ABSTRACT
This chapter presents a case of a 10-year-old boy who comes to the general practice surgery with his mother. His school has indicated that he has become increasingly disruptive in class. He has two older brothers, both of whom do well at school and have gentle and calm temperaments. Staff noticed that he used to rapidly nod and jerk his head, pat his lips or make kissing noises when he was engaged in work. More recently his fidgeting involves him tapping his foot, kicking his leg out and reaching to grab the air. Physical examination is unremarkable revealing a healthy 10-year-old of average height and weight. Neurological examination is normal. Blood pressure and heart rate are in normal range. History and examination have revealed a long course with motor and vocal tics and stereotypies, difficulties with concentration, attention, mood changes and obsessionality. Important differentials would include attention deficit hyperactivity disorder, obsessive-compulsive disorder, depressive disorder or complex partial seizures.
