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Tourette’s is a condition in which both motor movement and vocalization tics occur.  Considered to be recurring, sudden, disruptive and rapidly expressed movements or vocalizations, tics are the chief characteristics of this disorder.  Tics can occur many times per day, often in episodes, or, over more prolonged periods, can also appear in episodes after sometime in which they have been absent.  Considered to be chiefly a childhood disorder typically diagnosed before age 18, Tourettes also affects some adults, but is significantly rarer in adulthood.  It is estimated that from 1 to 10 children in 1000 may have Tourette’s.  Symptoms can be seen in children as young as 2 although the onset of this disorder is typically diagnosed as occurring around 6-7 years of age.  The disorder has a strong family pattern and appears to occur in families in which Tourette’s and other similar tic disorders have also occurred.  The following lists are examples of tics that are seen in persons with this disorder.  Physicians, when evaluating a child for this condition, will look for tics of motor movement and vocalization (American Psychiatric Association, 2000).  Examples of both types of symptoms are given here.  A child must have symptoms of both motor movement and vocalization in order to be diagnosed with this disorder.
Examples of motor movement tics are:

• eye blinking
• jerking
• grimacing
• squinting
• foot tapping
• scratching
• punching
• tongue darting
• repetitive touching of self, others and/or objects
• shrugging
• squatting
• hopping
• twirling

Examples of vocal tics are:

• barks
• whistles
• grunts
• groans
• hissing
• gurgling
• tongue clicking
• throat clearing
• echoing of sounds or words
• obscenities

Many children are not aware of their tics; however, many do report building tension and physical sensations just prior to episodes.  Additionally, children often report a more relaxed state after tic behavior.  Fewer episodes, along with a greater ability to suppress symptoms, can occur in specific settings such as school or home as well as when engaged in some focused activities.

Other Conditions that Frequently Occur with Tourette’s Disorder

There are rare neurological complications that can be related to symptoms of Tourette’s particularly if forceful and repetitive movements such as head jerking cause injury to the neck, spine or head.  Additionally, some individuals develop orthopedic problems if repetitive movements such as squatting are severe and persistent.   Obsessive Compulsive Disorder, and traits of this disorder, is common among children with Tourette’s.  ADHD is also another common condition among children with Tourette’s (Hay, Hayward et al, 2007, p. 768).

The Impact of Tourette’s Disorder upon Children and Their Families

There is a high degree of social stigma associated with the symptoms of this condition.  Consequently, children with Tourette’s experience a great deal of emotional, psychological and social distress and require much support.  Their symptoms are often highly visible, unusual and disruptive.  As a result, children report discomfort, shame, embarrassment and anxiety when with others and when in settings where it is appropriate to be attentive and quiet.  They may seek to avoid such settings and activities and in doing so will disrupt the family’s routines and activities.  School and other developmentally appropriate activities are also frequently disrupted by symptoms.  Consequently, learning and achievement are affected.  Additionally, children with this disorder can be alienated and ridiculed by peers as well as considered disruptive and intrusive by teachers and caregivers.  Children with Tourette’s Disorder are consequently at risk for severe anxiety, low self-esteem, depression, academic delays, poor social development, social withdrawal and conflict with others.  Families in which children have this condition can experience a great deal of disruption in daily routine as children attempt to cope with symptoms and related negative experiences.  Family events can trigger increased symptoms and distress particularly if the child feels pressure to ‘behave well’ or participate appropriately in the important event.  Consequently, all family members must adapt to and cope with the symptoms of this disorder during times of increased stress whether in crisis or celebration.  Children with Tourette’s, during particularly severe and prolonged periods of increased symptoms, may require intensified care to reduce their distress and possibly to prevent injury.  Family members such as the primary caregivers and siblings affected by the disruptions of such episodes may need occasional respite.

Treatment Options

Some children with Tourette’s many not need treatment if tics are not severe, however others may benefit from medications that help reduce or control their symptoms so that age-appropriate activities are not disrupted.  Physicians may prescribe antipsychotic, anti-depressant, stimulant or adrenergic inhibitor medications in an effort to reduce symptoms.  Physicians may also treat co-occurring and related issues with medication such as the severe anxiety and depression that can result from the stress of having Tourette’s.  Additionally, psychotherapy is often helpful in reducing the emotional and psychological distress caused by the condition. Supportive and educational services for family members can help improve coping strategies for managing the child’s condition and also reduce the stress of doing so.  Remedial and support services in educational settings help children whose symptoms have caused academic disruption.  At times, some children with Tourette’s will require highly structured and therapeutic environments for age-appropriate academic and social opportunities.  If the condition is severe, children may require periods of individual support that is highly structured in order to prevent self-injury or disruption of age and developmentally appropriate activities.  Some children will, for example, require a therapeutic classroom in which teachers and assistants are trained specifically to educate children with such disorders. 

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, D.C.: American Psychiatric Association.

Hay, Hayward, Levin, Sondheimer. (2007). Current Diagnosis and Treatment in Pediatrics. USA: Mosby, p.768.