Tourette syndrome and tic disorders

What it is

Tics are sudden, rapid, recurring movements (blinking, head-jerking, shoulder-shrugging, facial grimacing) or sounds (sniffing, throat-clearing, grunting, words). Tourette syndrome is diagnosed when both motor and vocal tics have been present, not necessarily together, for more than a year, beginning in childhood. When only motor or only vocal tics persist, it is called a persistent tic disorder.

Tics typically come and go, shift over time, and flare with stress, tiredness or excitement. Many people feel a building urge before a tic and a brief relief after, and can suppress tics for a while, but suppression takes effort and the tics tend to rebound. The widely believed idea that Tourette means shouting obscenities describes a rare feature present in only a minority; most tics are far more ordinary. Tics are involuntary; they are not naughtiness, nervous habits to be scolded away, or bids for attention.

How common is it

Tic disorders are common in childhood, and Tourette syndrome, where both motor and vocal tics persist, affects roughly 1 in 100 children, more boys than girls. Tics usually begin between the ages of about five and seven, often peak in the early teens, and improve for many people by adulthood.

What causes it

Tourette syndrome is a neurodevelopmental condition with a strong genetic component, so it often runs in families, and it reflects differences in the brain circuits that control movement. It is not caused by bad parenting, diet, or stress, though stress, tiredness, and excitement can make tics more noticeable. Tics are involuntary, not naughtiness or a habit to be scolded away.

How it is diagnosed

There is no laboratory test. A clinician makes the diagnosis from the history and observation, looking for both motor and vocal tics present for more than a year and beginning in childhood. They also assess for the conditions that commonly travel with tics, ADHD and OCD, which often cause more difficulty than the tics themselves.

What helps

Many childhood tics are mild and fade through adolescence, needing only understanding and education for the family and school. Reducing stress and accommodating tics (rather than drawing attention to them) often reduces them. When tics interfere with daily life, the first-line treatment is a behavioural therapy: comprehensive behavioural intervention for tics (CBIT), which teaches awareness of the pre-tic urge and a competing response, with good evidence and no medication side effects.

Where tics are more disabling, medication can reduce their severity, prescribed and monitored by a specialist; it manages tics rather than curing them. Co-occurring ADHD and OCD are common and often cause more difficulty than the tics themselves, so assessing and treating them matters. The most protective factor is an environment that understands tics for what they are.

Tourette in the African context

Tics are widely misunderstood, and a child who blinks, jerks, sniffs, or makes sounds is often scolded, punished, or thought to be misbehaving or possessed, none of which helps and all of which raises the stress that makes tics worse. Awareness among teachers and families is low, and specialist services are scarce. The most protective thing is an environment that understands tics for what they are, involuntary and not chosen, and responds with calm acceptance rather than correction.

Helping the child

How adults respond shapes a child's experience of tics greatly.

• Try not to draw attention to tics, mock them, or tell the child to stop, since this raises stress and makes tics worse.
• Stay calm and accepting, and educate teachers and classmates so the child is understood, not teased.
• Reduce stress and pressure where you can, and allow the child to tic without shame.
• Ask about behavioural therapy (CBIT) where tics interfere, and about assessment for ADHD and OCD. See our ADHD and OCD guides.
• Protect the child's confidence, and find help if tics cause pain or distress. Our find a therapist page can help.