Tourettes

What is it?

Tourettes, or tic disorders, is a condition characterised by involuntary and uncontrollable sounds and movements. Research estimates that approximately 1% of school aged children in the UK are affected by Tourette's syndrome (TS).

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 include OCD as well as ADHD.

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.

Motor tics

  • 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.

Sound

  • 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 reduced 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.

  • Copropraxia - the making of obscene or otherwise unacceptable movements or gestures.
  • Coprolalia - using obscene or unacceptable language. Many people assume people with TS have this but in reality it only affects around 10% of people with TS.
  • 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"

Treatment

There is no cure for Tourette's syndrome, and it is difficult to measure the effectiveness of treatments because of the nature of tics that come and go naturally. Sometimes medication is recommended but these often have different effects on different people and so several may need to be tried before the 'right' one is found. At CAMHS, we might first try out Habit Reversal Therapy, more information is available in our leaflet.


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