Tourette's disorder (TD), sometimes called Tourette's syndrome (TS), is a neurological disorder characterized by multiple repeated tics. Tics are abrupt, purposeless, and involuntary vocal sounds or muscular jerks. Symptoms of TD usually begin between the ages of 5 and 10 years of age, and usually begin with mild, simple tics involving the face, head, or arms. With time, tics become more frequent and increase in variety, involving more body parts such as the trunk or legs, and often become more disruptive to activities of daily living (ADLs).
What causes Tourette's disorder?
Tourette's disorder is an autosomal dominant disorder. Autosomal means that both males and females are affected, and dominant means that one copy of the gene is necessary to have the condition. This means that a parent with TD or a parent who has the gene for TD has a 50/50 chance, with each pregnancy, to pass the gene on. TD is associated with a non-genetic cause in 10 to 15 percent of children. Complications of pregnancy, low birthweight, head trauma, carbon monoxide poisoning, and encephalitis are thought to be associated with the onset of non-genetic TD.
Dominant disorders exhibit something known as incomplete penetrance, which means that not everyone with the gene will have symptoms of Tourette's disorder. In other words, if a parent passes the gene on to a child, the child may not have any symptoms of the disorder. If a daughter inherits the gene, there is a 70 percent chance that she will have at least one of the signs of TD. On the other hand, if a son inherits the gene, there is a 90 percent chance that he will have at least one of the signs of TD.
Finally, dominant disorders can also exhibit something known as variable expressivity. This means that there are differences in the expression of the TD gene in different people. For example, one person with TD may have obsessive-compulsive disorder, while another has a chronic tic disorder, while another has full-blown TD. In addition, there are differences in expressivity between males and females: males are more likely to have full-blown TD or chronic tics, while females are more likely to have obsessive-compulsive disorder.
Who is affected by Tourette's disorder?
A diagnosis of TD is generally made before the child reaches his/her 18th birthday. In the majority of cases, a child is diagnosed around the age of 7. TD affects more males than females.
What are the symptoms of Tourette's disorder?
Tic behaviors seen in TD change over time, and vary in frequency and complexity. The following are the most common tic behaviors associates with TD. However, each child experiences symptoms differently. Symptoms may include:
- involuntary, purposeless, motor movements (may involve different parts of the body, such as the face, neck, shoulders, trunk, or hands)
- head jerking
- any excessively repeated movements (i.e., foot tapping, leg jerking, scratching)
Some of the more complex tic behaviors associated with TD may appear purposeful, and may include the following:
- sticking out the tongue or lip-smacking
- touching behaviors
- making obscene gestures
In addition to some, or all, of the above symptoms, TD is also characterized by one or more vocal tics (meaningless sound), in order for a diagnosis of TD to be made, including the following:
- grunting or moaning sounds
- tongue clicking
- throat clearing, snorts, or coughs
- squeaking noises
- echoing sounds or phrases repeatedly
Forty percent of children and adolescents who have TD also have attention problems and 30 percent have academic difficulties. However, most have a normal intelligence and do not usually have primary learning disabilities. Twenty-five to 30 percent also experience symptoms of obsessive-compulsive disorder (OCD), which is an anxiety disorder in which a person has an unreasonable thought, fear, or activity (obsession) that he/she tries to manage through a ritualized activity (compulsion) to reduce the anxiety.
The symptoms of TD may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.