YGTSS
Yale Global Tic Severity Scale
Date
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Year
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Patient Name
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First Name
Last Name
Motor Tic Symptom Checklist
Select motor tics present during the past week and the worst ever period
Simple Motor Tics (Rapid, darting, "meaningless"):
Current
Worst Ever
Eye blinking
Eye movements
Nose movements
Mouth movements
Facial grimace
Head jerks/movements
Shoulder shrugs
Arm movements
Hand movements
Abdominal tensing
Leg, foot, or toe movements
Other
If other please specify here:
Complex Motor Tics (Slower "purposeful"):
Current
Worst Ever
Eye movements
Mouth movements
Facial movements or expressions
Head gestures or movements
Shoulder movements
Arm movements
Hand movements
Writing tics
Dystonic postures (involuntary muscle contractions)
Bending or gyrating
Rotating
Leg, foot or toe movements
Blocking
Tic related compulsive behaviors (touching, tapping, grooming, evening-up)
Copropraxia (obscene gestures)
Self-abusive behavior
Paroxysms of tics (sudden attack or violent expression)
Disinhibited behavior (rude, tactless or offensive behaviors)
Other
If you selected Paroxysms of tics please indicate how long these episodes usually last:
If you selected Disinhibited Behavior please describe behaviors below:
If other please specify here:
Simple Phonic Symptoms (Fast, "meaningless" sounds):
Current
Worst Ever
Sounds and noises
Other
If you selected Sounds and noises please indicated which of the following are exhibited Coughing, throat clearing, sniffing, animal or bird noises
If other please specify here:
Complex Phonic Symptoms (Words, phrases, statements):
Current
Worst Ever
Syllables
Words
Coprolalia (obscene language)
Echolalia (Repitition or copying of sounds/words heard)
Palilalia (Repetition of syllables, words or phrases)
Blocking (Interrupting tics while talking)
Speech atypicality's (Sudden changes in volume or pitch)
Disinhibited speech (Lack of restraint in speech)
If you selected Syllables, Words or Coprolalia please describe tics below:
If you selected Speech atypicality's please describe below:
If you selected Disinhibited Speech please describe below (Do not include disinhibitions in ratings of tic behaviors):
Please rate the number of tics experienced:
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0 - None
1 - Single Tic
2 - Multiple Discrete Tics (2-5)
3 - Multiple Discrete Tics (>5)
4 - Multiple discrete tics plus at least one orchestrated pattern of multiple simultaneous or sequential tics where it is difficult to distinguish discrete tics
5 - Multiple discrete tics plus several (>2) orchestrated paroxysms of multiple simultaneous or sequential tics that where it is difficult to distinguish discrete tics
Please rate the frequency of tics:
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0 - None: No evidence of specific tic behaviors
1 - Rarely: Specific tic behaviors have been present during previous week. These behaviors occur infrequently, often not on a daily basis. If bouts of tics occur, they are brief and uncommon.
2 - Occasionally: Specific tic behaviors are usually present on a daily basis, but there are long tic-free intervals during the day. Bouts of tics may occur on occasion and are not sustained for more than a few minutes at a time.
3 - Frequently: Specific tic behaviors are present on a daily basis. Tic free intervals as long as 3 hours are not uncommon. Bouts of tics occur regularly but may be limited to a single setting.
4 - Almost Always: Specific tic behaviors are present virtually every waking hour of every day, and periods of sustained tic behaviors occur regularly. Bouts of tics are common and are not limited to a single setting.
5 - Always: Specific tic behaviors are present virtually all the time. Tic free intervals are difficult to identify and do not last more than 5 to 10 minutes at most.
Please rate the intensity of tics:
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0 - Absent
1 - Minimal Intensity: Tics not visible or audible (based solely on patient's private experience) or tics are less forceful than comparable voluntary actions and are typically not noticed because of their intensity.
2 - Mild Intensity: Tics are not more forceful than comparable voluntary actions or utterances and are typically not noticed because of their intensity.
3 - Moderate Intensity: Tics are more forceful than comparable voluntary actions but are not outside the range of normal expression for comparable voluntary actions or utterances. They may call attention to the individual because of their forceful character.
4 - Marked Intensity: Tics are more forceful than comparable voluntary actions or utterances and typically have an "exaggerated" character. Such tics frequently call attention to the individual because of their forceful and exaggerated character.
5 - Severe Intensity: tics are extremely forceful and exaggerated in expression. These tics call attention to the individual and may result in risk of physical injury (accidental, provoked or self-inflicted) because of their forceful expression.
Please rate the complexity of the tics:
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0 - None: If present, all tics are clearly "simple" (sudden, brief, purposeless) in character.
1 - Borderline: Some tics are not clearly "simple" in character.
2 - Mild: Some tics are clearly "complex" (purposive in appearance) and mimic brief "automatic" behaviors, such as grooming, syllables, or brief meaning ful utterances such as "ah huh," "hi" that could be readily camouflaged.
3 - Moderate: Some tics are more "complex" (more purposive and sustained in appearance) and may occur in orchestrated bouts that would be difficult to camouflage but could be rationalized or "explained" as normal behavior or speech (picking, tapping, saying "you bet" or "honey,", brief echolalia {Repetition or copying of sounds/words heard}).
4 - Marked: Some tics are very "complex" in character and tend to occur in sustained orchestrated bouts that would be difficult to camouflage and could not be easily rationalized as normal behavior or speech because of their duration and/or their unusual, inappropriate, bizarre or obscene character (a lengthy facial contortion, touching genitals, echolalia {Repetition or copying or sounds/words heard}, speech atypicality's {Sudden changes in volume or pitch}, longer bouts of saying "what do you mean" repeatedly, or saying "fu" or "sh").
5 - Severe: Some tics involve lengthy bouts of orchestrated behavior or speech that would be impossible to camouflage or successfully rationalize as normal because of their duration and/or extremely unusual, inappropriate, bizarre or obscene character (lengthy displays or utterances often involving copropraxia {Obscene gestures}, self-abusive behavior, or coprolalia {Obscene language}).
Please rate the level of interference that the tics have:
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0 - None
1 - Minimal: When tics are present, they do not interrupt the flow of behavior or speech.
2 - Mild: When tics are present, they occasionally interrupt the flow of behavior or speech.
3 - Moderate: When tics are present, they frequently interrupt the flow of behavior or speech.
4 - Marked: When tics are present, they frequently interrupt the flow of behavior or speech, and they occasionally disrupt intended action or communication.
5 - Severe: When tics are present, they frequently disrupt inteded action or communication.
Score:
Please rate the level of impairment the tics have:
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0 - None
10 - Minimal: Tics associated with subtle difficulties in self-esteem, family life, social acceptance, or school or job functioning (infrequent upset or concern about tics vis a vis the future, periodic, slight increase in family tensions because of tics, friends or acquaintances may occasionally notice or comment about tics in an upsetting way)
20 - Mild: Tics associated with minor difficulties in self-esteem, family life, social acceptance, or school or job functioning.
30 - Moderate: Tics associated with some clear problems in self-esteem family life, social acceptance, or school or job functioning (episodes of dysphoria, periodic distress and upheaval in the family, frequent teasing by peers or episodic social avoidance, periodic interference in school or job performance because of tics).
40 - Marked: Tics associated with major difficulties in self-esteem, family life, social acceptance or job functioning.
50 - Severe: Tics associated with extreme difficulties in self-esteem, family life, social acceptance, or school or job functioning (severe depression with suicidal ideation, disruption of the family {separation/divorce, residential placement}, disruption of social tics - severely restricted life because of social stigma and social avoidance, removal from school or loss of job).
Total Score:
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