Child 9 - 11

Form Approved
OMB NO. 0920-24EG
Exp. Date XX/XX/20XX

Attachment 6: Child Self Report (ages 9-11 years)
Table of Contents
A.
B.

Screen for Child Anxiety Related Disorders (SCARED)
Clinical Assessment
a. Ask Suicide Screening Questions (ASQ)
b. Yale Global Tic Severity Scale (YGTSS)

Children aged 9–11 years will complete the Screen for Child Anxiety Related Disorders (SCARED) and will participate in a
clinical assessment along with the parent. The calculated burden includes the SCARED and the clinical assessment.

Public reporting burden of this collection of information is estimated to average 30 minutes, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not
conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden
to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333; ATTN: PRA (0920-24EG).

Form Approved
OMB NO. 0920-24EG
Exp. Date XX/XX/20XX
A. Screen for Child Anxiety Related Disorders (SCARED)
Proposed Question
Response options
Completing the survey is voluntary. If you are not comfortable answering a question,
just leave it blank.
Please complete the following questions about yourself.
How old are you, in years?
Free text (numerical)

Taken From
Revised from a
previous project.

Asking to make
sure they are using
the correct form.
Will have message
to contact project
staff if not between
9-11. “If you are
not between the
ages of 9-11 years,
please request an
alternative form
from the project
staff.”
Below is a list of sentences that describe how people feel. Read each phrase and decide SCARED
if it is “Not True or Hardly Ever True” or “Somewhat True or Sometimes True” or “Very
True or Often True” for you. Then for each sentence, fill in one circle that corresponds
to select the response that seems to describe you for the last 3 months.
 Not true or hardly true
SCARED
1. When I feel frightened, it is hard to
 Somewhat true or sometimes true
breathe.
 Very true or often true
2. I get headaches when I am at school.
 Not true or hardly true
SCARED
 Somewhat true or sometimes true
 Very true or often true
3. I don’t like to be with people I don’t
 Not true or hardly true
SCARED
know well.
 Somewhat true or sometimes true
 Very true or often true
4. I get scared if I sleep away from home.
 Not true or hardly true
SCARED
 Somewhat true or sometimes true
 Very true or often true
5. I worry about other people liking me.
 Not true or hardly true
SCARED
 Somewhat true or sometimes true
 Very true or often true
6. When I get frightened, I feel like passing  Not true or hardly true
SCARED
out.
 Somewhat true or sometimes true
 Very true or often true
7. I am nervous.
 Not true or hardly true
SCARED
 Somewhat true or sometimes true
 Very true or often true
8. I follow my mother or father wherever
 Not true or hardly true
SCARED
they go.
 Somewhat true or sometimes true

Form Approved
OMB NO. 0920-24EG
Exp. Date XX/XX/20XX
9. People tell me that I look nervous.

10. I feel nervous with people I don’t know
well.
11. I get stomachaches at school.

12. When I get frightened, I feel like I am
going crazy.
13. I worry about sleeping alone.

14. I worry about being as good as other
kids.
15. When I get frightened, I feel like things
are not real.
16. I have nightmares about something
bad happening to my parents
17. I worry about going to school.

18. When I get frightened, my heart beats
fast.
19. I get shaky.

20. I have nightmares about something
bad happening to me.
21. I worry about things working out for
me.
22. When I get frightened, I sweat a lot.

23. I am a worrier.
















































Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

Form Approved
OMB NO. 0920-24EG
Exp. Date XX/XX/20XX
24. I get really frightened for no reason at
all.
25. I am afraid to be alone in the house.

26. It is hard for me to talk with people I
don’t know well.
27. When I get frightened, I feel like I am
choking.
28. People tell me that I worry too much.

29. I don’t like to be away from my family.

30. I am afraid of having anxiety (or panic)
attacks.
31. I worry that something bad might
happen to my parents.
32. I feel shy with people I don’t know
well.
33. I worry about what is going to happen
in the future.
34. When I get frightened, I feel like
throwing up.
35. I worry about how well I do things.

36. I am scared to go to school.

37. I worry about things that have already
happened.
38. When I get frightened, I feel dizzy.















































Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true
Not true or hardly true
Somewhat true or sometimes true
Very true or often true

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

SCARED

Form Approved
OMB NO. 0920-24EG
Exp. Date XX/XX/20XX
39. I feel nervous when I am with other
children or adults and I have to do
something while they watch me (for
example: read aloud, speak, play a
game, play a sport.)
40. I feel nervous when I am going to
parties, dances, or any place where
there will be people that I don’t know
well.
41. I am shy





Not true or hardly true
Somewhat true or sometimes true
Very true or often true

SCARED





Not true or hardly true
Somewhat true or sometimes true
Very true or often true

SCARED

Not true or hardly true
SCARED
Somewhat true or sometimes true
Very true or often true
Did anyone help you complete this
Yes, someone helped me, but I
New
survey?
completed most of the survey on my
own.
 Yes, someone helped me with all or
most of the survey.
 No, I completed the survey on my own.
[If the respondent skipped any questions, they will receive the following message:]
You skipped one or more questions on this page. Please review and complete the question(s) before going to
the next page. If you intentionally skipped the question(s), you can go to the next page.

B. Clinical Assessments (attached)
a. Ask Suicide Screening Questions (ASQ)
b. Yale Global Tic Severity Scale (YGTSS)






Form Approved
OMB NO. 0920-24EG
Exp. Date XX/XX/20XX
The following questions will be asked by a trained professional, not as part of the survey.
a.

Ask Suicide Screening Questions (ASQ) (these are in a separate REDCap form since they are not part of the
self-report survey; these questions will be asked by a healthcare provider or trained program staff member to
individuals with tic disorders aged 9-26 years with possible input from parent for children 9-17 years.

Question

Response Options

Taken From

Note to person administering the ASQ: Please provide the following information to the respondent before asking
the questions.
This survey asks about mental health and emotional well-being. If you answer that you have had suicidal
thoughts or behaviors, or purposely tried to hurt yourself, we may inform your doctor or other clinic staff. This
would be to ensure your safety and provide you with support and care.
By completing this survey, you accept and consent to this protocol. If you have concerns or need immediate
help, please tell the clinic staff.
1) In the past few weeks, have you wished you were dead?
 Yes
ASQ
 No
 Refused to answer
2) In the past few weeks, have you felt that you or your family
 Yes
ASQ
would be better off if you were dead?
 No
 Refused to answer
3) In the past week, have you been having thoughts about
 Yes
ASQ
killing yourself?
 No
 Refused to answer
4) Have you ever tried to kill yourself?
 Yes
ASQ
 No
 Refused to answer
[If yes to 4,]
Free text
ASQ
4a) How?
4b) When?
The patient answered "No" to questions 1 through 4; therefore,
 Ask question #5
Incorporated
screening is complete, and it is not necessary to ask question
 Finish the ASQ
from ASQ
#5. No intervention is necessary; however, clinical judgment
instructions,
can always override a negative screen.
within skip
pattern. ASQ
instructions
Do you want to ask the patient question #5 (Are you having
included
thoughts of killing yourself right now?) or finish the ASQ?
below.
[If “Yes” or “Refused” to any of the above (Q1-Q4)] This patient is
 Yes
ASQ
considered a positive screen. Ask question #5 to assess acuity.
 No
5) Are you having thoughts of killing yourself right now?

Form Approved
OMB NO. 0920-24EG
Exp. Date XX/XX/20XX
[If yes to Q5]
5b) Please describe:
[If yes to Q5]
Patient is acute positive screen (imminent risk identified)

Open ended

ASQ

Patient requires a STAT safety/full mental health evaluation. Patient cannot leave until evaluated for safety.
Keep patient in sight. Remove all dangerous objects from room. Alert physician or clinician responsible for
patient's care.
Provide resources to all patients: 988 Suicide and Crisis Lifeline, 988 (call, text), https://988lifeline.org/ (and
relevant local information)
[If no to Q5]
Patient is non-acute positive screen (potential risk identified).
Patient requires a brief suicide safety assessment to determine if a full mental health evaluation is needed. If a
patient (or parent/guardian) refuses the brief assessment, this should be treated as an "against medical advice"
(AMA) discharge.
Alert physician or clinician responsible for patient's care.
Provide resources to all patients: 988 Suicide and Crisis Lifeline, 988 (call, text),
https://988lifeline.org/
Initials of person (staff/professional) completing ASQ
Open ended
Overview of ASQ - this information is included above, within skip logic, and only included here
for reference.
If patient answers "No" to all questions 1 through 4, screening is complete (not necessary to
ask question #5). No intervention is necessary (*Note: Clinical judgment can always override a
negative screen).
If patient answers "Yes" to any of questions 1 through 4, or refuses to answer, they are
considered a positive screen. Ask question #5 to assess acuity.
"Yes" to question #5 = acute positive screen (imminent risk identified)
Patient requires a STAT safety/full mental health evaluation. Patient cannot leave until
evaluated for safety.
Keep patient in sight. Remove all dangerous objects from room. Alert physician or clinician
responsible for patient's care.
"No" to question #5 (but “Yes” or “Refused” to one of questions 1-4) = non-acute positive
screen (potential risk identified)
Patient requires a brief suicide safety assessment to determine if a full mental health
evaluation is needed. If a patient (or parent/guardian) refuses the brief assessment, this should

ASQ

Form Approved
OMB NO. 0920-24EG
Exp. Date XX/XX/20XX
be treated as an "against medical advice" (AMA) discharge.
Alert physician or clinician responsible for patient's care.
Provide Resources to All Patients:
• 988 Suicide and Crisis Lifeline, Call or Text 988
• Visit https://988lifeline.org to chat

ID #:

Y G T S S
Yale Global Tic Severity Scale
Yale Child Study Center

October 1992 version

1

NAME:

TODAY'S DATE :

/

/

RATER:

MOTOR TIC SYMPTOM CHECKLIST
Description of Motor Tic Symptoms. Motor tics usually begin in childhood and are characterized by
sudden jerks or movements, such as forceful eye blinking or a rapid head jerk to one side or the other.
The same tics seem to recur in bouts during the day and are worse during periods of fatigue and/or stress.
Many tics occur without warning and may not even be noticed by the person doing them. Others are
preceded by a subtle urge that is difficult to describe (some liken it to the urge to scratch an itch). In
many cases it is possible to voluntarily hold back the tics for brief periods of time. Although any part of
the body may be affected, the face, head, neck, and shoulders are the most common areas involved. Over
periods of weeks to months, motor tics wax and wane and old tics may be replaced by totally new ones.
Simple motor tics can be described as a sudden, brief, "meaningless" movement that recurs in bouts (such
as excessive eye blinking or squinting). Complex motor tics are sudden, stereotyped (i.e., always done in
the same manner) semi-purposeful (i.e., the movement may resemble a meaningful act, but is usually
involuntary and not related to what is occurring at the time) movements that involve more than one
muscle group. There may often be a constellation of movements such as facial grimacing together with
body movements. Some complex tics may be misunderstood by other people (i.e., as if you were
shrugging to say "I don't know"). Complex tics can be difficult to distinguish from compulsions; however,
it is unusual to see complex tics in the absence of simple ones. Often there is a tendency to explain away
the tics with elaborate explanations (e.g., “I have hay fever that has persisted” even though it is not the
right time of year). Tics are usually at their worst in childhood and may virtually disappear by early
adulthood, so if you are completing this form for yourself, it may be helpful to talk to your parents, an
older sibling, or a relative, as you answer the following questions.
• Age of first motor tics? ________________ years old
• Describe first motor tic: ________________________________________________
• Was tic onset sudden or gradual?

_______________________________________

• Age of worst motor tics? ________________ years old

Motor Tic Symptom Checklist
In the boxes on the left below, please check with a mark (x) the tics the patient
1) has EVER experienced
2) is CURRENTLY experiencing (during the past week)
State AGE OF ONSET (in years) if patient has had that behavior.
Also, in the tic descriptions below, please circle or underline the specific tics that the patient has
experienced (circle or underline the words that apply).
2

Ever

[In Years]
CurAge
rent
of
onset

The patient has experienced, or others have noticed, involuntary
and apparently purposeless bouts of:
-eye movements.
eye blinking, squinting, a quick turning of the eyes, rolling of the
eyes to one side, or opening eyes wide very briefly.
eye gestures such as looking surprised or quizzical, or looking to
one side for a brief period of time, as if s/he heard a noise.
-nose, mouth, tongue movements, or facial grimacing.
nose twitching, biting the tongue, chewing on the lip or licking the
lip, lip pouting, teeth baring, or teeth grinding.
broadening the nostrils as if smelling something, smiling, or other
gestures involving the mouth, holding funny expressions, or
sticking out the tongue.
-head jerks/movements.
touching the shoulder with the chin or lifting the chin up.
throwing the head back, as if to get hair out of the eyes.
-shoulder jerks/movements.
jerking a shoulder.
shrugging the shoulder as if to say "I don't know."
-arm or hand movements.
quickly flexing the arms or extending them, nail biting, poking with
fingers, or popping knuckles.
passing hand through the hair in a combing like fashion, or
touching objects or others, pinching, or counting with fingers for no
purpose, or writing tics, such as writing over and over the same
letter or word, or pulling back on the pencil while writing.
-leg, foot or toe movements.
kicking, skipping, knee-bending, flexing or extension of the ankles;
shaking, stomping or tapping the foot.
taking a step forward and two steps backward, squatting, or deep
knee-bending.

3

Ver

Ever

Current

Age
of
onset

The patient has experienced, or others have noticed, involuntary and
apparently purposeless bouts of:

Ver

-abdominal/trunk/pelvis movements.
tensing the abdomen, tensing the buttocks.
-other simple motor tics.
Please write example(s):

-other complex motor tics.
touching
tapping
picking
evening-up
reckless behaviors
stimulus-dependent tics (a tic which follows, for example, hearing a
particular word or phrase, seeing a specific object, smelling a
particular odor). Please write example(s):
____________________________________________________________
rude/obscene gestures; obscene finger/hand gestures.
unusual postures.
bending or gyrating, such as bending over.
rotating or spinning on one foot.
copying the action of another (echopraxia)
sudden tic-like impulsive behaviors. Please describe:
____________________________________________________________
tic-like behaviors that could injure/mutilate others. Please describe:
____________________________________________________________
self-injurious tic-like behavior(s). Please describe:
____________________________________________________________
-other involuntary and apparently purposeless motor tics (that do not fit in
any previous categories).
Please describe any other patterns or sequences of motor tic
behaviors:
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
___________________________________________________________

4

Phonic (Vocal) Tics
Description of Phonic (or Vocal) Tic Symptoms Phonic tics usually begin in childhood,
typically after motor tics have already started, but they can be the first tic symptoms. They are
characterized by a sudden utterance of sounds such as throat clearing or sniffing. The same
tics seem to recur in bouts during the day and are worse during periods of fatigue and/or
stress. Many tics occur without warning and may not even be noticed by the person doing
them. Others are preceded by a subtle urge that is difficult to describe (some liken it to the
urge to scratch an itch). In many cases it is possible to voluntarily hold back the tics for brief
periods of time. Over periods of weeks to months, phonic tics wax and wane and old tics may
be replaced by totally new ones. Simple phonic tics are utterances of fast, meaningless sounds
whereas complex phonic tics are involuntary, repetitive, purposeless utterances of words,
phrases or statements that are out of context, such as uttering obscenities (i.e., coprolalia), or
repeating over and over again what other people have said (i.e., echolalia). Complex tics can
be difficult to distinguish from compulsions; however, it is unusual to see complex tics in the
absence of simple ones. Often there is a tendency to explain away the tics with elaborate
explanations (e.g., “I have hay fever that has persisted” even though it is not the right time of
year). Tics are usually at their worst in childhood and may virtually disappear by early
adulthood, so if you are completing this form for yourself, it may be helpful to talk to your
parents, an older brother or sister, or older relative, as you answer the following questions.

• Age of first vocal tics? ________________ years old.
• Describe first vocal tic: ________________________________________________
• Was tic onset sudden or gradual? _________________________________________
• Age of worst vocal tics? ________________ years old.

5

Phonic Tic Symptom Checklist
In the boxes on the left below, please check with a mark (x) the tics the patient
1) has EVER experienced
2) is CURRENTLY experiencing (during the past week)
State AGE OF ONSET (in years) if patient has had that behavior.
Also, in the tic descriptions below, please circle or underline the specific tics that the patient has
experienced (circle or underline the words that apply).
[In Years]

Ever Current

Age The patient has experienced, or others have noticed, bouts of
of involuntary and apparently purposeless utterance of:
onset
-coughing.
-throat clearing.
-sniffing.
-whistling.
-animal or bird noises.
-Other simple phonic tics. Please list:
-syllables. Please list:
-words. Please list:
-rude or obscene words or phrases. Please list:
-repeating what someone else said, either sounds, single words or
sentences. Perhaps repeating what’s said on TV (echolalia).
-repeating something the patient said over and over again
(palilalia).
-other tic-like speech problems, such as sudden changes in volume
or pitch. Please describe:

Describe any other patterns or sequences of phonic tic behaviors:

6

Ver

SEVERITY RATINGS
Motor

NUMBER
None
Single tic
Multiple discrete tics (2-5)
Multiple discrete tics (>5)
Multiple discrete tics plus as least one orchestrated pattern of multiple simultaneous or
sequential tics where it is difficult to distinguish discrete tics
Multiple discrete tics plus several (>2) orchestrated paroxysms of multiple simultaneous
or sequential tics that where it is difficult to distinguish discrete tics

o
o
o
o
o

o
o
o
o
o

0
1
2
3
4

o

o

5

Motor

FREQUENCY
NONE No evidence of specific tic behaviors
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.
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.
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.
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.
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.

ABSENT
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.
MILD INTENSITY Tics are not more forceful than comparable voluntary actions or
utterances and are typically not noticed because of their intensity.
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.
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.
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.

7

Phonic

o
o

o
o

0
1

o

o

2

o

o

3

o

o

4

o

o

5

Motor

INTENSITY

Phonic

Phonic

o
o

o
o

0
1

o

o

2

o

o

3

o

o

4

o

o

5

Motor

COMPLEXITY
NONE If present, all tics are clearly "simple" (sudden, brief, purposeless) in character.
BORDERLINE Some tics are not clearly "simple" in character.
MILD Some tics are clearly "complex" (purposive in appearance) and mimic brief
"automatic" behaviors, such as grooming, syllables, or brief meaningful utterances such
as "ah huh," "hi" that could be readily camouflaged.
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).
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, speech atypicalities, longer bouts of saying "what do you mean"
repeatedly, or saying "fu" or "sh").
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, self-abusive behavior, or coprolalia).

o
o
o

o
o
o

0
1
2

o

o

3

o

o

4

o

o

5

Motor

INTERFERENCE
NONE
MINIMAL When tics are present, they do not interrupt the flow of behavior or speech.
MILD When tics are present, they occasionally interrupt the flow of behavior or speech.
MODERATE When tics are present, they frequently interrupt the flow of behavior or
speech.
MARKED When tics are present, they frequently interrupt the flow of behavior or
speech, and they occasionally disrupt intended action or communication.
SEVERE When tics are present, they frequently disrupt intended action or
communication.

8

Phonic

Phonic

o
o
o
o

o
o
o
o

0
1
2
3

o

o

4

o

o

5

IMPAIRMENT
NONE
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).
MILD Tics associated with minor difficulties in self-esteem, family life, social acceptance, or
school or job functioning.
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).
MARKED Tics associated with major difficulties in self-esteem, family life, social acceptance, or
school or job functioning.
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).

o
o

0
10

o

20

o

30

o

40

o

50

SCORING
Number
(0-5)

Frequency
(0-5)

Intensity
(0-5)

Complexity
(0-5)

Interference
(0-5)

Motor Tic
Severity
Vocal Tic
Severity

Total Tic Severity Score = Motor Tic Severity + Vocal Tic Severity (0-50)

Total Yale Global Tic Severity Scale Score (Total Tic Severity Score +
Impairment) (0-100)

9

Total
(0-25)