Child's Tic Log
Daily report
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Date *
MM
/
DD
/
YYYY
Hours of sleep *
Any physical activities during the day *
Sleep disturbances?  If so, describe.  If no, "N/A" *
Diet (no need to include macro/micro nutrients or calories).  E.g., Breakfast: eggs and toast; Lunch: ham and cheese sandwich and carrots; Snack: cheese and crackers; Dinner: turkey burgers and salad; Dessert: caramel popcorn *
Rate severity of tics (average over the course of the day; see question below about activities which may have precipitated periods of increased tics) *
no tics
many tics (more than 10 per hour)
Type of tics *
Required
Description of motor and/or vocal tics (please note if motor and vocal occurred simultaneously, and/or if motor or vocal tics happened in succession. E.g., "While shaking my head I simultaneously cleared my throat," or "after shaking my head, I wrinkled my nose"). *
Were tics disruptive socially and/or in school?   *
Strategies used to help with tics (e.g., go for a walk, fidget toys, writing, meditation, chatting with friends, breathing exercises, music, other).
Reflecting on those times during which tics were both/either frequent and/or severe, describe any activities in which you were involved or thoughts that might have occurred (e.g., "my tics were severe at X time and I was just about to engage in Y activity").   *
Reflections about the day including any noticeable triggers, reasons why tics might have been less frequent or more frequent, discomforts, things that helped when tics occurred more frequently, other, etc.  
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