The target symptom for treatment should be determined before treatment, i.e., the symptom that has the greatest impact on the child’s daily life, learning, or social activities. Twitching is usually the target symptom, while some children are treated for co-morbid symptoms, such as hyperactive impulsivity and obsessive-compulsive thoughts. The principle of treatment is to give equal emphasis to pharmacological and psychological-behavioral treatment, and to focus on individualization of treatment. 1.Medication: For children with moderate to severe TD that affects daily life, learning or social activities, if the effect of pure psychological-behavioral treatment is not good, medication should be added. Medication should have a certain course and appropriate dosage, and should not be changed or stopped prematurely. (1) Commonly used drugs: ①Dopamine receptor blockers: are the classic drugs for TD treatment. Commonly used drugs are as follows: thiopride, also known as Tebri, commonly used therapeutic dose of 150-500 mg / d, 2-3 times / d, few and mild side effects, may have dizziness, fatigue, drowsiness, gastrointestinal reactions, etc. ② Central alpha agonists: commonly used colistin: receptor agonist, especially for children with TD co-morbid ADHD; poor tolerance to oral preparations, can be treated with colistin patch; ③ Selective 5hydroxytryptamine reuptake inhibitors: new antidepressants, such as fluoxetine, paroxetine, sertraline, fluvoxamine, etc., with anti-twitch effects; synergistic effects can be produced in combination with risperidone; also used in the treatment of TD + obsessive-compulsive disorder. Other drugs: clonazepam, sodium valproate, topiramate and other drugs have anti-TD effects (antiepileptic drugs), of which clonazepam treatment dose is 1-2 mg/d, 2-3 times/d, common side effects are drowsiness, dizziness, weakness, vertigo, etc.; sodium valproate treatment dose is 15-30 mg/(kg?d), pay attention to side effects such as liver function impairment; topiramate treatment dose is 1-4 The dose of topiramate is 1-4 me∥(kg?d), and the side effects such as loss of appetite, weight loss, sweating disorder and cognitive impairment should be noted. The application of multi-receptor modulating drugs in combination or the exploration of new drugs has become a trend in the treatment of refractory TD. (2) Drug treatment plan: ① Preferred drugs: thiopride, aripiprazole, colistin, etc. can be used. Start from the lowest dose and gradually increase the dose slowly (increase the dose once in I-2 weeks) to the target therapeutic dose. ②Intensive treatment: After the condition is basically controlled, the treatment dose needs to be continued for at least I~3 months and intensive treatment is given. The purpose of intensive treatment and maintenance therapy is to consolidate the efficacy and reduce relapse. ④Discontinuation: After the maintenance treatment phase, if the disease is completely controlled, the drug can be considered to be gradually reduced and stopped for at least 1 to 3 months. If the symptoms recur or worsen, resume the medication or increase the dose. ⑤ Combination medication: When the use of a single drug can only partially improve the symptoms, or when there are co-morbidities, consider asking for a neurological consultation to consider combination medication; refractory TD also requires combination medication. 2.Non-pharmacological treatment (1)Psycho-behavioral treatment: It is an important means to improve tic symptoms, intervene in co-morbidities and improve social functions. For mildly ill children with good social adjustment ability, most psycho-behavioral treatment alone can be effective. First, through psychological counseling for the child and parents, the child’s psychological state can be adjusted to eliminate the sense of stigma, and through health education, the child, parents and teachers can be instructed to understand the disease correctly, not to pay too much attention to the child’s tic symptoms, and to reasonably arrange the child’s daily life and reduce the school burden. At the same time, corresponding behavioral treatment can be given, including habit reversal training, exposure and response prevention, relaxation training, positive reinforcement, self-monitoring, fading exercises, cognitive behavioral therapy, etc.12…. Among them, habit reversal training and exposure and response prevention are the first-line behavioral treatments (ix). (2) Neuromodulation therapy: neuromodulation therapy such as repetitive transcranial magnetic stimulation, electroencephalographic biofeedback and transcranial microcurrent stimulation can be tried for the treatment of children with drug-refractory TD. Deep brain stimulation has more definite efficacy but is invasive and invasive treatment, which is mainly applicable to the treatment of drug-refractory TD in older children (above 12 years old) or adults. 3. Treatment of co-morbidities (1) Co-morbid ADHD (TD+ADHD): It is the most common clinical co-morbidity. Central alpha agonists may be preferred: such as colistin, which has both anti-twitch and attention-improving effects heart. Tomoxetine does not induce or aggravate tics and is also indicated in children with TD with co-morbid ADHD. There is a potential risk of exacerbating or inducing tics with central stimulants, but clinical evidence is inconsistent, and there are successful experiences of using methylphenidate for TD+ADHD treatment in clinical practice. The combination of a conventional dose of dopamine receptor blocker (e.g., thiopirid) with a low-dose central stimulant (e.g., methylphenidate, 1/4 to 1/2 of the conventional dosage) is now generally advocated for the treatment of children with TD+ADHD, which can effectively control ADHD symptoms and has insignificant effects on tic symptoms in most children. (2) Co-morbidities of other behavioral disorders: such as learning difficulties, obsessive-compulsive disorders, sleep disorders, mood disorders, self-injurious behaviors, conduct disorders, etc., should be treated with educational training, psychological intervention, combined medication and other therapies along with TD, and promptly referred to child psychiatry for comprehensive treatment.