ABSTRACT
ABSTRACT Background and Objective Pediatricians and pediatric subspecialists worldwide have reported a marked increase in functional (conversion) disorders with tic-like behaviors during the COVID-19 pandemic. These patients often report frequent viewing of Tourette Syndrome (TS) TikTok videos, suggesting disease modeling. We aimed to evaluate tic phenomenology in videos posted on TikTok. Methods The 100 most-viewed videos under #tourettes in TikTok were randomly assigned to two primary reviewers (n=3; <2 years independent practice), all pediatric neurologists specializing in movement disorders, for extraction and classification of tic phenomenology. Initial disagreements were solved by consensus. If not resolved, a senior reviewer (n=5; >2 years independent pediatric movement-disorder practice) served as tiebreaker. In addition, two primary and one senior reviewer rated each video on a Likert scale from 1= “All the tics are typical of TS” to 5= “None of the tics are typical of TS”. Mean scores and Spearman correlation between primary and senior reviewers were calculated. Results Six videos without tic-like behaviors were excluded. Most videos depicted coprophenomena (coprolalia: 53.2%; copropraxia: 20.2%), often with unusual characteristics. Frequently, videos demonstrated atypical phenomenology such as very strong influence by the environment (motor: 54.3%; phonic: 54.3%), aggression (19.1%), throwing objects (22.3%), self-injurious behaviors (27.7%), and long phrases (>3 words; 45.7%). Most videos portrayed atypical, non-tic behaviors (Median [IQR] Likert ratings: Primary 4.5 [4-5]; Senior 5 [3-5]). Primary vs. senior rater scores demonstrated moderate agreement (r = 0.46; p<0.001). Conclusions TS symptoms portrayals on highly-viewed TikTok videos are predominantly not representative or typical of TS. Highlights Many teenagers with functional tic-like disorder have been reported during the COVID-19 pandemic. These patients report increased viewing of Tourette Syndrome TikTok videos, a popular social media platform, and present with similar tic-like behaviors. Current TikTok videos are poorly representative of Tourette syndrome and more consistent with functional tic-like behavior. We provide a detailed description of the phenomenology tics and tic-like behavior portrayed in TikTok.