Tic Disorders and Tourette Syndrome

Tics are purposeless, involuntary, and repetitive movements and vocalizations. Tic disorders are diagnosed by a neurologist specializing in movement disorders. Diagnosis should not be based on videos seen on social media platforms.

Tics are most prevalent in males and begin in early childhood with blinking, neck movement, throat clearing, and other common behaviors. It is believed that roughly 50% of people with tics do not receive a diagnosis or treatment.

Many tics are transient in nature, and cause no distress or difficulty with the completion of daily tasks. Tics become an issue when they increase in intensity, frequency, number, and impairment. 

Tics are often preceded by a thought or feeling called a premonitory urge.  An urge is a signal that a tic is about to occur. Tics can involve multiple muscle groups and are often chained together, with one tic quickly being followed by another. Tics can cause great frustration, embarrassment, and physical pain.  Excessive attention to tics from concened peers, teachers, and family members often exacerbates the tics and makes them harder to manage. It is best not to discuss someone's tics unless they chose to discuss them with you.

Some people just have motor (movement) tics and some people just have vocal (sound) tics.  Vocalizations can include words and phrases. Coprolalia is a more rare type of tic that involves saying inappropriate things such as racial slurs. People with Coprolalia tend to feel very remorseful when unwanted words or phrases are said and often try to mask what they are saying. Nonetheless, it is incredibly hard for the words to not slip out without extensive practice using a breathing pattern to overcome the tic. The frequency and intensity of tics varies from person to person, day to day, and over periods of time. Stress, thoughts, emotions, physical activity, and environment all play a role.

Provisional Tic Disorder is common in young children and is defined as motor or vocal tics occurring for less than one year. After one year of motor or vocal tics, neurologists tend to make a diagnosis of Chronic Tic Disorder. People with both motor and vocal tics lasting for more than one year are typically diagnosed with Tourette Syndrome, aka Tourette's, Tourette Disorder, or TS. 

Many people with tic disorders also have concerns related to anxiety, depression, Autism, OCD, ADHD, gender dysphoria, handwriting, and executive functioning. Some people with tic disoreders also have Body Focussed Repetitive Behaviors (BFRB) such as skin picking or biting and hair pulling (trichotillomania).

Tic disorders are best managed with a team approach. Family support along with pharmaceuticals and habit reversal therapy are often considered. Accommodations at school and work also make it possible for people with tics to stay engaged and successful. It also helps to stay physically active and to engage  in meaningful activities such as music, art, sports, work, and volunteering. It is also useful to get outdoors everyday for a nice walk for both physical and emotional health benefits.