Tourette Syndrome

What is Tourette syndrome?

Tourette syndrome is a neurological tic disorder whose hallmark symptom is tics. Tics come in different forms (e.g., repetitive movements, repeating one’s words) and are very difficult to control. Even when people with Tourette syndrome can control a tic, it’s only for a short while. Eventually, the tic has to occur.^[1]

Common tics include shoulder shrugging, eye blinking, throat clearing, and echolalia - repeating what other people have just said. These tics are in response to what’s called a premonitory urge, or a physical sensation like a tingling or an itch. Expressing the tic relieves these sensations.

Symptoms of tourette’s begin in childhood; there are various early indicators of tourette's that a parent can keep track of if they are concerned their child has the disorder. If someone develops tics for the first time as an adult, it will not be due to tourette’s.

Symptoms of Tourette syndrome

As noted above, the primary symptom of Tourette’s disorder is tics. These tics fall into one of two categories: motor and vocal. In both cases, the tics might be simple or complex.^[2]

Simple tics involve a limited number of movements or actions. Good examples of a simple tic are eye blinking and throat clearing. These types of tics are sudden, repetitive, and brief.

Complex tics involve coordinated patterns of movement across multiple muscle groups. An example of this might be tilting one’s head to the left while hopping up and down.

• Vocal tics include sounds or verbalizations, depending on whether it’s a simple or complex tic. Simple vocal tics include grunting, barking, or humming. The previous example of throat clearing is also a simple vocal tic.

A complex vocal tic is much more involved. These tics include repeating words or phrases, repeating what others have just said (echolalia), and in rare cases, coprolalia. This is a condition in which a person uses inappropriate or vulgar language.

• Motor tics include simple and complex movements. Examples of a simple motor tic include eye blinking, shoulder shrugging, and head jerking. Complex motor tics include repetitive motions that appear purposeful, such as touching and sniffing an object or a combination of simple motor tics.

Other complex motor tics manifest as hopping, jumping, or twisting, arm flapping, kicking, or stomping.

The symptoms of Tourette syndrome usually appear between the ages of 5 and 10.^[1] Motor tics in the head and neck area are most common at this age. Common triggers include anxiety, stress, or excitement. Periods of calm or focus on an activity tend to reduce the manifestation of tics.^[2] 

Simple tics often precede complex tics, though, as time goes by, people with Tourette’s disorder experience different tics. The frequency of tics also changes. Approximately one-third of children with Tourette’s disorder have no tics by the time they enter adulthood.^[3]

Tourette’s symptoms commonly associated with the disorder in popular culture - echolalia and coprolalia - are rare. Neither symptom is necessary for a Tourette syndrome diagnosis.^[1]

Other conditions often accompany tourette’s symptoms or conditions. Behavioral, mental, and developmental disorders are most common and include:^[2]

• Obsessive-compulsive disorder (OCD)
• Attention-deficit hyperactivity disorder (ADHD)
• Behavioral or conduct disorders
• Learning disabilities, such as difficulty reading or writing
• Difficulty falling or staying asleep
• Anxiety
• Sensory processing issues, such as difficulty responding to visual, auditory, and tactile inputs

Additionally, some people with Tourette syndrome exhibit social deficits. This typically manifests as a lack of social bonds and an inability to maintain social relationships.

Causes of Tourette syndrome

The specific cause of Tourette’s disorder isn’t particularly well understood. However, modern research shows that genetics is part of the equation and that chemical imbalances in the brain might also be a factor.

Studies reveal that Tourette syndrome is likely a dominant gene, with roughly a 50% chance of the gene passing from one generation to the next. Boys with this gene are about three to four times as likely as girls to develop the disorder.^[4]

Additionally, researchers believe that the development of Tourette’s might be related to the breakdown of dopamine in the brain,^[4] or that dysfunction of dopamine transmission might be the cause.^[5] Issues with this breakdown/poor transmission leads to a buildup of dopamine; this is believed to contribute to tourette’s in some people.

Genetic factors and dopamine abnormalities don’t explain the development of Tourette syndrome in every patient, though. Approximately one in 20 children develop the disorder due to one of several potential risk factors, including:^{[6] [4]}

• Carbon monoxide poisoning
• Smoking during pregnancy
• Complications during pregnancy
• Low birth weight
• Head injury
• Encephalitis, or swelling in the brain

Other risk factors include a family history of the disease, infection, and poor physical health. Extreme stress and poor emotional health might also be risk factors.^[3]

Diagnosing Tourette syndrome

Diagnosis of Tourette syndrome begins with a physical examination and a mental health evaluation.^[2]

A physical examination helps rule out other conditions that might cause Tourette-like symptoms (e.g., allergies that cause frequent eye blinking). Likewise, a doctor might order blood tests, neuroimaging (e.g., electroencephalogram (EEG), or magnetic resonance imaging (MRI)) to eliminate other potential causes of the symptoms.

A mental health evaluation serves much the same purpose. A mental health professional will explore the symptomatology and will typically ask questions like:

• What type of tics are occurring?
• How frequently do tics occur?
• When did the tics first appear?
• What medications are being used?

For a clinical diagnosis of Tourette syndrome, mental health professionals consult the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). The DSM-V outlines the following criteria for diagnosing the disorder:^[7]

• Tics have been present for at least a year.
• Tics began before the patient’s 18th birthday.
• Though they might not occur simultaneously, multiple motor and vocal tics are present.
• Symptoms do not result from another medical condition, medication, or drug use.

These diagnostic processes help doctors rule out various conditions. For example, a primary symptom of Huntington's disease is involuntary, jerky movements of the limbs, which might be mistaken for a Tourette syndrome tic. Other conditions often ruled out include seizures, postviral encephalitis, and overuse of medications.

Treatment for Tourette syndrome

There is no cure for Tourette syndrome, though most people with this disorder do not need treatment. However, if the symptoms are severe enough, treatment might take one of two courses: behavioral therapy or medication.

Therapies include:^[8]

• Habit reversal training, which identifies the feelings that trigger tics. Once the trigger feelings are identified, a new, less noticeable method of relieving the urge to tic is implemented.
• Exposure with response prevention (ERP), which is a behavioral therapy focusing on improving control over tics. Through repeated exposure to the feelings that trigger tics, the patient learns how to tolerate the urge to tic without expressing it.

Medications are another option to help control tics. These include:^[9]

• Antipsychotic medications that block dopamine receptors in the brain, which helps alleviate tics. Common examples include Pimozide, Risperidone, and Aripiprazole.
• Methylphenidate medications, which are stimulants typically used to treat ADHD. However, they show promise for reducing tics while also treating ADHD symptoms. Common examples include Ritalin, Equasym, and Concerta.
• Selective Serotonin Reuptake Inhibitors (SSRIs), which are a popular medicine for treating depression and OCD. Common examples include Fluoxetine, Escitalopram, and Citalopram.

The preferred method of treating Tourette syndrome is behavioral therapy. Medications have varying efficacy from one person to the next. They also present a range of side effects that could make daily functioning more difficult than it already is. This being the case, medications are usually only prescribed if the tourette’s symptoms are severe.

Self-care for Tourette syndrome

As noted earlier, tourette’s symptoms often improve with age and treatment. However, there are many things you can do to improve your ability to cope with this disorder, starting with getting plenty of sleep and avoiding stressful situations.

Other self-care approaches include:^[10]

• Avoiding boredom by filling your time with enjoyable activities. If your attention is on an activity, there’s a lesser likelihood that tics will occur.
• Finding ways to reduce stress.
• Researching Tourette syndrome to learn more about the disorder.
• Communicating to people in your social and occupational circles about the disorder to help them understand your situation.
• Joining a support group to build connections with people who understand what it’s like living with Tourette syndrome.

Above all, if you feel like you’re struggling to manage your Tourette’s, reach out to a mental health professional.

Helping someone with Tourette syndrome

If you know someone with Tourette syndrome, one of the best things you can do is educate yourself about the disorder. Guides like this are a great start for being more informed about the nature of Tourette’s and its effects on people.

Other strategies you can use to help someone with Tourette syndrome include:

• Be available to provide emotional and moral support. Living with Tourette syndrome is easier with a strong support network.
• Be patient. If a friend or a family member has a tic, let it run its course.
• Meet others where they’re comfortable. Some people are very open about their Tourette syndrome. Others prefer not to discuss it.
• Be available for fun and relaxing activities that can help reduce the occurrence of tics.

If your child has Tourette syndrome, there are additional things you can do to help them manage the disorder:

• Work closely with teachers and school administrators to ensure your child gets the support they need. Tourette’s is a disability, so if your child is having issues at school they will likely qualify for an individualized education plan (IEP) or 504 plan to accommodate their learning requirements (e.g. one to one teaching time, custom learning materials, etc.).
• Focus on helping your child build self-esteem. This disorder can make children very self-conscious.
• Keep a keen eye out for changes in your child’s behavior, especially changes in tics. Appraise your child’s doctor of any changes.

FAQs about Tourette's

How common is Tourette syndrome?

Tourette syndrome affects approximately one in 160 children in the United States.^[11] Worldwide, estimates are that Tourette syndrome affects one percent of the population.^[12] The disorder is more common in boys, who are also more likely to have chronic tics.^[6]

How does Tourette syndrome impact daily life?

This disorder can have significant impacts on social and educational functioning during childhood. However, many people with Tourette syndrome grow out of their tics, which lessens the effects of the disorder on daily life. Those whose tics that remain into adulthood often see improvement with behavioral therapy, medication, or a combination of the two.