Tourette syndrome (TS) is a neurological disorder that starts in childhood. It becomes clear in kids before the age of 18 years.
TS involves repetitive movements and vocalizations called motor and vocal tics.
There's no cure for TS, but it doesn't shorten your child's life expectancy.
The Tourette Syndrome Clinic at UPMC Children's Hospital of Pittsburgh has many options to help manage your child's tics.
To plan a visit, call 412-692-5520.
What Is Tourette Syndrome?
TS is a nervous system disorder that causes tics.
Tics are rapid, repetitive, stereotyped, involuntary movements or vocalizations.
Although tics aren't voluntary, people can often suppress them for a short time. They are quick, but can cluster — and many tics can occur together in succession.
Kids who have TS often describe a feeling before a tic called a premonitory urge.
Tics can start very early, commonly around age 4 or 5.
For a diagnosis of TS, a child will have had:
- Two or more motor tics and at least one vocal tic.
- Tics occurring for more than one year.
- Tics starting before age 18.
How common is TS?
In the U.S., about 1 out of every 160 kids between 5 and 17 has TS.
It's more common in boys than girls.
TS looks different in each child, but many options exist to help manage symptoms.
What Causes Tourette Syndrome?
Doctors don't know exactly what causes TS. There's likely a difference in motor pathways and neurochemical signals in the brain.
We do know TS runs in families. A parent with TS carries a chance to pass this disorder on to their children.
Researchers are working to find the genes involved with TS.
What Are Tourette Syndrome Symptoms?
Motor and vocal tics are the main symptom of TS.
The type of tic and length of symptoms helps doctors make a diagnosis.
- Provisional tic disorder. Tics occur for less than one year.
- Persistent motor or vocal tic disorders. When a child has one type of tic (either motor or vocal) that lasts for more than one year.
- Tourette syndrome. When a child has both motor and vocal tics for more than a year.
Motor tic symptoms
Some of the most common motor tics are:
- Blinking or eye-rolling.
- Squinting.
- Smacking or licking lips.
- Facial grimacing or twitching.
- Jerking the head or shoulders.
Vocal tics
Some of the most common vocal tics are:
- Sniffing.
- Coughing.
- Snorting.
- Grunting.
- Humming.
Other less obvious vocal tics can include repeating:
- The last heard sounds or words (echolalia).
- Their own sounds or words (palilalia).
- Sounds in their head (silent).
Rare TS tics
There are other rarer tics as well, such as:
- Making obscene or vulgar gestures (copropraxia).
- Blurting out slurs or profanity (coprolalia).
In more complex cases, a child may have multiple motor or vocal tics in a series.
Other compulsions that can be hard to differentiate from tics are repetitive touching, licking, or thoughts.
What triggers Tourette syndrome symptoms?
Tics can increase with anxiety or excitement.
A person's surroundings can also influence them. For example, hearing another person sniff or cough may trigger a similar sound.
Most people with TS will outgrow their tics by the end of their teen years. Puberty is a time when tics may increase for some people, but usually thereafter, they gradually improve. Eventually, for a majority of people, they resolve.
How Do You Diagnose Tourette Syndrome?
No test or imaging study can confirm a TS diagnosis. Doctors diagnose it based on symptoms you provide during a medical history and observing the concerning movements and vocalizations.
During an appointment, doctors will ask you and your child about their tics.
The doctor will want to know:
- When the tics started.
- How often your child has tics.
- Which specific tics they have now and have had in the past.
- Whether tics bother your child.
The doctor will also ask about your child's other symptoms, such as if they:
- Seem hyperactive, impulsive, or anxious.
- Have obsessive thoughts or compulsive behaviors.
- Are overly emotional, easy to cry, or quick to temper.
- Have oppositional behaviors like anger and defiance or physical or verbal aggression.
What Other Health Issues Occur With Tourette Syndrome?
Kids with TS often have other mental health and behavioral issues.
These include:
Among kids with TS, 86% have one or more of these issues.
Anxiety and hyperactivity can make tics worse. The reverse is also true. Tics can cause kids to feel more anxious and increase behavior issues.
What Are the Treatment Options for Tourette Syndrome?
Some kids may need medicines and therapy to help control their tics. Others may need treatment to help with mental health issues, like ADHD or OCD. And still, others may need treatment for both.
Treating the whole child and knowing how TS relates to their other symptoms is vital.
Your treatment team may include not only your child's PCP and neurologist but also a therapist and psychiatrist.
The decision to start treatment is individual.
The best treatment approach considers all aspects of TS and targets the most outstanding symptom.
These may include:
- Physical discomfort.
- Social issues.
- Disruption in daily activities, including at home and school.
Common treatments for TS include:
- Medicines for tics. Not all kids with TS will need medicines for tics. But for some, it's the right choice. Doctors may start with clonidine and guanfacine, but there are others.
- ADHD drugs. Stimulants, such as methylphenidate, can help manage ADHD symptoms.
- Medicines for anxiety or OCD. Antidepressants or SSRIs may help manage these symptoms, such as Prozac®, Zoloft®, or Paxil®.
- Tic therapy. Comprehensive behavioral intervention for tics (CBIT) can help kids learn to manage and control tics.
- Cognitive behavioral therapy. CBT (talk therapy) can help kids manage anxiety, depression, and OCD.
It's also crucial to be open with your child's teachers. Kids with TS can gain from educational support, such as a 504 plan.
