool for tic disorders: using “disinhibition” to unify the spectrum

Chronic Tic Disorders (CTDs) including Tourette's Disorder are common pediatric conditions that, like many other mental health conditions, are under-recognized and under-managed in the primary care setting. Pediatric Primary Care Providers (PCPs) often feel undertrained in mental health evaluation and management, but the Medical Home partnership between PCPs and their patients and families usually serves as the most available opportunity for timely and comprehensive assessment and care coordination of mental health concerns; PCPs and families may feel confused, surprised, and bewildered by the wide range in the clinical presentations of tics and their seemingly dissimilar coexisting conditions that appear to blur the margins between mental health and neurology. This article endeavors to teach PCPs - who can thereby teach families of children with CTDs - a general clear and understandable principle that bridges mental and behavioral health with neurophysiology. This principle is one of "disinhibition," which is believed to underpin tic behaviors and a variety of symptoms of frequent coexisting conditions. The teaching approach set out in this article is schematic and takes advantage of active learning methods. Once understood, families and PCPs can then use their knowledge of disinhibition to help prioritize concerns and engage with greater purpose and direction in management of symptoms, anticipation of possible symptom evolution, and to advocate more persuasively for appropriate educational or related services when indicated.