Qiang Qiang, an 8-year-old boy in the second grade, presented to the clinic with “involuntary blinking and throat clearing for 2 years”. His mother told him that when he was 6 years old, he liked to watch TV and play games on the computer and gradually started to blink his eyes. The child’s eyes were examined by an ophthalmologist and no disease was found, so he thought it was a bad habit and was not treated. In the last 1 year or so, there have been actions such as throat clearing, nose sucking, neck tilting, shoulder shrugging, etc., and he has to do some strange actions regardless of the occasion, and he himself said to his mother that he would be “comfortable” if he did the actions and “uncomfortable” if he controlled them. For this reason, he was often teased by his classmates and surrounding partners, and he did not want to go to school anymore. During the examination, the doctor found that the child repeatedly cleared his throat and kept shaking his shoulders during his speech. During the conversation, Qiangqiang said, “I don’t want to do these strange movements, but I can’t control it.” The reason he doesn’t want to go to school is that he is afraid that his classmates will laugh at him. Is Qiang Qiang’s reluctance to go to school a bad habit or a disease? Qiang Qiang has Tourette’s Syndrome. Tic disorder is a neuropsychiatric disorder that begins in childhood and adolescence and is characterized by involuntary sudden, rapid, repetitive, stereotyped single or multi-site muscle twitching or vocal twitching, such as craning the neck, shrugging the shoulders, sniffing, and clearing the throat. The disorder is most common in school-age children, most commonly between the ages of 4 and 7, and the condition is usually most severe between the ages of 10 and 12. The cause of tics is unclear and may be related to a variety of factors. Tic episodes are conscious and can be self-controlled for a short period of time and disappear or diminish after falling asleep. The symptoms are varied and can occur sequentially or simultaneously. What are the other manifestations of Tourette’s syndrome? The symptoms of tic disorder usually begin in the face and progress to the head, neck, and shoulder muscles, and then spread to the trunk and upper and lower extremities, showing a variety of motor or vocal tics. The face often shows blinking, squinting, raising eyebrows, opening mouth, shrinking nose, making strange equations; the head and neck shows nodding, shaking head, slanting neck, twisting neck, shrugging shoulders, etc.; the trunk shows thorax, twisting waist, abdominal muscle twitching; the upper limbs show rubbing fingers, clenching fists, shaking hands, raising arms, tiptoeing, shaking legs, abnormal gait, etc. Vocal twitches can be characterized by strange animal-like sounds, nasal aspiration, throat clearing, coughing, grunting, spitting, screaming, sucking, etc. There are also more complex vocal tics, such as swearing, repetitive speech, and imitative speech. The frequency and intensity of the tics fluctuate, with some symptoms resolving on their own temporarily or over time, and others worsening or decreasing in response to certain triggers. Some parents seek treatment after noticing abnormal symptoms in their children. They often or repeatedly take their children to ophthalmologists, quintuplegics, and respiratory medicine, but usually no specific abnormalities are detected. Some parents often think that their children are mischievous and do so intentionally, and reprimand them a few times to restrain them, so they do not take it seriously. In the early stages of symptoms, some children can still be controlled. In order to avoid the ridicule of classmates and teachers and the reprimand of parents, they often make other movements after the twitching in an attempt to cover it up, or do it secretly when people around them are not paying attention. When the twitching progresses to repeatedly making faces, cursing, imitating others, or even making some nasty actions, it will be intensified after being criticized by parents. This often has the effect of delaying early detection and treatment. Could Qiang Qiang be ADHD? Parents of ADHD and Tourette’s Syndrome should be careful to differentiate. ADHD, also known as attention deficit hyperactivity disorder, is a group of syndromes in which there is a marked difficulty in concentration, short attention span, excessive or impulsive activity compared to children of the same age. The main manifestations are inattention, carelessness, missing things, procrastination, small movements in class, interruptions, capriciousness and impulsivity, emotional instability, and poor self-control. Teachers often respond that children are “disobedient children” and “troublemakers”. They tend to be hyperactive and do not consider the opinions or discipline of others around them.