PUTS Screening Tool: Premonitory Urge for Tics Scale (Ages 10 and up)

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Premonitory Urge for Tics Scale (PUTS)

Most people with tics notice something in their body just before a tic happens. It might be an itch, a pressure, a tight or wound-up feeling, or a sense that something is not quite right. That feeling has a name, the premonitory urge, and it matters a lot. It is the exact thing that behavioural therapy for tics learns to catch and work with.

These ten questions ask what that feeling is like for you. They were written for young people, and they work best from about age 10 and up. Teens and adults use them too. It takes about two minutes. If you are a parent of a younger child, you can read the questions together, but keep the result loose: under 10, many children cannot yet describe the urge reliably, and that is completely normal.

This is not a diagnosis, and it does not measure how severe the tics are. It describes the feeling before the tic. For how I think about tics more broadly, see tics, Tourette syndrome, and habit disorders.

Think about the feelings you get right before your tics. For each sentence, choose how true it is for you. There are no right or wrong answers. Go with what feels most true lately.
1. Right before I do a tic I feel like my insides are itchy
2. Right before I do a tic I feel pressure inside my brain or body
3. Right before I do a tic I feel “wound up” or tense inside
4. Right before I do a tic I feel like something is not “just right”
5. Right before I do a tic I feel like something isn’t complete
6. Right before I do a tic I feel like there is energy in my body that needs to get out
7. I have these feelings almost all the time before I do a tic
8. These feelings happen for every tic I have
9. After I do the tic, the itchiness, energy, pressure, tense feelings or feelings that something isn’t “just right” or complete go away, at least for a while
10. I am able to stop my tics even if only for a short period of timeNot added to the total, but still worth answering.

PUTS Total Score (items 1 to 9)

0
What this means: The total adds up items 1 to 9, each scored 1 to 4, so it runs from 9 to 36. Item 10 is left out of the total because, in the original study, it did not hang together with the other nine (Woods et al., 2005). The bands are a rough guide from a clinical handout used by the University of Washington’s developmental-behavioural paediatrics team, not from the original paper.

A higher score is not bad news. It usually means the feeling before a tic is strong and easy to notice, and noticing it is the very first skill we build in behavioural therapy for tics. A lower score does not rule tics out either: some people, especially younger children, feel little or no urge at all. Either way, a proper conversation about the tics is where the real picture comes from.

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The PUTS was developed by Douglas W. Woods and colleagues (Woods, Piacentini, Himle, & Chang, 2005). Items unmodified.
References

Woods, D. W., Piacentini, J., Himle, M. B., & Chang, S. (2005). Premonitory Urge for Tics Scale (PUTS): Initial psychometric results and examination of the premonitory urge phenomenon in youths with tic disorders. Journal of Developmental & Behavioral Pediatrics, 26(6), 397-403.

Reese, H. E., Scahill, L., Peterson, A. L., Crowe, K., Woods, D. W., Piacentini, J., Walkup, J. T., & Wilhelm, S. (2014). The premonitory urge to tic: Measurement, characteristics, and correlates in older adolescents and adults. Behavior Therapy, 45(2), 177-186.