Tourette syndrome and tics

What it is

Tourette syndrome involves multiple motor tics and at least one vocal tic for more than a year, beginning in childhood. Tics are involuntary and often follow a building urge.

Common experiences

Tics wax and wane and can increase with stress or excitement. Swearing tics are uncommon; most people with Tourette do not have them.

What helps

Do not tell someone to stop or stare; allow tic breaks. Behavioral therapy (CBIT) and medication are options to discuss with a clinician.

Across life

Tics typically begin in childhood, often peak around ages 10 to 12, and improve for many people by adulthood. ADHD and OCD frequently occur alongside Tourette.

Evaluation and treatment

A clinician such as a neurologist, pediatrician, or psychiatrist diagnoses it from history and observation. Many people need no treatment. Options include education, CBIT (Comprehensive Behavioral Intervention for Tics), and medication.

Myth vs fact

Myth: people with Tourette can stop tics if they try. Fact: tics can be held back briefly, but it takes effort and the urge builds.

Full chapter

Definitions and criteria

The DSM-5-TR diagnoses Tourette's disorder when a person has had multiple motor tics and at least one vocal tic at some point, though not necessarily at the same time. Tics may come and go in frequency but must have persisted for more than a year since the first tic, must have begun before age 18, and must not be caused by a substance or another medical condition. Persistent (chronic) motor or vocal tic disorder, in which only one type of tic is present, and provisional tic disorder, in which tics have lasted less than a year, are related diagnoses. The ICD-11 uses the term Tourette syndrome. Tics that first appear in adulthood need a medical evaluation to look for other causes.

What tics are

Tics are sudden, rapid, repeated, non-rhythmic movements or sounds. Simple tics include eye blinking, shoulder shrugging, sniffing, and throat clearing; complex tics involve coordinated sequences of movements or words and phrases. Many people feel a building urge, often described as an itch or pressure, before a tic and relief after it (Leckman et al., 1993). Tics wax and wane over days, weeks, and months, and often increase with stress, excitement, tiredness, or attention to them. People can often hold tics back for a while, but suppression takes effort and the urge tends to build; studies have not found that suppression makes tics worse afterward (Himle et al., 2007; Woods et al., 2008a).

How common it is and what causes it

Studies estimate that Tourette syndrome affects somewhere under 1 percent of school-age children, with boys affected more often than girls, and that transient or chronic tics of any kind are considerably more common (Knight et al., 2012; Scharf et al., 2015). Tourette is highly heritable and runs in families, although no single gene explains it (Mataix-Cols et al., 2015). Research points to differences in circuits connecting the cortex, basal ganglia, and thalamus that help control movement (Albin & Mink, 2006). Tourette is not caused by parenting, stress alone, or attention seeking.

Course across life

The DSM-5-TR notes that tics usually begin in early childhood and are often most severe around ages 10 to 12. In a follow-up study of children with Tourette, tic severity was at its worst around age 10 on average and improved substantially by early adulthood for many people (Bloch et al., 2006). Not everyone improves, and tics can fluctuate throughout life, which is why support should not stop when someone reaches adulthood.

Common misunderstandings

Swearing or inappropriate words (coprolalia) occur in only a minority of people with Tourette (Freeman et al., 2000), although media often show it as the main feature. Tics are not a habit, a choice, or bad behavior, and telling someone to stop usually makes things harder. Many families describe children who hold tics in at school and release them at home, which can look like tics appearing from nowhere or being under control, when in fact the person is working hard to suppress them.

Functional tic-like behaviors

Since about 2020, clinics around the world have reported more teenagers, especially girls, with sudden-onset, often complex tic-like movements and sounds that differ from typical Tourette tics in how they start, how they look, and the age at onset; these are called functional tic-like behaviors (Pringsheim et al., 2021). Researchers have linked some cases to exposure to videos of tics on social media (Hull & Parnes, 2021). These symptoms are real and distressing, they are not faked, and they deserve evaluation and treatment from a clinician who can tell them apart from Tourette.

Co-occurring conditions

Most people with Tourette have at least one other condition. In a large study, about 86 percent had at least one other psychiatric diagnosis at some point, most often ADHD, OCD, anxiety, and mood disorders (Hirschtritt et al., 2015). Learning differences and sleep problems also occur. For many people these co-occurring conditions affect daily life more than the tics do, so assessment and support should cover the whole person.

Wellbeing and safety

A systematic review found reduced quality of life in people with Tourette across the lifespan, with both tic severity and co-occurring conditions contributing (Evans et al., 2016). Misunderstanding and bullying are common experiences for young people with tics (Storch et al., 2007). A Swedish national register study found higher rates of suicide attempts and death by suicide among people with tic disorders (Fernandez de la Cruz et al., 2017). Recognition, effective treatment of co-occurring conditions, supportive schools, and communities that understand protect wellbeing. If you are struggling or having thoughts of suicide, please see the Crisis help page.

Getting evaluated

Diagnosis is clinical, based on history and observation; no blood test or scan diagnoses Tourette. Clinicians such as neurologists, pediatricians, psychiatrists, and psychologists with experience in tics take a detailed history, observe tics, ask about urges, and screen for ADHD, OCD, anxiety, and learning difficulties. Tools such as the Yale Global Tic Severity Scale rate how severe tics are and how much they interfere with life (Leckman et al., 1989). Tics are sometimes mistaken for habits, allergies, or vision problems before diagnosis. Sudden onset of severe or complex tics, or new tics in adulthood, deserve prompt medical review to consider other causes.

Behavioral treatment

Comprehensive Behavioral Intervention for Tics (CBIT) teaches people to notice the early urge, use a competing response that makes the tic hard to perform, and change situations that make tics worse, alongside education and relaxation (Woods et al., 2008b). CBIT reduced tics in randomized trials with children (Piacentini et al., 2010) and adults (Wilhelm et al., 2012). Access to trained therapists can be limited, and some programs can be delivered by video.

Medication and other treatments

Many people with mild tics need no treatment. When tics cause pain, injury, distress, or interference with life, a comprehensive systematic review summary prepared for the American Academy of Neurology found that behavioral therapy and several classes of medication can reduce tics, with different side effect profiles (Pringsheim et al., 2019). Medication choices belong with a specialist clinician and the person, and should take co-occurring ADHD, OCD, and anxiety into account. Specialist centers can discuss options for severe tics that do not respond to usual treatment.

Practical strategies

Helpful steps include allowing tic breaks, reducing stress, protecting sleep, planning rest after demanding days, and letting people choose whether to suppress tics in public. Fidget tools, movement breaks, and a calm space can help. The communication cards on the Toolkit page can make it easier to explain what you need when explaining is tiring.

School, work, and rights

In the United States, the IDEA lists Tourette syndrome as a condition that can qualify a student for services under the other health impairment category (34 C.F.R. 300.8(c)(9)), and Section 504 and the ADA provide accommodations at school and work. In the UK, the Equality Act 2010 requires reasonable adjustments, and in Canada provincial and territorial human rights codes require accommodation to the point of undue hardship. Useful adjustments include tic breaks, a separate room or extra time for tests, explaining tics to classmates or colleagues when the person wishes, and not penalizing tics. Laws and eligibility vary, so confirm locally, and see the Resources page.

Identity and being understood

Tourette is often shown in media as swearing, which is not typical and fuels misunderstanding. Many people with Tourette describe being stared at, laughed at, or told to stop. Calm acceptance, and not being asked to stop, changes the experience. Tics are one part of a person, who also has interests, strengths, and goals.

For families, teachers, and colleagues

Do not tell someone to stop, stare, or comment on tics. Allow tic breaks, reduce time pressure and stress where you can, and focus on the person's strengths and goals. Explain Tourette to others only with the person's agreement. Seek help for co-occurring ADHD, OCD, anxiety, and learning difficulties, since they often matter as much as the tics. The Resources page lists the Tourette Association of America and other organizations.

Sources

1. American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).
2. World Health Organization. International Classification of Diseases, 11th Revision (ICD-11), section on Tourette syndrome.
3. Leckman, J. F., Walker, D. E., & Cohen, D. J. (1993). Premonitory urges in Tourette's syndrome. American Journal of Psychiatry, 150(1), 98-102.
4. Himle, M. B., Woods, D. W., Conelea, C. A., Bauer, C. C., & Rice, K. A. (2007). Investigating the effects of tic suppression on premonitory urge ratings in children and adults with Tourette's syndrome. Behaviour Research and Therapy, 45(12), 2964-2976.
5. Woods, D. W., et al. (2008a). Durability, negative impact, and neuropsychological predictors of tic suppression in children with chronic tic disorder. Journal of Abnormal Child Psychology, 36(2), 237-245.
6. Knight, T., Steeves, T., Day, L., Lowerison, M., Jette, N., & Pringsheim, T. (2012). Prevalence of tic disorders: A systematic review and meta-analysis. Pediatric Neurology, 47(2), 77-90.
7. Scharf, J. M., Miller, L. L., Gauvin, C. A., Alabiso, J., Mathews, C. A., & Ben-Shlomo, Y. (2015). Population prevalence of Tourette syndrome: A systematic review and meta-analysis. Movement Disorders, 30(2), 221-228.
8. Mataix-Cols, D., et al. (2015). Familial risks of Tourette syndrome and chronic tic disorders: A population-based cohort study. JAMA Psychiatry, 72(8), 787-793.
9. Albin, R. L., & Mink, J. W. (2006). Recent advances in Tourette syndrome research. Trends in Neurosciences, 29(3), 175-182.
10. Bloch, M. H., et al. (2006). Adulthood outcome of tic and obsessive-compulsive symptom severity in children with Tourette syndrome. Archives of Pediatrics & Adolescent Medicine, 160(1), 65-69.
11. Freeman, R. D., et al. (2000). An international perspective on Tourette syndrome: Selected findings from 3,500 individuals in 22 countries. Developmental Medicine & Child Neurology, 42(7), 436-447.
12. Pringsheim, T., et al. (2021). Rapid onset functional tic-like behaviors in young females during the COVID-19 pandemic. Movement Disorders, 36(12), 2707-2713.
13. Hull, M., & Parnes, M. (2021). Tics and TikTok: Functional tics spread through social media. Movement Disorders Clinical Practice, 8(8), 1248-1254.
14. Hirschtritt, M. E., et al. (2015). Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome. JAMA Psychiatry, 72(4), 325-333.
15. Evans, J., Seri, S., & Cavanna, A. E. (2016). The effects of Gilles de la Tourette syndrome on quality of life across the lifespan: A systematic review. European Child & Adolescent Psychiatry, 25(9), 939-948.
16. Storch, E. A., et al. (2007). Peer victimization in youth with Tourette's syndrome and chronic tic disorders: Relations to tic severity and internalizing symptoms. Journal of Psychopathology and Behavioral Assessment, 29(4), 211-219.
17. Fernandez de la Cruz, L., et al. (2017). Suicide in Tourette's and chronic tic disorders. Biological Psychiatry, 82(2), 111-118.
18. Leckman, J. F., et al. (1989). The Yale Global Tic Severity Scale: Initial testing of a clinician-rated scale of tic severity. Journal of the American Academy of Child & Adolescent Psychiatry, 28(4), 566-573.
19. Woods, D. W., Piacentini, J. C., Chang, S. W., et al. (2008b). Managing Tourette Syndrome: A Behavioral Intervention for Children and Adults, Therapist Guide. Oxford University Press.
20. Piacentini, J., et al. (2010). Behavior therapy for children with Tourette disorder: a randomized controlled trial. JAMA, 303(19), 1929-1937.
21. Wilhelm, S., et al. (2012). Randomized trial of behavior therapy for adults with Tourette syndrome. Archives of General Psychiatry, 69(8), 795-803.
22. Pringsheim, T., et al. (2019). Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology, 92(19), 907-915.
23. Individuals with Disabilities Education Act regulations, 34 C.F.R. 300.8(c)(9) (other health impairment, which lists Tourette syndrome).
24. Equality Act 2010 (United Kingdom).

Citations are listed so you can verify claims and read further. Guidance is revised over time, so check for newer editions.