Lots more kids have tics than Tourette’s syndrome. The diagnosis of Tourette’s syndrome require several different ongoing ticks and represents more severe and persistent tics. It is formally diagnosed with reference to diagnostic criteria (DSM V) which basically equate to the presence of at least two motor ticks and one vocal tics since childhood.
Tics are therefore a lot more common than Tourette’s syndrome although Tourette’s syndrome is surprisingly common and affects about 1% of school aged children.
A tic is an involuntary and sudden, rapid movement that is not rhythmic and is recurrent. A feeling of mounting inner tension occurs before the tic, and this feeling is relieved by the tic. A motor tic involves the muscle – for example, eye blinking, facial grimacing, shoulder shrugging, neck stretching. Vocal tics involves vocalisations – such as sniffing, grunting, and throat clearing. Tics can be more complex.
It’s easy to see why the diagnosis of tics or Tourette's may not be considered because symptoms such as sniffing, blinking or clearing their throat might might suggest physical causes resulting in referral to ENT surgeons for example. It’s therefore useful to be aware of the huge range of tics that might occur – also including nasal twitching, facial grimacing, head stretch or nodding, leg or feet movements, tapping. Other vocal tics includ coughing, barking, panting, hissing, moaning. The list is much longer than this. Swearing is a well known one but occurs in only about 10% of older children with Tourette’s. Complex tics may suggest a behaviour problem but are in fact tics – spitting, hopping, kicking, feet shuffling, flapping arms, twirling hair, making animal-like sounds are just a few of the possibilities.
Tourette’s syndrome is four times more common boys. The average age of onset is 6 years. The key is to consider the diagnosis in the first place - but because Tourettes and even tics were once considered quite rare, they can easily be overlooked.
The diagnosis of tourettes (and tics) does help parents understand the problem. The condition is neurodevelopmental (ie. related to how the central nervous system develops and not being naughty) and there are effective treatments out there.
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