Symptoms of TS
The key features of Tourette Syndrome (TS) are tics; both repeated movements and sounds that are chronic (long-term) and involuntary. Someone with TS may be able to suppress their tics for a period but eventually they have to let them out.
Tics usually start in childhood around the age of seven, and are usually worst between 10-12 years. However, in approximately half of people with TS, most symptoms disappear by the age of 18. Each person with TS will have different symptoms. Some people may have a mild form, and they and those close to them may not even be aware that they have TS.
Over 85 percent of people with TS have more than just tics. Additional conditions (comorbidities) include obsessive compulsive disorder (OCD) as well as attention deficit hyperactivity disorder (ADHD). Children and adults may also suffer from ‘rages’. Comorbidities often cause more problems than the tics and can be less visible.
Types of TS
Generally, TS can be classified corresponding to levels of severity and complexity and whether other conditions can occur together with TS.
- Pure TS – motor (movement) and vocal tics only.
- Full blown TS - Paliphenomena, echophenomena, copropraxia/coprolalia, NOSI, movement and sound tics.
- TS plus - OCB or OCD, ADHD, depression, anxiety, SIB, sleep disorders, personality disorders, other psychopathology, conduct disorder, paliphenomena, echophenomena, copropraxia/coprolalia, NOSI, movement and sound tics.*
Please note that this information is a guide only. Tics and behaviours vary widely, and it is possible, for example, to have OCB and sleep disorders without coprolalia.
- Copropraxia - the making of obscene or otherwise unacceptable movements or gestures.
- Coprolalia - using obscene or unacceptable language.
- Coprophenomena - the involuntary expression of socially unacceptable words or gestures.
- Echophenomena - repeating other people’s words (echolalia) and other people’s gestures (echopraxia).
- NOSI - Non-Obscene Socially Inappropriate behaviour, involves saying things that are socially unacceptable.
- Paliphenomena - Similar to echophenomena. Involves the person with TS repeating their own words and actions such as "Hello, I came here by bus bus bus bus".
Types of tics
Tics often start around the head and face, like blinking and/or grimacing, these are known as motor tics; vocal tics tend to appear later. The different tics can be simple, such as blinking, or complex, like jumping.
- Simple: Eye blinking, head jerking, shoulder shrugging and facial grimacing.
- Complex: Jumping, touching other people or things, smelling, twirling and sometimes hitting or biting oneself.
- Simple: Throat clearing, yelping and other noises, sniffing, coughing and tongue clicking.
- Complex: Uttering words or phrases out of context, coprolalia (saying socially unacceptable words), and echolalia (repeating a sound, word, or phrase just heard).
Even within the same person, tics vary in many ways:
- they wax and wane; get better and worse over time
- they change; one tic stops and another starts
- they may be made worse by stress and anxiety
- they may be alleviated with relaxation or concentration on an absorbing task
In some situations it may be difficult to believe these noises or actions that people with TS make are involuntary, but they are part of the symptoms of TS.
TS and swearing - coprolalia
It is commonly assumed that everybody with TS swears. However, only 10 per cent of people with TS have a swearing tic, known as coprolalia. Some people also have copropraxia, making rude gestures.
Non-Obscene Socially Inappropriate (NOSI) behaviour affects some people with TS, where they have a compulsion to do or say the wrong thing, which may be socially unacceptable; for example, touching something they should not, or commenting on somebody’s physical appearance.
Some people with TS have vocal tics that take the form of random words or phrases or repeating what you or someone else has just said echolalia.
Although the word ‘involuntary’ is generally used to describe the movements and sounds, most people with TS can suppress their tics for a short time. This could be compared to the experience of suppressing a sneeze. A good way to experience this is to see how long you can avoid blinking for. The longer you hold your eyes open, the greater the urge to blink. This is similar to how it feels to need to tic.
Supressing tics does not mean they go away, instead the tics are deferred and can be stronger when they are finally released. Some people with TS refer to this as a tic attack. When possible, it is best to let out tics as and when they come.
It is important, however, to remember that tics are involuntary and that people cannot help but let them out. Tics are not a behavioural issue.
Tic disorders or Tourette Syndrome?
Some people may be diagnosed with a tic disorder rather than Tourette Syndrome. The following is a brief description of the various tic disorders.
- Transient tic disorder - consists of multiple motor and/or phonic tics which last at least 4 weeks, but less than 12 months
- Chronic tic disorder - either single or multiple motor or phonic tics, but not both, which are present for more than a year
- Tourette Syndrome - when both motor and phonic tics are present for more than a year
- A tic disorder not specified - tics are present, but do not meet the criteria for any specific tic disorder