Tics Associated With Tourette Syndrome

Tourette syndrome (TS) is a condition characterized by repeated sounds or physical movements that are often described as vocal tics and motor tics. You or your child may have symptoms that lead you to wonder about TS or a tic disorder.

Rest assured that you are not alone and that this is a more common concern than you probably realize. You might have questions about what is causing the actions, what to expect, and whether they will get better or worse.​

Mother and son sitting on a couch and looking at a cell phone
mixetto / iStockphoto

What Are Tics?

Tics are brief sounds or physical movements that usually recur in almost exactly the same way over the course months or years. Common tics include eye blinking, nose or face twitching, shoulder shrugging, neck turning, and throat clearing.

You may have a general sense that you can suppress your tics with great effort, as most people describe a strong urge to make the movement or the sound. The actions can usually be controlled temporarily, but then the urge typically builds up and the tics may occur rapidly in a manner that is described as a burst.

Tics most commonly begin during childhood, between the ages of 5 and 10. Oftentimes tics resolve within a few months, and are known as transient tics. Experts estimate that approximately 20% of school-aged children temporarily experience some form of tics.

Many children will discover their tics improve significantly or disappear by late adolescence. However, sometimes, they can persist as a chronic tic disorder into adulthood. They may be diagnosied with a chronic motor tic disorder, vocal tic disorder, or Tourette syndrome.

What Is Gilles de la Tourette Syndrome? 

A well-known disorder called Giles de la Tourette syndrome (TS), often referred to as Tourette for short, is characterized by having multiple motor tics and at least one vocal tic lasting more than 12 months. Most people who have tics do not have TS.

In general, people who have TS are aware of the symptoms and are able to temporary control the tics. Imagine trying to hold back a sneeze or a cough, or refrain from scratching a terrible itch. Usually, a person who is living with TS can suppress the movements or vocal sounds for a short time in limited circumstances, such as in situations that are socially or professionally valued.

The majority of individuals living with chonic tics or TS experience syptoms of mild to moderate severity that do not significantly interfere with quality of life and that do not require medical treatment. However, some individuals living with TS experience severe tics that are embarrassing, awkward, or painful and interfere with having a normal social, school or professional life.

Will the Tics Get Better or Worse?

Most of the time, tics get better over time. Some people experience a waxing and waning of symptoms. For instance, some people who have been tic free for a period of time may have episodes of exacerbation that can last for a few months, particularly during times of stress or anxiety.

There is no evidence that early intervention can help prevent the symptoms from worsening. There is some evidence that children who experience shame or excessive attention related to the tics can become anxious. The best thing to do as the onlooker is to ignore the tic; do not stare, do not react or respond, and do not point it out... they already know.

Treatment

Most of the time, awareness and understanding of the symptoms is the most important aspect when it comes to dealing with tics and TS. Some people can identify triggers and can develop methods to suppress the tics during times when the movements or sounds would be distracting or troublesome. Psychologists may teach relaxation techniques, implement biofeedback, or implement habit reversal training, among other tools that can help. A more recent and promising treatment strategy is called Comprehensive Behavioral Intervention for Tics (CBIT), and is recommended by some experts as a first-line treatment.

There are some medications available for the control of tics, including risperidone, pimozide, aripiprazole, clonidine, clonazepam, and tetrabenazine. The first 3 medications are categorized as antipsychotics because they were developed for psychotic disorders and that is what they are most commonly used for. However, if your healthcare provider prescribes one of these medications for the control of your tics or your child’s tics, rest assured that this does not mean that you have a psychotic disorder. Some of the medications used to control tics may produce side effects that can be more serious than the tics themselves, and thus some patients choose not to take medication.

Another approach to controlling the tics of TS is a procedure called deep brain stimulation (DBS). DBS involves the surgical placement of a device that electrically stimulates a targeted region of the brain. DBS is a safe technique that requires an intricate and carefully planned surgical procedure. DBS has been used as a treatment for several neurological conditions, including epilepsy and Parkinson’s disease. Not everyone with Tourette’s is expected to benefit from DBS, and it is only recommended for conditions that are severe and that do not improve with the usual treatments.

Are Tics or Tourette Syndrome Caused by a Mental Condition?

There are a few other conditions that seem to be more common among those who have tics or TS, such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), autism spectrum disorder, anxiety, and depression. Individuals who have tics or TS have the same intelligence level as those who do not have these conditions but may have challenges with learning due to their comorbidities.

Conditions That Can Be Confused With Tics and Tourette Syndrome

There are other common habits and conditions that may be confused with tics. Fidgeting is a deliberate and habitual type of movement that is more controllable and less repetitive than tics. Tremors, such as those seen in​ ​Parkinson’s disease or benign essential tremor, are not as controllable as tics and usually worsen over time. Seizures are characterized by involuntary movements and/or change in consciousness, while there is no change in awareness or consciousness associated with tics.

Why Do Some People Have Tics or Tourette Syndrome?

So far, it is not completely clear why these conditions develop. There does appear to be a strong genetic component, with most scientific reports consistently pointing to about a 50% family history of tics. There may also be other environmental or developmental factors that have not yet been identified.

Overall, tics and TS have been quite steady as far as prevalence in the general population and do not seem to be increasing or decreasing. These conditions occur throughout the world at a fairly constant rate.

A Word From Verywell

For most people, living with tics or Tourette syndrome turns out to be less stressful than worrying about tics or TS. Many parents become frustrated, anxious and frightened about their child's future when they see their child making unusual movements or sounds. You should discuss the symptoms with your child’s doctor, who can help alleviate the stress you are experiencing and decide if any medical testing or therapeutic treatment is necessary.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. Diagnosing tic disorders.

  2. National Institute of Neurological Disorders and Stroke. Tourette syndrome fact sheet.

  3. Scahill L, Specht M, Page C. The prevalence of tic disorders and clinical characteristics in childrenJournal of Obsessive-Compulsive and Related Disorders. 2014;3(4):394-400. doi:10.1016/j.jocrd.2014.06.002

  4. Tourette Association of America. Tourette syndrome: An overview.

  5. Hasan S. Tics. Nemours Children's Health.

  6. NHS. Tics - Overview.

  7. Pringsheim T, Holler-Managan Y, Okun MS, et al. Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disordersNeurology. 2019;92(19):907-915. doi:10.1212/WNL.0000000000007467

  8. Smeets AY, Duits AA, Leentjens AF, Schruers K, et al. Thalamic deep brain stimulation for refractory Tourette syndrome: Clinical evidence for increasing disbalance of therapeutic effects and side effects at long-term follow-upNeuromodulation: Technology at the Neural Interface. 2018;21(2):197-202. doi:10.1111/ner.1255619

  9. Centers for Disease Control and Prevention. Risk factors and causes for Tourette syndrome.

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.