Early Symptoms of Tourette Syndrome

tourette syndrome

The early symptoms of Tourette syndrome appear during childhood (approximately between the ages of 2 and 12) and usually include tics in the head and neck area. These tics are sudden, brief, and repetitive movements involving a limited number of muscle groups. As the disease progresses, the tics may affect muscles in the trunk and extremities as well. Conversely, the tics may come and go over time and vary in frequency, location, and severity. In addition to motor tics, the patient may later on develop vocal tics such as repeatedly clearing his or her throat, sniffing, or grunting. Motor and vocal tics are categorized as simple and complex. Contrary to common belief, the most well-known symptom of Tourette – coprolalia or cursing and swearing at inappropriate places and times – only affects about 10%-15% of people with this condition.

Tourette syndrome symptoms






Simple tics

·         Eye blinking.

·         Head jerking.

·         Shoulder shrugging.

·         Eye darting.

·         Finger flexing.

·         Sticking tongue out.

·         Hiccoughing.

·         Yelling.

·         Throat clearing.

·         Barking.



Complex tics

·         Touching the nose.

·         Touching others.

·         Smelling objects.

·         Obscene gestures.

·         Arm flapping.

·         Hopping.

·         Employing different tones of voice.

·         Repeating one’s or others’ words or phrases.

·         Cursing and swearing.


These symptoms are usually at their worse before the mid-teen years and improve in the late teen years and early adulthood in most cases. Stress, anxiety, fatigue, and excitement can trigger and worsen the tics, as do certain physical experiences – a tight collar can lead to neck tics; hearing someone sniff or clearing their throats can result in similar vocal tics. Regardless of what triggers the tics, people with Tourette experience something called premonitory urge (e.g. an itch, tingle, or tension). Certain patients can delay, conceal, or suppress their tics. However, not only does this require considerable effort but expressing the tic actually soothes the sinister urge. Unfortunately, tic expression can disrupt the patient’s life and work, and even be dangerous, for example if the tic involves punching one’s own face.

Other complications resulting from Tourette syndrome include the following related conditions:

·         Attention-deficit/hyperactivity disorder.

·         Obsessive compulsive disorder.

·         Learning disabilities.

·         Sleep disorders (though not as severe, the tics continue during sleep).

·         Depression.

·         Anxiety.

The cause or causes of Tourette syndrome have not been clearly determined. However, it is thought that a mixture of hereditary and environmental factors is at play. As such, a family history of the condition is a major risk factor, as is being male – men are 3-4 times more likely to be diagnosed with Tourette than men. Additionally, abnormalities in regions of the brain such as the basal ganglia, frontal lobes, and cortex, as well as in the circuits that connect these regions and the neurotransmitters that allow the nerve cells to communicate with each other are believed to play a role in the onset of Tourette disease.  

This condition is not preventable and there are no tests of any kind that can specifically diagnose it – at most, magnetic resonance imaging (MRI) or computerized tomography (CT),   electroencephalogram (EEG) studies, or certain blood tests are used to rule out other conditions that may cause similar symptoms. Therefore, physicians base their diagnosis on the early symptoms of Tourette syndrome, along with any other signs and symptoms that may appear later. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association, the following must occur for a diagnosis of Tourette to be made:

·         Motor and vocal tics must be present, though not necessarily at the same time.

·         Tics take place several times daily, almost every day or intermittently for over a year. There must not be a period of more than three months without tics.

·         Tics appear before the patient turns 18.

·         The tics are not a side effect of medication or other substances, nor are they a result of other conditions.

Common tics are seldom misdiagnosed. Nevertheless, the diagnosis may be delayed because the patients, their families, and even their doctors are not familiar with the symptoms, or chalk them up to a different cause. For instance, eye blinking may be considered a sign of vision problems, while sniffling may be deemed a consequence of allergies.

Tourette syndrome is an incurable, lifelong, and chronic disorder, but it isn’t degenerative. Moreover, by their late teens-early 20’s many patients have improved to the point that they don’t need medication to suppress their tics – or have even become symptom-free. In fact, most people who have Tourette do not require medication to suppress their tics – unless their symptoms interfere with functioning. No specific medication can help all people with this condition to relieve all of their symptoms, but there are several alternatives available with varying degrees of effectiveness.

Medication for Tourette syndrome

Dopamine blockers

·         Fluphenazine.

·         Haloperidol (Haldol).

·         Pimozide (Orap).

Botox injections

·         For simple vocal tics.


·         Methylphenidate (Concerta, Ritalin, others). Dextroamphetamine (Adderall XR, Dexedrine, others).

Central adrenergic inhibitors

·         Clonidine (Catapres).

·         Guanfacine (Tenex).


·         Fluoxetine (Prozac, Sarafem, others).


Other treatment options include different forms of therapy:

·         Psychotherapy.

·         Behavior therapy.

·         Deep brain stimulation.

Additionally, families living with Tourette syndrome can cope with this condition by encouraging children and teens to engage in physical and mental activities like sports, exercise, hobbies, writing, painting, music, etc. it has been observed that the severity and frequency of tics is lessened when the patient participates in an engrossing activity. Learn more about this disorder and find support groups on the Tourette Syndrome Association’s official website.