What is Tourette Syndrome (TS)?
Tourette syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The early symptoms of TS are typically noticed first in childhood, with the average onset between the ages of 3 and 9 years. TS occurs in people from all ethnic groups; males are affected about three to four times more often than females. Although Tourette and Tic Disorders were once thought to be rare, it has become increasingly apparent that they are common conditions.
Symptoms of Tourette Syndrome (TS)
Tics are classified as either simple or complex. Simple motor tics are sudden, brief, repetitive movements that involve a limited number of muscle groups. Some of the more common simple tics include eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Simple vocalizations might include repetitive throat-clearing, sniffing, or grunting sounds.
Complex tics are distinct, coordinated patterns of movements involving several muscle groups. Complex motor tics might include facial grimacing combined with a head twist and a shoulder shrug. Other complex motor tics may actually appear purposeful, including sniffing or touching objects, hopping, jumping, bending, or twisting.
Perhaps the most dramatic and disabling tics include motor movements that result in self-harm such as punching oneself in the face or vocal tics including swearing or repeating words or phrases.
Tics are often worse with excitement or anxiety and better during calm, focused activities. Certain physical experiences can trigger or worsen tics, for example tight collars may trigger neck tics or hearing another person sniff or throat-clear may trigger similar sounds. Tics do not go away during sleep but are often significantly diminished.
What Causes Tourette Syndrome (TS)?
The causes of Tourette and other Tic Disorders remain unknown. The conditions are hereditary and so genetics clearly play a role in many, if not most or all, occurrences of the conditions. Environmental, developmental or other factors may also contribute to these disorders but, at present, no specific agent or event has been identified. Therefore, TS and Tic Disorders are likely to be caused by complex interactions between genetic and other factors which may vary in different individuals. Studies are underway to find the genes and other factors underlying the development of these disorders.
TS commonly co-occurs with a number of other neurodevelopmental and neuropsychiatric conditions, some of which may present before and cause more impairment than the tics themselves.
The most common co-occurring conditions include the following:
Attention Deficit Hyperactivity Disorder (ADHD) — Problems with concentration, hyperactivity, and impulse control.
Obsessive-Compulsive Disorder [or Behaviors] (OCD/OCB) — Repetitive, unwanted or intrusive thoughts and/or repetitive behaviors. There are many types of obsessive thoughts or urges, including excessive concerns about doing something “just right,” as well as intrusive religious, sexual, or aggressive thoughts. These thoughts lead to compulsions, which are unwanted behaviors that the individual feels he/she must perform over and over or in a certain way.
Learning difficulties — Difficulties related to reading, writing (dysgraphia), mathematics, Executive Function Challenges, and/or processing information that are not related to general intelligence.
Behavior problems — Aggression, rage, oppositional defiance or socially inappropriate acts (disinhibition).
Anxiety — Excessive worries or fearfulness, including excessive shyness and separation anxiety.
Mood problems — Periods of depression or elevated mood that result in a change in behavior or functioning, which may be significantly different from the child’s usual self.
Social skills deficits and social functioning — Trouble developing social skills; maintaining social relationships with peers, family members, and other individuals; and acting in an age-appropriate manner.
Sleeping problems — Difficulty falling or staying asleep, bedwetting, walking or talking while asleep.
How is Tourette Syndrome (TS) diagnosed?
TS is a diagnosis that doctors make after verifying that the patient has had both motor and vocal tics for at least one year. The existence of other neurological or psychiatric conditions can also help doctors arrive at a diagnosis.
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