https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/tics-and-tourette-syndrome/
Tics and Tourette syndrome - information of parents and carers
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Tics
Tics are sudden, repetitive movements or sounds that are difficult to control.
There are two types of tics: motor and vocal tics.
- Motor tics are movements of the body, like eye blinking and shoulder shrugging.
- Vocal tics are sounds that you make with your voice, or things like sniffing and throat clearing.
Tics are common in children of primary school age – for most young people they are harmless and do not require specialist assessment.
What is Tourette syndrome (TS)?
Tourette syndrome is a neurodevelopmental condition characterised by motor and vocal tics. The symptoms can range from mild to severe.
Tics usually begin in childhood and if they persist longer than a year a child could be diagnosed with Tourette syndrome. The condition is referred to as 'a syndrome' due to the frequency with which conditions such as attention deficit hyperactivity disorder (ADHD) and anxiety disorders co-occur alongside tics.
What is the history of Tourette syndrome?
Tourette syndrome was first described in the 19th Century by a neurologist, George Gilles de la Tourette, after whom the condition is named.
How many people have Tourette syndrome?
Worldwide, Tourette syndrome is thought to affect about 1% of the population.
Tourette syndrome affects people from all backgrounds and ethnic groups equally.
Tics affect more boys than girls – we do not yet know why this is the case.
How is Tourette syndrome diagnosed?
There are no specific tests used to diagnose Tourette syndrome. Diagnosis is made through observation and history taking. Genetic testing is not typically needed, and more information can be found about this here:
A health professional will consider and ask about these factors as part of the assessment. Whether your child:
- Has multiple motor, and one or more vocal tics that happen regularly, although not necessarily at the same time.
- Has tics occurring many times a day, or on and off, for longer than one year.
- Has tics that began before age 18.
- Doesn’t have any other conditions that could cause the tics.
Other common conditions associated with Tourette syndrome
Tourette syndrome is associated with other conditions:
- Attention deficit hyperactivity disorder (ADHD)
- Autism spectrum disorder (ASD)
- Obsessive compulsive disorder (OCD) and other anxiety disorders
- Anger or rage attacks
- Functional tics
- Learning differences such as dyslexia or dysgraphia
- Low mood
We routinely screen for these additional difficulties as part of an assessment with our team as these often have as much or even greater impact on the child’s life than the tics themselves.
Managing Tourette syndrome
Many young people with tics don’t need to see a health professional or have specific treatment for their tics. However, for those who do need this support, a detailed assessment is necessary to help guide the clinician in understanding what the child’s concerns are and how they should be treated.
Tic disorders are experienced on a spectrum of severity, so there is no ‘one size fits all’ assessment or treatment.
The first intervention is usually learning about tics, which professionals refer to as ‘psychoeducation’.
Once the young person, their family, friends and school understand about Tourette syndrome, they can often cope well, and no specific treatments may be needed.
If tics are having a significant impact on a young person’s life, and the young person is bothered by their tics and motivated, behavioural therapies such as Exposure and Response Prevention and Habit Reversal Training may be helpful.
Psychological approaches can also help family members to cope better with the stresses that supporting a person with Tourette syndrome can bring.
Some of the difficulties in Tourette syndrome can be helped with medication. These include the tics themselves, ADHD, OCD, anxiety and sometimes depression. The combination of medicines varies from person to person.
Functional tics
Functional tics are tic-like movements that may look like tics seen in people with Tourette syndrome but are thought to be triggered by stress or anxiety. Functional tics are more common in girls than boys, and often start in teenage years. Many people with functional tics, also have a history of Tourette syndrome, in addition to undiagnosed neurodevelopmental conditions such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD).
Autism and ADHD can increase anxiety, particularly if undiagnosed. It is well known that symptoms of ASD and ADHD in girls are more likely to be missed by their parent/carers, teachers, and clinicians than boys with the same conditions.
The first step in helping functional tics is to understand the nature of the tics and treat the symptoms that are thought to have triggered and more importantly maintained functional tics for the young person.