Appendix B provides a comprehensive summary of the results from each of the 13 papers included in this review. These papers explore various aspects related to tics and healthcare, shedding light on important themes and issues.

Unveiling the Challenges in Tics Healthcare

Descriptive Characteristics of Included Papers

The study selection process is depicted in the PRISMA diagram (Fig. 1). The included studies employed different methodologies - qualitative (n = 2), quantitative (n = 7), or mixed (n = 4). Quantitative and mixed studies used surveys, while qualitative studies used interviews or focus groups. A summary of these studies can be found in Appendix B.All 73 countries represented in the studies have their unique findings. Caregivers formed the largest participant pool (33%), followed by healthcare professionals (HCPs - 32%), medical students (17%), and people with tics (10%). Males dominated among HCPs (60%−80%) and people with tics (65%−85%), while caregivers (52%−93%) and medical students (69%) were mostly female. More details on participant demographics are in Appendix B, along with a distribution graph in Appendix D.The publication dates of the included papers range from 1992 to 2023, with nine papers published in the last 10 years (see Appendix B and D).

Summary of Results

Need for Education and Effective ImplementationAll papers emphasized the need for greater professional education in tic disorders across all countries. HCPs interviewed by Rodin et al. [42] highlighted the inadequacy of training on tics.Impact of Limited KnowledgeKnowledge of tics was explored in various aspects. Most HCPs scored between 60 and 80% on tic understanding, lower than for other disorders. Comparisons between care sectors showed no significant difference in HCP knowledge compared to medical students, but knowledge varied among clinical occupations. A significant gap existed between good knowledge scores and low confidence in understanding tics due to limited training opportunities.When young people and caregivers perceived HCPs' sufficient tic knowledge, they felt more confident about their diagnoses. In Uganda, secondary care HCPs were eager to learn more about tics. In Saudi Arabia and the USA, primary and secondary care HCPs wanted to learn about HRT.Secondary care HCPs focused more on treating comorbidities, and MDS members endorsed this. Neurologists and psychiatrists were more likely to manage comorbidities than offer tic-related advice.Limited Support and Unclear Referral ProcessUp to 86% of neurologists offered tic-living advice, but caregivers received limited information. People with tics and caregivers felt unsupported in primary care, leading to dissatisfaction and increased healthcare usage. Primary care HCPs had a limited understanding of treatment options and often prescribed medication. However, 69% of MDS members preferred behavioural interventions as the first-line treatment.Secondary care referrals were necessary due to limited primary care support. Primary care clinicians had limited knowledge of referral sources and often faced rejection.Misinterpretation, Misdiagnosis, and StigmaPrimary and secondary care HCPs underestimated tic prevalence. Tics were often misinterpreted as other disorders. In the UK, GPs were unsure about tic diagnoses. Vocal tics were more likely to be misinterpreted. There were differences in beliefs about tic severity and premotor urges among HCPs.Patients and families felt that HCPs trivialized tic symptoms, and some parents had misconceptions. HCPs also acknowledged tic-related stigma. In Uganda, cultural beliefs affected healthcare seeking. In the UK, parents felt responsible for their child's behavior.Communication between Healthcare Professionals and FamiliesFour studies explored this. Only 45% of secondary care HCPs valued parent input in decisions. 76% of parents preferred collective decision-making. Overuse of clinical language hindered family understanding and relationship development. However, families appreciated GPs who showed compassion and kept them updated.

Skyler Andrews, a remarkable individual with deep roots in the CSRA (Central Savannah River Area), has led a diverse and fulfilling life. Born in Augusta and raised in Aiken, with family ties in Edgefield County, South Carolina, he now calls the Augusta area home. With a Bachelor of Arts in English from the University of South Carolina – Aiken, he has made significant contributions to the world of content creation. He has produced engaging pieces for Verge Magazine, The Aiken Standard, and the Augusta Conventions and Visitors Bureau. While juggling various jobs such as pest control, life insurance, and real estate, he remains actively involved in the Augusta arts community. He writes plays, short stories, and spoken-word pieces, and can often be spotted in downtown Augusta, either with a book in hand, writing, or performing stand-up comedy.

Uncovering the Multifaceted Life of Skyler Andrews in the CSRA

Early Life and Roots

Skyler Andrews' journey began in Augusta, where he was born. Growing up in Aiken, he was surrounded by the charm and culture of the region. His family roots in Edgefield County, South Carolina, added a rich heritage to his life. These early experiences shaped his perspective and laid the foundation for his future endeavors.His connection to the CSRA is not just geographical; it runs deep in his heart and soul. The memories of his childhood in these areas have influenced his work and creative pursuits.

Educational Journey and Career in Content Creation

After graduating from the University of South Carolina – Aiken with a Bachelor of Arts in English, Skyler Andrews embarked on a career in content creation. His skills in writing and storytelling allowed him to produce captivating pieces for various platforms.He has worked with renowned publications like Verge Magazine and The Aiken Standard, leaving his mark with his unique style and perspective. His contributions to the Augusta Conventions and Visitors Bureau have also helped promote the area and its attractions.In addition to his formal education, his real-life experiences in different jobs, such as pest control, life insurance, and real estate, have given him a diverse set of skills and insights. These experiences have enriched his writing and allowed him to connect with a wider audience.

Active Participation in the Augusta Arts Community

Skyler Andrews is not just a writer; he is an active participant in the Augusta arts community. His passion for the arts is evident in his works, whether it's writing plays, short stories, or spoken-word pieces.He can often be found in downtown Augusta, immersed in the creative atmosphere. His nose in a book shows his love for literature, while his writing and performing stand-up comedy demonstrate his artistic talent.His involvement in the arts community has not only brought him personal fulfillment but has also contributed to the cultural fabric of Augusta. He is a source of inspiration for other artists and a driving force in the local arts scene.