The answer is C, persistent motor tic disorder. Tic disorders are disruptive disorders usually affecting children, with the most severe tic disorder being Tourette’s. According to the DSM V, Tourette’s requires several motor tics AND at least one vocal tic. If both vocal and motor tics are not present, then it is not Tourette’s. Motor tics in general often involve the face and head (like this child.) Vocal tics include the well known “coprolalia” or speaking ‘bad’ words involuntarily, echolalia (repeating the words of others), and others. This child has no vocal tics and therefore has a persistent tic disorder. In general, tics do disappear over time, and persistent tic disorder is not diagnosed until a tic has been present for over a year. Treatment for tic disorders include psychoeducation and behavioral intervention therapy. There are pharmacological options for when the disorder is causing significant impairment: alpha-2 agonists (guanfacine), clonidine, and atypical or typical antipsychotics can be considered. While Tourette’s does appear to be linked with OCD, this child is not displaying clear obsessions, or compulsions (usually compulsions are more complex behaviors than a head nod or a blink). PANDAS is thought to be an autoimmune neuropsychiatric disorder appearing in children after a group B strep infection, and symptoms can resemble tic disorders and OCD-- however, we are not given a history of a strep infection here.

Publication reference : Evans J, Seri S, Cavanna AE. The effects of Gilles de la Tourette syndrome and other chronic tic disorders on quality of life across the lifespan: a systematic review. Eur Child Adolesc Psychiatry. 2016 Sep;25(9):939-48. doi: 10.1007/s00787-016-0823-8. Review. PubMed PMID: 26880181
Reference URL: https://www.ncbi.nlm.nih.gov/pubmed/26880181