What Is Tourette's Syndrome?

What Is Tourette's Syndrome?

Tourette’s syndrome (also called Tourette syndrome and Tourette's disorder) is a type of childhood-onset tic disorder characterized by involuntary, repetitive movements and vocalizations. It was named after French neurologist Georges Gilles de la Tourette, who first described the disorder in 1885.

Tourette's syndrome is often associated with obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD). In fact, according to the Centers for Disease Control and Prevention (CDC), 86% of children with Tourette's syndrome also have at least one other behavioral, mental, or developmental condition, and the most common of these are ADHD and OCD.

Symptoms

The main symptom associated with Tourette’s syndrome is the presence of tics, which are sudden, brief, involuntary, or semi-voluntary movements or sounds. Many patients report physical discomfort just before carrying out a tic. Affected children will execute the tic over and over again until it feels “just right.”

Motor Tics

Motor tics are involuntary movements caused by spasm-like contractions of muscles and are classified as either simple or complex.

• Simple motor tics involve only a single muscle or group of muscles and can be brief (such as eye-blinking or nose twitching), prolonged (such as shoulder turning or mouth opening), or sustained for a long period of time (such as extending or flexing a limb).
• Complex motor tics are more involved and often resemble normal movement such as jumping, hitting, throwing, or touching; however, they often occur in inappropriate settings or include inappropriate or obscene gestures.

Sound or Phonic Tics

Sound or phonic tics are involuntary sounds made with your mouth or vocal cords, and similar to motor tics, can be simple or complex.

• Simple phonic tics are usually meaningless noises or utterances. Common examples include blowing, coughing, throat clearing, grunting, sniffing, or hiccuping.
• Complex phonic tics are words or phrases that include obscenities, echoing what others say, and repeating one’s own statements.

Tics can be suppressed and usually improve when the child is distracted, however, they can reappear anytime.

Types

According to the DSM-5, there are three types of tic disorders:

• Tourette's syndrome
• Persistent (also called chronic) motor or vocal tic disorder
• Provisional tic disorder

Diagnosis

Tourette’s syndrome is relatively rare, occurring in less than 1% of the population. It is three to five times more common among males than females and usually begins between 5 and 10 years of age. For most children, symptoms tend to improve by the end of adolescence with a small number becoming symptom-free.

Tourette's syndrome is mostly known as a childhood disorder because, in most cases, symptoms decrease as the person reaches adolescence and early adulthood. According to the National Alliance on Mental Illness (NAMI), nearly 50% of people have significantly fewer tics as they reach adulthood. However, 10% to 15% of people with Tourette’s syndrome will have a progressive or disabling course that lasts into adulthood.

According to The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to be diagnosed with Tourette's syndrome, a person must meet have tics that begin before age 18, and meet the following criteria:

• Have two or more motor tics (e.g., blinking or shrugging the shoulders) and at least one vocal tic (e.g., humming, clearing the throat, or yelling out a word or phrase). Motor and vocal tics don’t have to happen at the same time.
• Have had tics for at least a year, with tics occurring many times a day (usually in bouts) nearly every day, or on and off.
• Have symptoms that are not due to taking medicine or other drugs or due to having another health condition like seizures, Huntington disease, or postviral encephalitis.

Causes and Risk Factors

There are no known causes for Tourette's syndrome. As tics and associated illnesses like OCD improve with medications that alter the brain neurochemicals serotonin and dopamine, it has been speculated that Tourette’s syndrome may be partially the result of abnormalities in the communication of these neurochemicals.

• Studies have noted abnormalities within an area of the brain called the basal ganglia (an area important to the initiation and cessation of movement) among people with Tourette’s syndrome.
• Genes may also play a role in developing Tourette’s syndrome. Close relatives of people with Tourette’s syndrome often have tics, OCD, or ADHD.

Many children with Tourette’s syndrome also have a number of co-occurring neurodevelopmental and neuropsychiatric conditions, including:

• Antisocial behavior
• Anxiety
• Attention-deficit/hyperactivity disorder (ADHD)
• Depression
• Inability to control anger
• Inappropriate sexual aggressiveness
• Obsessive-compulsive disorder (OCD)
• Poor impulse control
• Sleeping problems
• Social anxiety

Treatment

Although there is no cure for Tourette's syndrome, psychotherapy and/or medications can help manage the tics.

Psychotherapy

Behavioral treatments that aim to improve social functioning, self-esteem, and quality of life are the first-line treatment strategy for Tourette’s syndrome. Involving parents, teachers, and classmates in the efforts is often essential for effective treatment outcomes.

Common behavioral therapies for Tourette's syndrome include:

• Comprehensive behavioral intervention for tics (CBIT): An evidence-based type of behavioral therapy for Tourette’s syndrome, CBIT includes habit reversal, relaxation techniques, and education about tics.
• Habit reversal: One of the most studied types of behavioral interventions for people with tics and impulsive behaviors, habit reversal involves awareness training (to bring greater attention to tics) and competing response (an action meant to replace the tic).
• Parent training: Parent training improves understanding of the disorder and provides strategies for family members to be supportive. Learning positive reinforcement strategies for coping with behavioral issues is also part of parent training.

Medication

If the child is severely affected or engaging in self-harming behavior, medication may be needed. There are a variety of medications that are effective in treating the symptoms of Tourette’s syndrome, including:

• First generation antipsychotics, such as Haldol (haloperidol) and Orap (pimozide)
• Second generation antipsychotics, such as Abilify (aripiprazole)
• Antidepressants, such as Prozac (fluoxetine) or Anafranil (clomipramine)

Coping

In addition to working with your doctor or mental health professional, there are also a number of self-help strategies that you can use to help manage tics:

• Prevent triggers. While tics can occur on their own, anxiety, stress, lack of sleep, and boredom can make symptoms worse.
• Try relaxation techniques, including meditation, deep breathing, visualization, and progressive muscle relaxation.
• Find support. Consider joining an online support group such as one from the Tourette Association of America. Support groups are important for mental well-being, and can also be a helpful resource.