Indicators of Tourette Syndrome

What is Tourette syndrome?

Tourette syndrome is a neurodevelopmental disorder that affects the nervous system and causes spontaneous and repeated movements or noises, which are known as tics ^[1]. Tourette syndrome is one of three tic disorders included in the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5) ^[2].

Tics are categorized in two ways. Motor tics, which are physical movements, and vocal tics, which are sounds or words. Tics are involuntary and typically vary in severity, type, and frequency. They may occur at any time throughout the day. However, tics may be worse at certain times of the day and are often exacerbated by anxiety or excitement ^[3].

People with Tourette syndrome cannot stop their tics from happening, although some are able to repress them for a time. However, suppressing the tics often results in a build up of tension that can only be released by allowing the tic to occur later on ^[3].

Symptoms of Tourette syndrome typically emerge in childhood, often between the ages of 5 and 10 ^[1]. Research suggests that the condition affects around 1% of children ^[4] and that it is significantly more likely to affect boys than girls ^[5][6].

For many, symptoms of Tourette syndrome will be at their worst in their early teenage years and then significantly reduce in severity as adolescence progresses. However, for others, symptoms may persist into adulthood and may even worsen with age ^[1][3].

Early warning signs of Tourette syndrome

Typically, symptoms of Tourette syndrome emerge in childhood, usually before the age of 10 years old. The first signs to present are often motor tics, usually around the head and neck area, which may include grimacing and jerking movements of the head or shoulder ^[7].

Simple tics will typically be the first to emerge, often leading to the occurrence of complex tics. Simple tics involve a small movement of one part of the body, or a small, short sound ^[3].

Simple motor tics include ^[1][7]:

• Grimacing
• Repeated blinking
• Shrugging of the shoulders
• Jerking movements in the head or shoulder
• Eye rolling

Simple vocal tics include:

• Sniffing
• Grunting
• Humming
• Whistling
• Throat cleaning or coughing
• Animal sounds, such as barking

These movements and sounds may be repeated regularly and will often lead to the emergence of complex tics. Complex tics involve movements in a combination of muscles or areas of the body, or the use of several words or noises ^[3].

Complex motor tics include ^[1]:

• Touching other people or objects
• Lip smacking or sticking the tongue out
• Punching or kicking the self or others
• Jumping or twisting
• Copying other people’s movements
• Combinations of movements

Complex vocal tics include:

• Repetition of random words or phrases
• Repeating someone else’s words or phrases, also known as echolalia
• Saying rude words or phrases, or swear words, also known as coprolalia

It should be noted that, although Tourette syndrome is commonly associated with a person blurting out swear words, this symptom is actually only present in a tenth of all people with the condition and is not a requirement of the diagnosis ^[8][9].

Another sign of Tourette syndrome is the presence of an urge or build up of tension, known as a premonitory sensation, before a tic. It is usually a sensation felt in the eyes, throat, or muscles that is only relieved by carrying out the tic in this area ^[1][8].

For many people with Tourette syndrome, the severity of their symptoms is worsened by stress, anxiety, excitement, or tiredness ^[3].

Tourette syndrome symptoms in adults compared to children

Children with Tourette syndrome are often likely to experience other conditions as well, such as obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) ^[5][10]. This can also contribute to many children with Tourette syndrome being perceived as disruptive or having behavioral or conduct problems ^[1][9].

For school children, it can be useful if their teacher is aware of the condition and understands their symptoms. For example, a child with Tourette syndrome might shout or make a lot of movements while in class. If the teacher is unaware of the child’s condition, the teacher may think they are being intentionally disruptive and punish the child. Having a teacher respond in this way could exacerbate the child’s symptoms. It would be best to provide an adapted teaching style that meets the child’s needs ^[9].

Tourette syndrome in children is around 4 times more likely to occur in boys than girls ^[5][11]. However, in adults, the prevalence of the condition between genders is more equal and may even be more common or severe in females ^[6].

Often the symptoms of Tourette syndrome reduce with age, after being most persistent in childhood or adolescence. Research suggests that between 50-66% of children with Tourette syndrome experience a significant reduction in tics by adulthood ^[12].

However, for some people, symptoms of Tourette syndrome continue into adulthood and may even worsen in severity. Studies have found that adults with persisting symptoms experience a higher prevalence of motor tics and fewer vocal tics. Also, there is a higher prevalence of mood disorders and social anxiety and a lower prevalence of ADHD in adults with Tourette syndrome ^[10].

The importance of detecting Tourette syndrome early

Although there is no cure for Tourette syndrome, detecting the condition early and receiving an appropriate diagnosis can allow for quicker access to appropriate treatment. Early detection and intervention can reduce the impact the condition may have on a person’s quality of life.

Below are some examples of how Tourette syndrome can negatively impact a person’s life and why early intervention is key:

• Symptoms of Tourette syndrome can cause significant impairment in academic or professional functioning for some people, so having access to treatment and support can help to reduce this ^[9].
• Similarly, symptoms may lead to stigmatization or bullying, which can contribute to a severe impact on mental wellbeing, so having a diagnosis can help to improve understanding and acceptance for the individual and those around them ^[8].
• Motor tics such as jerking movements of the head or neck can lead to persistent pain if these symptoms are prolonged and unmanaged ^[3].
• Research shows that there is a high prevalence of coexisting conditions in those with Tourette syndrome, such as OCD and ADHD. Seeking early treatment for Tourette syndrome could help to receive a diagnosis and treatment for these other conditions as well, thereby potentially reducing the severity and persistence of unpleasant symptoms ^[3][8].

How to manage Tourette syndrome symptoms

Many people with Tourette syndrome do not seek or require treatment for their symptoms if they are able to manage them on their own. However, for others, these symptoms can cause pain, stress, or impaired functioning, so treatment is required to reduce the impact of the condition ^[3].

Therapy

Therapeutic interventions can help to reduce the severity of certain symptoms. For example, behavioral therapies can reduce the occurrence of tics by helping to learn alternative ways to release the urge or premonitory sensation and ways to control or tolerate this sensation ^[13].

Similarly, therapy can help manage symptoms of coexisting conditions, such as anxiety, depression, or OCD, while developing coping strategies and a better understanding of the condition.

Medication

Although there are no medications to cure Tourette syndrome, certain medications may be prescribed to help manage symptoms or coexisting conditions, including antidepressants such as fluoxetine and sertraline, antipsychotics such as risperidone or haloperidol, and stimulants such as methylphenidate ^[1].

Your doctor will decide if a medication is appropriate for your treatment, depending on your symptoms and the severity of your condition.

Self-care

Certain techniques may help with managing symptoms of Tourette syndrome, such as ^[13]:

• Learning triggers: If certain situations or emotions are more likely to cause the occurrence of tics, it can be useful to learn and recognize them. By understanding triggers, individuals better manage or avoid triggering circumstances.
• Controlling tics: Some people can repress or control their tics for a certain length of time, perhaps while at school or work, and then find a time or place to release control, such as after returning home, to prevent experiences of stigmatization, anxiety, or disrupted functioning that may occur. It is important to discuss techniques for recognizing, managing, and delaying tics with a therapist; they will have an understanding of the pros and cons of suppression and delaying the presence of tics, as well as ways to potentially release the urge of the tic altogether.
• Calming activities: Many people see a reduction in their tics when they are calm or focused, so it can be useful to engage in relaxation or breathing exercises, reading, or sports to help with this.
• Sleep: Some people find that their tics are worse when they are very tired, so ensuring that you get enough sleep can help to reduce their occurrence.
• Letting people know: Sometimes tics can worsen if talked about, so it may be useful to let others know what they are and ask them not to focus or draw attention to your tics if they occur.