Y G T S S-R

Yale Global Tic Severity Scale-Revised

Original Version October 1992 © J. Leckman

Revised Version September 2017 © J. Leckman

Investigators interested in using this rating scale should contact Dr. Joseph McGuire (jfmcguire@jhmi.edu), Dr.
Lawrence Scahill (lawrence.scahill@emory.edu), and Dr. James Leckman (james.leckman@yale.edu).

Revised Version September 2017

NAME: TODAY'S DATE: / /
RATER:

MOTOR TIC SYMPTOM CHECKLIST

Check motor tics that were present over the past week. When multiple tics within the same category
are present (e.g., other simple motor tics), please count them separately on Tic Number Dimension.

•Simple Motor Tics (Rapid, Darting, "Meaningless"):

o Eye blinking
o Eye movements
o Nose movements
o Mouth movements
o Facial grimace
o Head jerks/movements
o Shoulder shrugs
o Arm movements
o Hand movements
o Abdominal tensing
o Leg, foot, or toe movements
o Other simple motor tics (list and describe):

•Complex Motor Tics (Slower, "Purposeful"):

o Eye movements
o Mouth movements
o Facial movements or expressions
o Head gestures or movements
o Shoulder movements
o Arm movements
o Hand movements
o Writing tics
o Dystonic postures
o Bending or gyrating
o Rotating
o Leg or foot or toe movements
o Blocking
o Tic related compulsive behaviors (touching, tapping, grooming, evening-up)
o Copropraxia
o Self-abusive behavior
o Paroxysms of tics (displays), duration ___ seconds
o Disinhibited behavior (describe):*

o Other (list and describe):

Revised Version September 2017

PHONIC TIC SYMPTOM CHECKLIST

Check phonic tics that were present over the past week. When multiple tics within the same category
are present (e.g., other simple phonic tics), please count them separately on Tic Number Dimension

•Simple Phonic Symptoms (Fast, "Meaningless" Sounds):

o Coughing
o Throat clearing
o Sniffing
o Snorting
o Grunting
o Gulping
o Whistling
o Humming
o Mouth Noises (e.g., clicking, gargling, popping, kissing noises)
o Burping
o Hiccups
o Atypical breathing tics (e.g., forceful exhalation, wheezing, gasping, panting)
o Chirping or other bird noises (e.g., screeching):____________________________________
o Barking or other dog noises (e.g., growling): ______________________________________
o Other animal noises (e.g., squealing)
o Other simple phonic tics (list and describe):

•Complex Phonic Symptoms (Language: Words, Phrases, Statements):

o Syllables (e.g., "ahhh", "woo", "hmmm"):

o Words (e.g., "what", "dang", "Okay"):

o Phrases (e.g., "oh no", "here we go", "I know"):

o Coprolalia (e.g., obscene words):

o Echolalia (e.g., repeating others words or phrases)

o Palalalia (e.g., repeating self)
o Blocking (e.g., halted speech blocked speech, stuttering)
o Speech atypicalities (e.g., slow/fast speech rate, nasal speech, quivering voice, high or
low pitch/tone/volume):

o Disinhibited speech (e.g., blurting out words, talking excessively):

o Other complex phonic tics (e.g., list and describe):

Revised Version September 2017

NUMBER Motor Phonic

NONE. No tics present. o o 0

MINIMAL. Single tic present. o o 1
MILD. Multiple discrete tics (2-5). o o 2
MODERATE. Multiple discrete tics (>5). o o 3
MARKED. Multiple discrete tics plus as least one orchestrated pattern of o o 4
multiple simultaneous or sequential tics, where it is difficult to distinguish
discrete tics.
SEVERE. Multiple discrete tics plus several (>2) orchestrated paroxysms of o o 5
multiple simultaneous or sequential tics, where it is difficult to distinguish
discrete tics.

FREQUENCY Motor Phonic

NONE. No tics present. o o 0

MINIMAL. Specific tics are usually present on a daily basis, but there are long o o 1
tic-free intervals during the day. Bouts of tics may occur on occasion, but are not
sustained for more than a few minutes at a time.
MILD. Specific tics are present on a daily basis. Tic free intervals as long as 3 o o 2
hours are not uncommon. Bouts of tics occur regularly, but generally limited to a
single setting.
MODERATE. Specific tics are present virtually every waking hour of every day. o o 3
Bouts of tics are common and may not be limited to a single setting.
MARKED. Specific tics are present every waking hour. Bouts of tics are common o o 4
and may occur in multiple settings.
SEVERE. Specific tics are present virtually all the time. Tic free intervals are o o 5
difficult to identify and do not last more than 5 to 10 minutes. Bouts of tics are
very common and occur in multiple settings.

INTENSITY Motor Phonic

NONE. No tics present. o o 0

MINIMAL. Tics not visible or audible (based solely on patient's private o o 1
experience), or tics are less forceful than comparable voluntary actions and are
typically not noticed because of their intensity.
MILD. Tics are not more forceful than comparable voluntary actions or o o 2
utterances, and are typically not noticed because of their intensity.
MODERATE. Tics are more forceful than comparable voluntary actions, but are o o 3
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. Tics are more forceful than comparable voluntary actions or o o 4
utterances and typically have an "exaggerated" character. Such tics frequently call
attention to the individual because of their forceful and exaggerated character.
SEVERE. Tics are extremely forceful and exaggerated in expression. These tics o o 5
call attention to the individual and may result in risk of physical injury
(accidental, provoked, or self-inflicted) because of their forceful expression.

Revised Version September 2017

COMPLEXITY Motor Phonic

NONE. No tics present. o o 0

MINIMAL. If present, all tics are clearly "simple" (sudden, brief, purposeless) in o o 1
character.
MILD. Some tics are not clearly "simple" in character. o o 2
MODERATE. Some tics are clearly "complex" (purposive in appearance) and o o 3
mimic brief "automatic" behaviors, such as grooming, syllables, or brief
meaningful utterances such as "ah huh" or "hi" that could be camouflaged.
MARKED. Some tics are more "complex" (more purposive and sustained in o o 4
appearance) and may occur in orchestrated bouts that would be difficult to
camouflage, but could be rationalized or "explained" as normal behavior or
speech (tapping, saying "you bet", "honey", "FF", "sh", or brief echolalia).
SEVERE. Some tics are very "complex" in character and tend to occur in o o 5
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, bouts of copropraxia,
self-abusive behavior, coprolalia).

INTERFERENCE Motor Phonic

NONE. No tics present. o o 0

MINIMAL. When tics are present, they do not interrupt the flow of behavior or o o 1
speech.
MILD. When tics are present, they occasionally interrupt the flow of behavior or o o 2
speech.
MODERATE. When tics are present, they frequently interrupt the flow of o o 3
behavior or speech, but do not disrupt intended behavior or speech.
MARKED. When tics are present, they frequently interrupt the flow of behavior o o 4
or speech, and they occasionally disrupt intended action or communication.
SEVERE. When tics are present, they frequently disrupt intended action or o o 5
communication.

Revised Version September 2017

IMPAIRMENT SCALE
NONE. o 0
MINIMAL. Tics associated with subtle difficulties in self-esteem, family life, social o 10
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 o 20
acceptance, or school or job functioning.
MODERATE. Tics associated with some clear problems in self-esteem family life, social o 30
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 o 40
acceptance, or school or job functioning.
SEVERE. Tics associated with extreme difficulties in self-esteem, family life, social o 50
acceptance, or school or job functioning (severe depression with suicidal ideation,
disruption of the family (separation/divorce, residential placement), disruption of social
ties - severely restricted life because of social stigma and social avoidance, removal from
school or loss of job).

Revised Version September 2017

 Yale Global Tic Severity Scale-Revised (YGTSS-R)

Patient's/Subject's Initials:______________ Patient/Subject ID: ______________

Informant(s):_________________________ Date:_______/_______/__________

Visit:___________ Rater’s initials:_____________

Number Frequency Intensity Complexity Interference

Motor Tic
Score

Phonic Tic
Score

Total Tic
Score Sum of Motor and Phonic Tic Severity Scales =

Impairment
Score

Global
Severity
Score Total Tic Score + Impairment Score =

Revised Version September 2017