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Answer 9
  1. Evaluation of the child’s self-esteem. Children with tic disorders are frequently the victims of teasing by other children as well as social ostracism.5 Therefore, a detailed evaluation of the child’s self-esteem and use of coping strategies are essential.5 A referral for psychotherapy may be indicated if the child is experiencing feelings of low self-worth or is having difficulty with peer relationships.5 This is particularly true given the fact that tics are often exacerbated by stress.1 Therefore, children with tics may find themselves in a vicious cycle where stress caused by peer teasing exacerbates tics, and the worsening of tics results in increased teasing and subsequent stress. A child’s adaptation capacities, coping mechanisms, and interpersonal skills may play a significant role in outcome.5 Electrocardiography, magnetic resonance imaging, and electromyography are not indicated for the evaluation of a tic disorder in the absence of other neurologic signs or symptoms.5

    5. Popper CW, Gammon GD, West SA, Bailey CE. Disorders usually first diagnosed in infancy, childhood or adolescence. In: Hales RE, Yudofsky SC, editors. The American Psychiatric Publishing textbook of clinical psychiatry. 4th ed. Washington (DC): American Psychiatric Pub.; 2003.

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