Tics and Tourette Syndrome

Tics

Tics are sudden twitches, movements, or sounds that people do repeatedly. People who have tics cannot stop their body from doing these things. For example, a person might keep blinking over and over, or, a person might make a grunting sound unwillingly.

Having tics is a little bit like having hiccups. Even though you might not want to hiccup, your body does it anyway. Sometimes people can stop themselves from doing a certain tic for a while, but it’s hard. Eventually the person has to do the tic.

Tics come in many guises.  Some affect body movement (motor tics) and others result in a sound (vocal or phonic tics).  Tics can be simple or complex.  Simple tics usually use one part of the body (for example squinting the eyes) and complex tics involve several parts of the body and can have a pattern (for example bobbing the head, while jerking an arm and then jumping up).

Examples of tics include:

• blinking, wrinkling the nose or grimacing
• shrugging shoulders
• jerking or banging the head
• clicking the fingers
• touching other people or things
• coughing, grunting, sniffing, humming, throat clearing
• yelling out a word or phrase
• repeating a sound or phrase      

Tics are found in a spectrum of tic disorders as follows:

Transient tic disorder or provisional tic disorder –motor tics usually confined to the face and neck although other body parts may be affected; sometimes vocal tics are also present.  Tics only last a few weeks or months.

Chronic tic disorder – tics tend to persist rather than be transitory and can include blinking, sniffing or neck movements.  Tics occur for more than 1 year.

Tourette Syndrome – multiple motor tics and one or more vocal tics present for at least 12 months although not always concurrently.

A tic disorder not specified – tics are present, but do not meet the criteria for any specific tic disorder.

Tourette Syndrome

Tourette Syndrome is an inherited neurological condition which affects one in every hundred children and young people. The main signs are motor tics and vocal tics which have been present for over 12 months.  Boys are more likely to be affected than girls. TS is a complex condition and up to 85% of people with the condition will also experience co-occurring features and conditions which might include Attention Deficit Hyperactivity Disorder (ADHD), Obsessive compulsive Disorder (OCD), Autism, Anxiety, Rage. The profile for each individual with TS is therefore very different. It is the comorbid presentation of a child with TS that can make TS difficult for children, their families and their school to manage.

TS is often misunderstood as a condition which makes people swear, or say socially inappropriate things. Although it is true that ‘coprolalia’ – the clinical term for involuntary swearing – is a symptom of TS, it only affects a minority of people. 90% of people with TS do not have coprolalia.

Parents of children with TS typically notice tics in their children at six – seven years of age. Symptoms usually begin when a child is 5 – 10 years old. The first symptoms often are motor tics that occur in the head and neck area. Tics are usually worse during times that are stressful or exciting. They tend to improve when a person is calm or focused on an activity. The types of tics and how often a person has tics changes a lot over time. Even though the symptoms might appear, disappear, and reappear, these conditions are considered chronic (Tourettes Action)

Useful resources

Tourettes Action: Provides information for teachers and includes resources, top tips, advice and downloadable lesson plans and guidance.

Great Ormand Street Hospital have created an information sheet regarding diagnosis, treatment and associated conditions. It includes links to several useful documents including:

• An introduction to Tourette Syndrome
• Tourette Syndrome and ADHD
• Tourette Syndrome and anger management
• Tourette Syndrome and managing your own tics