Tic Disorders/Tourette Syndrome

Tics are repetitive involuntary or semi-voluntary movements or sounds. Tics may occur in healthy, otherwise normal children or in children with a variety of neurologic, developmental or psychiatric conditions.

Individuals who have one vocal and two motor tics for more than one year are classified as having Tourette Syndrome. Tourette syndrome is more common in boys than girls and is more common than once thought – affecting at least 1 in 1,000 to 1 in 2,000 people and maybe more. The majority of childhood tics resolve or improve significantly by early adulthood.

Rady Children's Hospital Tic/Tourette Center

Symptoms

Tics are repetitive involuntary or semi-voluntary movements or sounds. Tics vary over time in number, frequency, type and severity and may even disappear for weeks or months at a time. Tics may resolve spontaneously or may persist over time. Though many people may associate coprolalia or cursing with Tourette Syndrome, this is actually an uncommon symptom that has been sensationalized by the media.

Individuals with Tourette Syndrome may often have symptoms of obsessive compulsive disorder (OCD) or attention deficit hyperactivity disorder (ADHD) or other emotional or learning difficulties.

As a group, children with Tourette Syndrome have the same IQ range as the general population.  However, problems dealing with tics, often combined with attentional deficits or other learning difficulties, may require special education assistance or in school accommodations. 

Despite these symptoms, the majority of people with Tourette syndrome lead productive lives and many reach high levels of achievement in wide ranging fields.

Causes

No definite cause for tics has been established but research suggests abnormalities in signaling of a brain chemical, dopamine. Tic disorders are often inherited with similar tic, OCD or ADHD symptoms occurring in other family members. Occasionally, tics may be caused by certain medications. 

Rarely, tics are caused by infections or other neurologic disorders. Diagnosis requires expertise to sort through these possibilities.

Treatment

Many patients require no treatment for their tics. In these cases, we provide education and counseling. For those who do require treatment, though there is no cure, various therapies are available to help control tic symptoms. 

Behavioral therapy known as Comprehensive Behavioral Intervention for Tics (CBIT) or Habit Reversal Therapy (HRT) may be very effective in helping patients control tics and urges. Nurse Practitioner Gail Reiner provides this type of therapy in our clinic.

A variety of medication options are also available including medications that stimulate alpha receptors such as guanfacine and clonidine and medications that act on the dopamine system, including risperidone, aripiprizole and tetrabenazine. For patients with severe or dystonic tics, botulinum toxin injections are also available. Some patients who do not require treatment of their tics, will benefit from treatment of symptoms of ADHD, OCD and/or other emotional or learning difficulties.

Research

Physicians and researchers at Rady Children’s Hospital and UCSD are interested in better understanding the mechanisms underlying tic production and urge control to develop better therapies for patients with Tourette. Current studies funded by the Tourette Syndrome Association involve using behavioral therapy (CBIT) paired with functional MRI imaging to shed light on the mechanisms of tic suppression.

Get information on current research and clinical trials at Rady Children's Hospital.

What We Offer

The Tic/Tourette Center at Rady Children’s Hospital is a multidisciplinary clinic that specializes in evaluating, diagnosing and treating individuals with tic disorders including Tourette Syndrome. We provide neurologic evaluation to ensure correct diagnosis. For patients requiring treatment, we offer both behavioral (CBIT) and medication therapy options. In addition to providing expert medical care for individuals with tics and/or Tourette Syndrome, we work closely with psychiatrists, psychologists and other health professionals at Rady Children’s Hospital and in the community to coordinate a treatment plan.

The Tic/Tourette Center also works closely with the Tourette Syndrome Association, of which, Dr. Jennifer Friedman is a member. Opportunities are also available for patients to participate in research studies.