To examine the prevalence, clinical characteristics and course of children with tics identified in a community sample. This was a three-stage study. At the age of 9 to 11, parents of 8,244 children born at Aarhus University Hospital Skejby between January 1990 and April 1992 were invited to complete a screening questionnaire about tics. One year later participating parents completed the Strengths and Difficulties Questionnaire (SDQ). From December 2004 to June 2005, when the cohort was 13-15 years of age, parents of the children who screened positive for tics were interviewed in detail about tic disorders. The prevalence of Tourette Syndrome (TS) was 0.6 and 0.6% of chronic motor tics (CMT). Approximately one-third of those with a chronic tic disorder [CTD (TS and CMT)] reported remission of tics by age 13-15. On the parent-rated SDQ children with a CTD were five times more likely (OR = 5.0, 95% CI = 2.6-9.2) to fall into the clinical range of hyperactivity, twice as likely (OR = 2.2, 95% CI = 2.1-7.5) to exhibit disruptive and defiant behavior and over four times more likely to have emotional difficulties (OR = 4.7, 95% CI = 2.5-8.6) compared to children without tic disorders. Children with hyperactivity and CTD were more impaired than subjects with CTD only. Children with CTD and hyperactivity show greater symptom severity across several domains of behavior and overall impairment. In the absence of hyperactivity, children with CTD are at increased risk for emotional difficulties, but not disruptive behavior problems.