Hello, Welcome, this is my first written message on this forum, and I would just like to say that im 14 and I have similar problems to your daughter, yet im not inflicting pain on myself, just extreme anxiety due to distracting people when I cant help it. I have almost 30 ongoing tics at a time and they are all in a specific pattern. Did you have tics growing up? If not, you need to try to put yourself in your daughter's shoes. When you talk about it to her, do not call it a disability, because it is quite offensive to some people. Try seeing an osteopath, thats what im doing right now, and im using homeopathic. It's not affecting anything at all, apart from helping me deal with the tics. Also, something proven by science which can be extremely effective is doing intense exercise. Preferably outside, (right now im doing atleast 4-4 1/2 hours per day) and it helps to keep my mind off of it. I noticed that when i skip the exercise for a day, the tics are much worse. Every specialist i have seen has said that they usually go away before you are an adult. I try not to think about it. Something that helps a lot is to not talk about it AT ALL. If she has any other family, you should discuss with them and your daughter that you will not talk about it, because bringing it up brings it onto your conscience, which leads to making it worse. It is much worse at school for me than home, because at school i get constant comments on it, because i have to make noises during exams and I have to scratch people's arms, turn around and look at someone's work. The list goes on. Ignoring is a good idea to try, but not to neglect. I hope that this was helpful, and good luck. If your daughter would like, I could talk to her and it might help not just her, but me aswell to understand. If not, im totally ok with that. Thank you if you read this far