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Symptoms of TS

The key features of Tourette Syndrome (TS) are tics; both repeated movements and sounds that are involuntary. Most people with TS will experience co-occurring conditions also such as Obsessive Compulsive Disorder (OCD), Attention Deficit Hyperactivity Disorder (ADHD) and anxiety.

Tics

Tics usually start in childhood around the age of six to seven years and tic symptoms often fluctuate in severity and frequency.  Although the nature of tics is that they come and go, such patterns are also influenced by environmental factors including stress, excitement and relaxation.

Tics can occur in nearly any part of the body and in any muscle; some individuals report of ‘internal tics’ such as deep abdominal muscle tension and ‘stomach tics’ 

The biggest misconception around TS is that everybody with the condition swears.  Coprolalia is the clinical term for tics that produce socially unacceptable words; and only 10% of people with TS have this symptom.

Tics can be divided into Simple and Complex categories.  Below is an example of common motor and vocal tics:

 

 

Motor tics

Vocal tics

Simple

Eye blinking
Eye rolling
Grimacing

Shoulder shrugging

Limb and head jerking

Abdominal tensing

Whistling
Throat clearing
Sniffing

Coughing

Tongue clicking

Grunting

Animal sounds

Complex

Jumping

Twirling

Touching objects and other people

Obscene movements or gestures (copropraxia)

Repeating other people’s gestures (echopraxia)

Uttering words or phrases out of context

Saying socially unacceptable words (coprolalia)

Repeating a sound, word or phrase

(echolalia)

 

Premonitory urge

Many individuals experience a physical sensation – a premonitory feeling/urge – that precedes a tic.  It has been compared to other physical sensations such as the need to itch or sneeze, or a burning, electrical feeling inside.  Supressing a tic can increase the premonitory urge, and once a tic has been performed the premonitory urge often reduces.  For some people multiple attempts of a tic are necessary until it ‘feels right’ and the premonitory urge diminishes.

Can tics be controlled?

Although tics are involuntary, many people are able to suppress their tics for a short time. A helpful way of understanding this is to compare it to blinking. For a short period of time it is possible to keep your eyes wide open and avoid blinking – and with practice you will get better at doing it for longer – but eventually you will have to blink as the urge is too strong to control. Suppressing tics works in the same way. It can take a great measure of concentration – especially to begin with – to resist the urge to tic, but with practice a certain level of control can be applied. Some people will be able to suppress their tics more easily than others.

It is quite common for children with TS to suppress their tics at school, yet families will notice a marked increase in their child’s tics once they get home. This is likely to be a result in the change of environment. School is very structured and has reinforcers that may make a child want to control their tics. In comparison home life is more relaxed and therefore helps children to feel at ease with expressing their tics.

Co-occurring features and conditions

Over 85 percent of people with TS have more than just tics. Co-occurring symptoms may include obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), anger/rages and anxiety.  When a person presents with tics and co-occurring symptoms this is clinically referred to as ‘mixed neurodevelopment symptoms’.  Such additional symptoms may cause more problems than tics as they can be less visible.

You can read in more detail about co-occurring conditions here

 

 
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