Abdominal Tics in Children and Adolescents: A Phenomenology-First Diagnostic Framework and Differential Diagnosis.

Abstract

Abdominal tics are a less commonly described axial or tonic tic phenotype in children and adolescents with Tourette syndrome and chronic tic disorders. Their abdominal location and symptom language may create diagnostic uncertainty with gastrointestinal, epileptic, myoclonic, respiratory or functional presentations. This clinically focused narrative synthesis identified relevant literature through targeted searches of PubMed/MEDLINE, Scopus and Web of Science from database inception through March 2026, supplemented by a targeted PubMed/MEDLINE and citation-chasing update during revision through August 2026 focused on focal abdominal motor seizures, CASPR2-associated movement phenomena, peripheral nerve hyperexcitability and related mimics. Abdominal tics are supported by the same core tic features that apply across body regions: premonitory urge, partial suppressibility, stereotyped recurrence, waxing-and-waning course, sleep attenuation and prior or concurrent tics when present. Key neurological mimics include belly dancer's dyskinesia, propriospinal myoclonus, focal abdominal motor seizures, CASPR2-associated abdominal movement disorders and functional tic-like behaviours. Preserved awareness does not exclude a focal motor seizure. Gastrointestinal mimics include disorders of gut-brain interaction and inflammatory bowel disease. A pattern-directed clinical triage algorithm is proposed alongside management principles derived from established paediatric tic-disorder evidence, including behavioural intervention as first-line treatment and comorbidity-guided pharmacotherapy. A phenomenology-first, red-flag-guided approach can improve diagnostic clarity and help clinicians avoid both reflexive investigation and premature attribution of organic disease to tics. This review provides a practical clinical triage framework for determining when an abdominal movement behaves like a tic, when targeted neurological or gastrointestinal investigation is indicated and when management can follow established tic-disorder principles.