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Tourette Syndrome: Tics, Causes and What Helps

Tourette syndrome causes tics that most people can suppress only briefly. What tics really are, how severity changes with age, and which treatments work.

4 min read

Pop-art illustration of a bearded man in a collared shirt shown in profile, looking to one side against a plain background.

Key takeaways

  • Swearing is not the typical presentation. Involuntary swearing occurs in a small minority, yet it dominates every screen depiction of the condition, which shapes how people are treated before they open their mouths.
  • Tics are not fully involuntary and not voluntary either. Most are preceded by an uncomfortable build-up, and suppression is possible for a while at a rising cost, which is why a child can hold them in at school and release them at home.
  • Severity usually peaks around ten to twelve and then declines. A majority of people find their tics substantially reduced or manageable by their twenties, which is the single most reassuring fact about the condition.
  • Behavioural therapy is a first-line treatment, not a fallback. Habit reversal and comprehensive behavioural intervention have trial evidence comparable to medication, without the side effects.
  • What disables people is usually not the tics. Attention difficulties, obsessive-compulsive symptoms and anxiety occur alongside Tourette in most cases and often affect daily life more than the movements do.

Tourette syndrome is a condition almost everybody has heard of and almost nobody has correct. Involuntary swearing affects a small minority and defines the public image entirely, while the features that actually shape people’s lives, the premonitory urge and the conditions that travel alongside, are barely known outside clinics. [robertson-2017-tourette] This guide covers what tics are, what the trajectory looks like, what treatment works, and why the tics are often not the main problem.

What a tic is

A tic is a sudden, repetitive movement or sound. Motor tics run from simple, blinking, shrugging, head jerks, grimacing, to complex sequences that can look deliberate: touching things, jumping, repeating a gesture. Vocal tics run from sniffing, throat-clearing and grunting to syllables and whole words.

Tourette syndrome specifically requires multiple motor tics and at least one vocal tic, present for more than a year, with onset in childhood. Tics that are motor only, or vocal only, or that have lasted less than a year, are given other labels.

The waxing and waning is characteristic. Tics change in type and intensity over weeks and months, one disappearing as another arrives, with no reliable external cause. Families routinely attribute a bad month to a school change or a stressful event, and stress does aggravate tics, but the fluctuation happens regardless.

The premonitory urge, which explains most of the confusion

Most people with tics past early childhood describe a build-up before the tic: a tightening, an itch, a pressure that the tic discharges. It is closest to the feeling before a sneeze.

This is the single most useful thing for a teacher or a parent to understand, because it explains the pattern that causes the most trouble. Tics can be suppressed, for a while, at a rising cost in discomfort and attention. So a child holds them in through a school day and releases them the moment they get through the front door. To a parent this looks like the tics are chosen and aimed at them. It is the opposite: it is the bill for six hours of suppression arriving all at once.

It also means “just stop” is not a request that can be granted for more than a few minutes, and asking for it consumes the attention the child needs for everything else.

How tic severity typically changes with age Illustrative
0 25 50 75 100 Tic severity Age 6 Age 8 Age 10-12 Age 15 Age 18 Early 20s Average severity

The course described by Bloch and Leckman (2011), where tics typically peak around ten to twelve and decline through adolescence. Values illustrate the shape of that trajectory rather than reporting measured scores.

The trajectory is the reassuring part

Tics usually begin around five to seven, worsen through late childhood, peak around ten to twelve, and then decline. Bloch and Leckman describe this course, with the majority of people experiencing substantial improvement by early adulthood and only a minority continuing to have tics that meaningfully impair daily life. [bloch-2011-course]

This matters most during the peak, because the peak does not feel like a peak. It feels like a trend. A family sitting in the worst month of the worst year is usually much closer to the turn than it appears from inside it.

It is not certain, and a minority of adults do have persistent, severe tics. It is, though, the most likely outcome, and it is rarely the thing people are told first.

What tends to matter more than the tics

Most people with Tourette syndrome have at least one other condition alongside it. Hirschtritt and colleagues found the large majority met criteria for a co-occurring psychiatric disorder over their lifetime, most commonly attention deficit hyperactivity disorder and obsessive-compulsive disorder. [hirschtritt-2015-comorbid]

That finding reframes the whole condition. For a large share of people, the thing making school hard is the attention difficulty, and the thing making evenings hard is the compulsions, and the tics are the visible feature that gets all the clinical attention because it is the visible one. Our guides to ADHD and OCD cover the two that turn up most often.

Anxiety is the third common companion, and it has an obvious route in: a condition whose main feature is doing something conspicuous in public, that you cannot reliably stop, in front of people who assume you are choosing it.

Treatment

Mild tics that cause no distress and no impairment do not need treating, and saying so is part of good care rather than a way of declining to help.

Where treatment is wanted, behavioural therapy comes first. Piacentini and colleagues ran a randomised trial of comprehensive behavioural intervention for tics in children and found significantly greater improvement than in the control condition. [piacentini-2010-cbit] The approach teaches awareness of the premonitory urge and then a competing response, a movement incompatible with the tic, held until the urge subsides. It works with the urge rather than against it, which is why it succeeds where willpower does not.

Medication is used for severe tics or where behavioural therapy is not available, and the decision is a trade against side effects rather than a straightforward win. Treating co-occurring attention or obsessive-compulsive difficulties frequently improves quality of life more than reducing tic frequency does.

What is actually causing the difficulty?

For someone already diagnosed, or a family working out what to raise at the next appointment. This is not a test and cannot diagnose anything.

0 of 6 ticked

When to seek help

Speak to a doctor if tics are painful, are causing injury, are interfering with school, work or sleep, or if they appeared suddenly and severely rather than building gradually, which warrants assessment on its own terms. Ask specifically about attention and obsessive-compulsive symptoms even if nobody has raised them, because they are more likely than not to be present and are frequently the more treatable half of the picture.

If you are in crisis, contact your local emergency services or a crisis helpline.

Frequently asked questions

What is Tourette syndrome?

Tourette syndrome is a neurodevelopmental condition defined by the presence of multiple motor tics and at least one vocal tic, persisting for more than a year and starting in childhood. A tic is a sudden, repetitive movement or sound. Motor tics range from simple blinking, shrugging and head jerks to complex sequences that look almost purposeful. Vocal tics range from sniffing, throat-clearing and grunting to whole words. Tics wax and wane in type and intensity over weeks and months, which is characteristic and often mistaken for the condition improving or worsening for a reason.

Does everyone with Tourette swear involuntarily?

No. Involuntary swearing, called coprolalia, affects a small minority of people with the condition, yet it appears in nearly every dramatic portrayal. The consequence is practical rather than academic: people disclose a diagnosis and are immediately braced for something that will probably never happen, and people whose tics are blinks and throat-clearing are told they cannot have Tourette because they do not swear. Both errors delay recognition.

Can tics be controlled?

Partially, and at a cost. Most tics are preceded by a premonitory urge, an uncomfortable building sensation that the tic relieves, which people describe as being like a sneeze or an itch. That urge is why suppression is possible: a person can hold a tic in for a period, and the urge grows until they do not. This explains a pattern families find confusing, where a child tics very little at school and heavily as soon as they get home. That is not evidence the tics are chosen. It is evidence that the effort of holding them in has to be paid back.

Do tics get better with age?

Usually. Tics typically begin around five to seven, worsen through late childhood, peak somewhere around ten to twelve, and then decline through adolescence. By early adulthood a substantial majority of people have tics that are mild, intermittent or gone, and only a minority continue to have tics severe enough to affect daily life. This trajectory is worth knowing during the worst year, because that year usually looks like the beginning of a permanent decline and is in fact close to the peak.

What treatments work for tics?

For many people the first answer is that no treatment is needed, since mild tics that are not causing distress or impairment do not require intervention. Where treatment is wanted, behavioural therapy is first-line: habit reversal training and comprehensive behavioural intervention for tics teach awareness of the premonitory urge and a competing response that is incompatible with the tic. Medication is used where tics are severe or behavioural therapy is unavailable. Treating the conditions that occur alongside, particularly attention difficulties and obsessive-compulsive symptoms, often improves daily life more than reducing the tics does.

References

  1. 1.Robertson MM, Eapen V, Singer HS, Martino D, Scharf JM, Paschou P, et al. ( 2017). Gilles de la Tourette syndrome. Nature Reviews Disease Primers.
  2. 2.Bloch MH, Leckman JF ( 2011). Clinical course of Tourette syndrome. Journal of Psychosomatic Research.
  3. 3.Piacentini J, Woods DW, Scahill L, Wilhelm S, Peterson AL, Chang S, et al. ( 2010). Behavior therapy for children with Tourette disorder: a randomized controlled trial. JAMA.
  4. 4.Hirschtritt ME, Lee PC, Pauls DL, Dion Y, Grados MA, Illmann C, et al. ( 2015). Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome. JAMA Psychiatry.