Prevention of tic disorder (TD) includes etiological prevention, health education for parents and caregivers, early detection and diagnosis of the disorder. Prevention focuses on preventing recurrence of the disease, reducing functional impairment of the child, and improving the quality of life. 1. Prevention of TD Reducing external pathogenic or triggering factors The cause of TD is unknown, and current research suggests that TD is associated with a variety of factors such as genetics, immunity, neurotransmitter abnormalities and psychosocial factors. It is important to reduce the unfavorable factors during maternal pregnancy and birth, to achieve optimal birth and to reduce the adverse psychosocial factors after birth in order to prevent the occurrence of the disease. Infection and immunity theory suggests that autoimmune process secondary to streptococcal infection is a potential factor in the development of Tourette’s syndrome (TS); therefore, immunity in infancy and childhood should be actively improved to reduce the occurrence of infectious diseases. In addition, predisposing factors for the occurrence of tic symptoms should be reduced. Some diets such as seafood, food coloring and additives, and tryptophan-rich foods can induce tics or worsen existing tic symptoms, suggesting that these may be risk factors for the occurrence of TD. However, there is still a lack of evidence-based medical evidence to confirm this. Active treatment of tic symptoms It is important to recognize that TD is treatable, and children with TD can live and study normally after treatment. Parents should adopt a behavior management approach to deal with children with TD, which is often accompanied by emotional anxiety and depression, obsessive-compulsive behavior, oppositional defiance, and impulsive aggression, and must actively cooperate with the corresponding medication, rather than just assuming that the child is disobedient and attempting to use purely educational or Parents should not assume that the child is disobedient and try to change the accompanying “bad habits” by simple or violent education. Parents should not show anxiety or anger in front of their children. Parents should not be afraid, overly worried, or overwhelmed by the tics, and the child should gain confidence from the parents to overcome the disease. Parents should be made aware that the current treatment for TD is mainly symptomatic, i.e., tic symptoms are controlled and guided through medication, behavioral therapy and mental health education. The efficacy of drug therapy combined with behavioral therapy is positive for TD. Some parents worry that medication may affect the child’s “brain development” and that the side effects of medication may affect learning, so they terminate medication on their own, resulting in recurrent episodes of the disease and affecting the prognosis. Therefore, it is necessary to educate parents about drug therapy, correct their prejudices about drug therapy, and improve compliance with treatment. Parents should be made aware that some TDs such as TS need medication, and as chronic diseases, they must adhere to long-term and standardized treatment, follow medical advice for regular follow-up, and continue to adhere to medication when symptoms disappear. Improve family environment and promote psychological coping Psychosocial factors play an important role in the occurrence of TD. Tic symptoms can be triggered by various psychological events or factors that cause stress and anxiety in children at home, school and in society. Moreover, various types of TD may be aggravated by stress or anxiety, such as a repressive and stereotypical family atmosphere, parents’ overly high expectations of children, overly harsh and mean discipline of children, and the use of scolding, corporal punishment and other disciplinary methods; enthusiasm for high-intensity and demanding “intellectual development” or ability training that are incompatible with children’s age and qualifications and talents. Training, etc. The school’s strict requirements and heavy academic load can also make the child feel that he or she is living in a stressful and fearful environment, that he or she is not relaxed, that he or she is not getting the warmth he or she needs, and that his or her mental capacity is reduced. Mental health education for parents should be strengthened. Parenting styles and the family environment of children with TD should be improved to reduce the risk of TD. Some studies have found that poor parenting style, high punishment, excessive harshness, excessive interference and protection of children with TD and other parenting styles may promote the occurrence of TD. A study of family environment factors of children with TD found that families with children with TD had significantly lower scores than normal controls for factors reflecting good family structure, such as closeness, emotional expression, recreation, and organization, and significantly higher scores than normal controls for factors reflecting poor family structure, such as ambivalence. Both co-morbid and non-co-morbid TD families had family functioning deficits. For children with a clear diagnosis of TD, parents should accept the fact that the disease exists, adjust their mindset, face it positively, correctly understand the nature of the disease, and actively cooperate with doctors to help their children reduce their symptoms. Some parents have misconceptions and practices, for example, they often do not understand the child’s behavior and think that he or she is deliberately acting against the parents, and they adopt punitive, scolding and threatening methods to deal with the tic symptoms and the accompanying hyperactive impulse or compulsive symptoms. It was found that 73.9% of parents of children with TD had intervened in their children’s involuntary tic behavior by blaming and punishing them. Therefore, mental health education for parents should be strengthened to avoid problem-solving methods. Reduce study stress, improve lifestyle, and avoid aggravation of symptoms Psychological stress or a stressful study and lifestyle often lead to triggering the appearance of tic symptoms or aggravating existing symptoms. Research suggests that children with prolonged overload of study tasks, excessive study pressure, or prolonged exposure to television, computer games and other low-frequency radiation appliances, as well as watching thrilling and scary television or stimulating cartoons, can lead to excessive mental stress and trigger twitching or aggravation of symptoms. Therefore, parents should reasonably arrange the child’s daily life and study, combine work and rest, encourage and guide him/her to participate in various interesting games and activities to divert attention, and avoid excessive excitement and fatigue. Children with tic symptoms are often ridiculed by their classmates and show low self-esteem and low self-confidence in front of their classmates, so they need psychological support from school teachers. School teachers should be educated about health related to tics to make them realize that TD is a neuropsychiatric disorder that requires their cooperation in treatment, and not a deliberate act of disruption. At the same time, teachers should also be made aware that TD symptoms can worsen or recur under psychological stress, and that the child must be comforted and guided at the right time to improve his or her bad mood, encourage him or her to build confidence in learning, and help him or her gradually improve his or her symptoms. At the same time, teachers should also educate other students to avoid making fun of or discriminating against the child, so as to create an accepting environment for the child both physically and mentally. Improving the child’s ability to cope with stress The main psychological factors from children are introverted and unstable personalities, which are often characterized as withdrawn, passive, demanding perfection but lacking confidence, overly sensitive, and poorly controlled emotions. If children with such personality traits encounter adverse psychological factors that are beyond the capacity of the nervous system to tolerate, psychological stress is likely to occur, such as TD. Therefore, we should strengthen the child’s personality, parents and teachers should communicate with the child, actively channel the negative emotions, cultivate an optimistic personality, and improve his or her ability to cope with stress. 2. Strengthen mental health education to prevent the aggravation or recurrence of symptoms Encourage children to build confidence in overcoming the disease Tic symptoms can be reduced or alleviated with age and gradual improvement of brain development, and most children can work and live like normal people in adulthood without affecting family life. However, there are some children with prolonged symptoms or other psychological disorders associated with TD that may affect their normal life. Therefore, children should be encouraged to build up confidence in overcoming the disease, adapt to the lifestyle after the disease, and actively cooperate with the treatment to strive for early remission or partial remission of symptoms. Maintaining a positive attitude The symptoms of motor tics and involuntary vocalization will affect the child’s ability to attend classes, and the child’s attention will be easily distracted, resulting in poor academic performance; at the same time, the symptoms of ridicule and mockery by classmates will cause anxiety and depression in the child, which will in turn affect his or her motivation to learn. Some studies have found that the intelligence of children with TD is basically normal or at a normal level, and their intelligence is not related to the age and duration of the disease. Therefore, the learning problems of children with TD are secondary problems, not due to the low level of intelligence caused by the disease that affects their learning ability. Therefore, children with TD should be educated to maintain full confidence in their learning ability and maintain a positive attitude rather than choosing to give up. Enhance social interaction and promote social function rehabilitation Children with TD often have low self-esteem, social withdrawal, immature behavior, social impairment, stuttering and character discipline problems due to tic symptoms, which seriously affect social interaction and interpersonal relationships. Therefore, while receiving treatment, children with TD should consciously cultivate a sense of class honor and team spirit, integrate into the class, strengthen interactions, and participate more in group activities or games with classmates to improve their social skills and peer relationships during games and play. 3.Prognosis of TD The prognosis of TD is relatively optimistic, and most children with TD can live a normal life in adulthood and can perform any job they are engaged in. Clinical and demographic studies show that 80% of children with TD starting before the age of 10 will have significantly reduced or alleviated symptoms during adolescence; by the age of 18, 50% of children with TD will have stopped twitching and the severity of TD will be significantly reduced in adulthood; although mild twitching symptoms may remain, the intensity and frequency of twitching in the population after the age of 18 will mostly decrease to a level that does not affect the social function of the patient. Of course, there are some refractory cases, especially children with TD with behavioral and psychiatric disorders, for which treatment remains difficult, e.g., about 20% of children with TD have tic intensity that does not diminish, moderate overall functional impairment remains, and some children may even have increased symptoms in adulthood and may develop serious complications. The quality of life of children with TD may be affected by tic symptoms or associated psychological and behavioral disorders. There are many factors affecting the prognosis of TD, and the reports vary, with the following common factors. The presence of many co-morbidities in children with TD, such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, mood disorders, and conduct disorders, adds to the complexity of the condition and the difficulty of treatment. The presence of co-morbidities has been reported to affect the prognosis of TS to varying degrees, and Swain et al. concluded that the presence of co-morbidities is an important factor affecting the functional impairment of the child and influencing the prognosis. Medication Generally TD is treated with medication and the symptoms improve to a great extent. However, it has been suggested that the effect of medication on the prognosis and natural course of the disease in TS is not completely clear. It has also been found that many parents fail to adhere to their children’s medication, suddenly interrupt their medication, or frequently change their medication regimen, all of which cause children to fail to adhere to systematic treatment and make their condition prone to relapse or worsen their symptoms, often with a poor prognosis. In children with TD who have co-occurring ADHD, it has been suggested that methylphenidate may induce or aggravate tic symptoms. Recently, a Meta-analysis study concluded that regular doses of methylphenidate for TS co-occurring ADHD are equally effective and do not aggravate tic symptoms, while colistin provides the best combined effect on ADHD and tic symptoms. However, the treatment process needs to be closely monitored and carefully selected. There are other factors such as long duration of disease, early age of onset, frequent exposure to life events, and poor dietary habits that often suggest a poor prognosis for patients, but there is a lack of strong evidence to support this.