I am concerned that my granddaughter may be exaggerating or faking a tic disorder and may need counseling instead. she acts as though they are funny or cute and the vocals are more often than not with a 'cutesy' voice and facial expression?

Some basics: There are real tics & true tics occur with or without an audience. The person may be able to suppress them for a while and many try to incorporate them with a more acceptable action like a cough. They do effect the emotional state of the kid & those around them. How much is real or fake can sometimes be verified during a videotaped observation when the kid is alone.

TICS: This child needs to be evaluated by a Neurologist & Clinical Psychologist trained in CBIT Cognitive Behavioral Intervention for Tics. Tics are a neurological disorder difficult to treat because the impulse from the brain can't be prevented. Sometimes children try to act like they are joking to hide their embarrassment. The Doctors will be able to determine if this is a Tic or psychological.