Tourette's Disorder

Symptoms

Symptoms of Tourette's disorder (TD) include motor tics (sudden body movements) and vocal tics (sounds and words) that are not under your child's control. Motor and vocal tics can occur many times throughout the day. They can be simple or complex.

• Simple motor tics involve only one muscle group, while complex motor tics can be a combination of many simple motor tics or a series of movements that involve more than one muscle group.
• Simple vocal tics involve simple sounds made by moving air through the nose or mouth. Complex vocal tics involve words, phrases, and sentences.

Many children and adults with TD report feeling some urge or sensation in some part of the body that builds and builds until it is irresistible. This uncomfortable sensation can only be relieved by performing (releasing) the tic. This is known as "premonitory urge." Not everyone with TD is aware of such urges, though. In fact, many children may not even realize that they are having tics. They can be quite surprised when questioned about a tic they are having, such as when someone asks, "Why are you blinking so much?"

The tics are not always obvious. They may come and go over a period of months, change from one type to another, or disappear for no apparent reason. Tics tend to decrease or go away completely during sleep. Your child may suppress tics (much like suppressing a sneeze) or not have any for short periods, such as during a doctor visit, while absorbed in physical activity, or when concentrating on another activity. Sometimes tics last longer and are more severe than usual, such as after your child has tried to resist (suppress) them. They may also get worse when your child is ill, under stress, or excited.

Be aware that not all tics are related to TD; your child may have tics and not develop TD.

A common stereotype of people with TD is that they all have uncontrollable outbursts of cursing or obscene or sexual behavior. These types of complex tics are not required for a diagnosis of TD. Even though these types of tics may seem routine for TD from what you see on TV and in movies, most children and teens with TD do not have these symptoms.

Other myths about Tourette's disorder include a belief that the child can control tics if he or she wants to or that people with TD are trying to get attention.

Children with TD often have other disorders and problems, such as depression, attention deficit hyperactivity disorder (ADHD), or obsessive-compulsive disorder (OCD). For more information, see the following topics:

Depression in Children and Teens

Attention Deficit Hyperactivity Disorder (ADHD)

Obsessive-Compulsive Disorder (OCD)

Common patterns of Tourette's disorder

The tics of TD vary in type, severity, and how often they occur. A child may develop a new tic that seems to increase in frequency and severity over a period of weeks, and then it gradually tapers off or disappears. Weeks or months later, a new tic may start, or an old tic may come back and then occur more and more often and get more severe. This pattern of an increase in tics followed by a period of fewer symptoms and some periods when tics rarely occur is known as "waxing and waning" cycles and is typical of TD.

If your child's symptoms get worse, don't assume that you (or teachers) are doing something wrong. Although certain triggers at home or school can make tics worse, sometimes tics increase and become more severe for no apparent reason.

Although specific tics can come and go unpredictably, Tourette's disorder often follows a general pattern.

• Uncontrolled movements (motor tics) usually begin between ages 2 and 8. Uncontrolled sounds and words (vocal tics) can begin as early as age 2 but usually develop a few years after motor tics. The first tics are usually simple motor tics affecting the head and neck. But sometimes vocal tics appear before motor tics. Your child may or may not be aware of the tics, and you might ignore them because tics are easy to confuse with symptoms of a cold or allergies. At first, many parents mistake tics such as frequent blinking or winking with vision difficulties or playful behavior.
• Over the next few years the tics may change in location and become more severe and/or frequent at times. Your child probably will become aware of them and may explain them in different ways. Some ways may be comforting: "I have a silly little cough." Other ways can be upsetting: "I am going crazy," or "Something inside me is making me act goofy." Your child may try to cover up the tics by making other sounds or movements. The tics may appear to be normal activity (such as brushing hair away from the face) except that the activity is done repeatedly.
• Tics usually are most severe about age 12. Your child may be able to tell when a tic is starting (premonitory urge). He or she may feel muscle tightness, a skin irritation (such as a tickle), or a skin temperature change. But your child may not "feel" a tic coming on or only feel it sometimes.
• In adolescence, tics happen much less often or disappear for no reason for up to two-thirds of all children with TD.¹ By adulthood, many people with TD still have tics, but they occur less often and are less severe than in childhood. Adults may continue to have other disorders and problems such as ADHD or OCD.

Although the majority of children and teens with TD will have fewer tics after age 12, some will see an increase during the teen years, and the symptoms of other conditions (such as ADHD and OCD) may not decrease. For many youths, the tics of TD are not as much of a problem as interference from ADHD, OCD, mood disorders, or other conditions.

Tics that begin after age 18 are not considered TD but another tic disorder.

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Author:	Debby Golonka, MPH	Last Updated: September 27, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Karin M. Lindholm, DO - Neurology
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