Tourette's disorder (TD) is part of a cluster of diagnoses called the motor disorders. Motor disorders are a group of psychiatric conditions that include:
Motor disorders are a group of psychiatric conditions that affect the ability to produce and control bodily movements. Motor disorders may involve developmental delays and deficits involving fine and gross motor functions. Developmental coordination disorder is characterized by deficits in the acquisition and execution of coordinated motor skills and is manifested by clumsiness and slowness or inaccuracy of performance of motor skills that cause interference with daily living. Stereotypic movement disorder includes patterns of repetitive and seemingly driven yet purposeless motor behaviors. Examples of such behaviors include movements of the head, body, and hands that are developmentally abnormal. Tic disorders involve sudden, rapid and recurrent, non-rhythmic motor movements or vocalizations. Such motoric or vocal manifestations are observably involuntary.
Several types of tic disorders can be distinguished in DSM-5. These are as follows:
TD is characterized by the presence of multiple motor tics and one or more vocal tics. Persistent (chronic) motor tic disorder is characterized by the presence of single or multiple motor tics and the absence of any vocal tics. Persistent (chronic) vocal tic disorder is characterized by the presence of a single or multiple vocal tics and the absence of any motor tics.
Tics can be simple (of short duration) and can include motor behaviors such as eye blinking, shoulder shrugging, or movement of the extremities, or vocal behaviors such as throat clearing, sniffing, and grunting. Complex tics are of longer duration (on the order of seconds) and may include combinations of motor or vocal behaviors. Complex tics may involve imitating another person's motor or vocal behaviors, sexual or obscene gestures (copropraxia) or utterances (coprolalia), or they may be apparently nonsensical combinations of motions and/or vocalizations.
Because many individuals experience one or more tics at some point in their lives, a tic disorder is diagnosed only when the tics persist for one year or longer.
TD is a psychiatric disorder that affects between 0.05 - 3% of children and adolescents. The disorder typically has an onset around age 5 - 7, with symptoms often remitting by early adulthood.
However, earlier ages of onset have been observed. To be diagnosed with TD, the tics must be present for one year or longer.
TD is characterized by the presence of multiple motor tics and at least one vocal tic at some point during the illness (although note that the motor and vocal tics do not have to co-occur). The tics are repetitive (i.e., the individual repeatedly performs the same tic[s] rather than displaying a random pattern of motor or vocal behaviors), sudden, and rapid. Many individuals with TD report that the tics are difficult to resist performing; however, they may be suppressed for a limited time period in certain situations. Tics may be performed in response to a sensation, bodily discomfort, or an urge (called a premonitory urge).
Tourette's disorder can range from mild to severe. In severe cases, the tics can cause musculoskeletal pain or injury. Social isolation or bullying can also occur, particularly in adolescence. Children with TD often experience other psychiatric disorders, including attention deficit/hyperactivity disorder, obsessive-compulsive disorder, and separation anxiety disorder, while adolescents with TD are more likely to experience major depressive disorder, substance use disorder, or bipolar disorders.
TD is characterized by abnormalities of brain function that are thought to underlie symptoms. In particular, there is evidence that abnormal activation in the cortico-striato-thalamo-cortical pathways, which are implicated in motor behavior, may underlie symptoms. Dopaminergic dysfunction has also been proposed to play a role in TD. In addition, the sense of relief that an individual experiences after performing a tic is thought to maintain symptoms. There is also some evidence that tic disorders can begin following streptococcal infections (called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS); however, the neurobiology of these cases is not well understood. The disorder has a genetic component, although having a predisposition to TD does not mean that someone will necessarily develop TD.
Tourette's disorder is treatable. Published treatment recommendations for children and adolescents with TD are available from the American Academy of Child and Adolescent Psychiatry and the European Society for the Study of Tourette Syndrome (ESSTS) Guidelines Group (Pharmacological Interventions and Behavioral Interventions). Note that in the case of mild TD, treatment may not be necessary and the tics may remit spontaneously. However, in the case of moderately or more distressing or impairing tics, treatment can be helpful.
Clinical research suggests that the following treatments are indicated for the treatment of children with TD:
In addition, the following treatments are considered promising:
Clinical research suggests that the following treatments are indicated for the treatment of children with TD:
In addition, the following treatments are considered promising: