Questions & Answers

What are tic disorders and Tourette's Disorder (TD) (also known as Tourette Syndrome)?

Tics are neurobiologically based involuntary, rapid, recurrent muscle movements and/or vocalizations. Tic disorders are common in youth, and are classified as either transient (lasting more than four weeks but less than a year) or chronic (lasting greater than one year). TD is the most complex of the chronic tic disorders, and is characterized by multiple motor and vocal tics lasting greater than one year.

Don't all kids have tics at some time or other?

Many do. Transient tics may affect children between the ages of six and ten, but they often disappear.

What are the most common symptoms of TD?

Tics typically begin by around age six to seven years; often motor tics precede vocal tics. TD symptoms usually emerge between 5 and 18 years of age. TD symptoms change periodically in number, frequency, type and severity over time. Common motor tics include eye blinking, shoulder shrugging, and facial grimacing. Common vocal tics include throat clearing, coughing and sniffing.

What is the cause of TD?

No definite cause has yet been established, but considerable evidence points to disinhibition of several pathways in the brain connecting muscular movement, vocalization, cognitive and emotional functions.

Is TD inherited?

Genetic studies indicate that TD is inherited, although the exact gene or genes are not known. Family members with a child with TD may be affected by obsessive compulsive symptoms or disorder (OCD).

How are tic disorders and TD diagnosed?

Diagnosis is made by evaluation of the history of onset of symptoms and by observation. TD is not diagnosed by laboratory work such as blood tests, X-rays, EEG, or MRI.

How many people are affected with tic disorders or TD?

Up to 20-25% of children may be diagnosed with a tic disorder, most often in the school age period. TD is less common, but may affect up to 4% of school age children. Males are more often affected than females. All races and ethnic groups are affected.

Should I punish my child when he makes these strange sounds?

Children with tics or Tourette's Disorder cannot control their involuntary sounds and movements and should not be blamed for them. Punishment or teasing doesn't help and may damage the child's self-esteem. The best approach for transient tics is to ignore them as much as possible. In the majority of cases they disappear on their own. Parents can help children with tics become more relaxed by making sure they are not overscheduled and by not being overly critical.

Is it possible to cure TD?

The best we can do is control the symptoms, and there are two basic methods for doing this. The first method is behavioral techniques. The second method is medication. The medications for treatment of TD fall into two major categories: neuroleptics and ant-ihypertensives.

How are tic disorders treated?

For mild to moderate symptoms, the current first recommended treatment is Comprehensive Behavioral Intervention for Tics (CBIT). The primary component of CBIT is habit reversal training. Habit reversal training consists of tic-awareness and competing-response training. Awareness training and competing response training are practiced in treatment sessions one tic at a time. Usually treatment can be completed in approximately 8-12 sessions.

Medication is the treatment of choice for management of more severe symptoms. Individuals respond differently to the various types of medications, and frequently it takes some time until the optimal treatment for each individual is achieved. Almost all of medications commonly prescribed for TD treatment do not have a specific Federal Drug Administration indication for the disorder.

Since all medication has side effects, is it better to let TD take its course?

No. Children with TD who don't get treatment suffer in other ways. They may become alienated from their peers and find it difficult to function socially. The disorder can have a considerable negative impact on a child's self-esteem, and if left untreated, may lead to adjustment difficulties or depression.

Is there a remission?

Many people with TSD experience an improvement in ticsget better , not worse, as they mature. In a small minority of cases, symptoms remit completely in adulthood. It is estimated that 20 to 30% of all children with TD outgrow the disorder in their teens or early twenties.