Tourette syndrome and tic disorders: symptoms, causes and treatment

Key points

• Tourette syndrome is a neurological condition causing sudden, repeated movements and sounds, called tics [1].
• Swearing as a tic (coprolalia) is the best known feature and the least typical, at an estimated 10% to 30% of cases [3][4].
• Most tics follow a building sensation, the premonitory urge, that the tic relieves, so they can be held back only briefly [2][4].
• Up to 85% of people with Tourette syndrome also have ADHD, OCD or anxiety [3].
• Behavioural therapy comes before medication, though few UK clinicians deliver it, and about half of children improve by adulthood [1][7].

What Tourette syndrome is

Tourette syndrome is a neurological condition that causes sudden, repeated movements and sounds called tics [1]. It is diagnosed when several motor tics and at least one vocal tic have been present for at least 12 months [3]. Tics usually begin around the age of 6 [1].

If you need help now. Samaritans: call 116 123, free, 24/7. Shout: text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.

More than 300,000 children and adults in the UK have Tourette syndrome, about one school child in a hundred [3], and it is more common in boys [1][3].

Coprolalia, swearing as a tic, is the feature most people have heard of, and most people with Tourette syndrome do not have it: estimates run at 10% to 30% [3][4]. Its absence does not rule the condition out [4].

Symptoms

Tics are fast, repeated muscle movements producing sudden body jolts or sounds, grouped as motor (movement) or vocal (sound) and as simple or complex [2][4].

• Simple motor tics. Blinking, eye rolling, grimacing, shoulder shrugging, head or limb jerking [4].
• Complex motor tics. Jumping, twirling, touching things, obscene gestures (copropraxia), copying others’ gestures (echopraxia) [4].
• Simple vocal tics. Throat clearing, sniffing, coughing, tongue clicking, grunting [4].
• Complex vocal tics. Phrases out of context, repeating a phrase (echolalia), socially unacceptable words (coprolalia) [4].

The premonitory urge. Most people describe an unpleasant sensation building somewhere in the body before a tic, which the tic then relieves [2]. Holding the tic back makes the urge stronger until it is hard to resist. Tourettes Action compares the urge itself to needing to sneeze or scratch an itch, and suppressing a tic to holding your eyes open to avoid blinking [4].

This is why tics are better described as unvoluntary than involuntary: the movement is not chosen the way an ordinary action is, but it is not a reflex either. It is also why suppression works only for a while. Holding tics back at school and releasing them at home is common, and it is tiring [4].

Tics are often mistaken for fidgeting or habits, and specialists rule out epilepsy, autism, dystonia and Sydenham’s chorea [6].

Types

Tic disorders differ by how long tics have lasted and by which kinds of tic occur.

• Tourette syndrome. Several motor tics and one or more vocal tics, for at least 12 months, starting before the age of 18 [1][3].
• Chronic (persistent) tic disorder. Tics lasting over a year where only motor tics, or only vocal tics, occur. Tourette syndrome requires both [1][3].
• Provisional (transient) tic disorder. Tics lasting some months, then settling. These are common in childhood, usually starting around the age of 5 [2][10].

Functional tic-like behaviours are a different presentation, part of functional neurological disorder. From 2020 and 2021, clinicians specialising in tics saw many more people, particularly teenagers, presenting this way [9]. Onset is sudden and severe rather than gradual, usually after the age of 10 or 11, and can begin in adulthood. There is often no premonitory urge, and the tics cannot be suppressed even briefly [9].

People with functional tics are not faking: the movements come from the brain outside voluntary control, and someone can have both this and Tourette syndrome [9]. Treatment differs, using psychological therapy and physiotherapy, and medicines used for Tourette’s tics do not always help [9].

Causes and risk factors

The cause has not been fully established [5]. Evidence points to inherited risk and to differences in the brain circuits controlling movement [2][5].

• Genetics. It runs in families and is more likely if a parent has it [1]. No single gene causes it and there is no genetic test: many gene variations each add a small amount of risk [5].
• Brain function. Scans show differences in the motor circuits, alongside an imbalance in the brain’s chemical messengers, including dopamine [5].

Two popular explanations are not supported. Tics are not caused by parenting, and stress, excitement and tiredness make tics more frequent without causing them [1][2]. The theory that streptococcal infection triggers Tourette syndrome, often called PANDAS, has been hard to prove, and there is no good evidence for antibiotics [5].

How it is diagnosed

There is no single test [10]. Diagnosis is clinical, made by a neurologist, psychiatrist or paediatrician, with a GP as the gatekeeper for referral to community paediatrics, CAMHS or neurology [1][6]. A GP may recognise the pattern where tics began before 18 and involve both sounds and movements [1].

The specialist talks through symptoms and observes any tics in the session [6]. Tics often settle in a clinic room, so a tic diary and video recorded at home are useful to bring [6]. An EEG, MRI or blood tests are used only to rule out other conditions [6]. No reliable figure exists for UK waiting times.

A diagnosis names a pattern. It does not predict how severe tics will become, since symptoms wax and wane [3].

Treatment

Tourette syndrome cannot be cured, and treatment is offered when tics cause problems [1]. NHS advice is behavioural therapy first, with medicine considered if that has not helped [1].

Behavioural therapy. Habit reversal training is the best validated behavioural treatment [7]. It teaches a competing response, a deliberate movement that blocks the tic, worked out from the premonitory urge that precedes it [7]. It is often given inside a package known as CBIT, and exposure and response prevention works in a similar way, on the urge rather than the tic [7]. Courses run to 8 to 12 sessions, with most research showing a 30% to 40% reduction in tics among those who respond [7]. Access is limited: few UK clinicians deliver it, and Tourettes Action keeps a list of practitioners [7].

Medication. No medicine is licensed specifically for tics in the UK, so prescribing is a decision for a specialist or GP in each case [8]. The groups used act on dopamine, such as aripiprazole and risperidone, or are noradrenergic, such as clonidine and guanfacine [8]. Side effects vary by group and include weight gain, stiffness, drowsiness and low mood [8].

Co-occurring ADHD, OCD and anxiety are treated in their own right [3].

Outlook. Tics usually improve after puberty, and about half of children with a diagnosis see a significant reduction by adulthood [2][3]. For others they continue and vary through life [10].

Living with Tourette syndrome

Stress, excitement and tiredness are common triggers, so sleep and pacing the day may reduce how often tics come [1][2].

Suppressing tics all day at school or work is tiring, and somewhere private to let tics out is more useful than holding them longer [4]. Tourettes Action offers employment and education support, and support groups online and in person [1]. If you are a parent, tell the school what your child’s tics look like and that they are not deliberate.

When to speak to a professional

Speak to a GP if:

• tics are causing pain, injury or exhaustion
• tics are getting in the way of school, work or sleep
• you or your child are being bullied, withdrawing or feeling low because of tics
• tics started suddenly and severely, or first appeared in adulthood, since functional tics are treated differently [9]

Ask about a referral if tics have lasted a year or more and involve both sounds and movements [1][6]. Mention obsessive thoughts, compulsions or attention difficulties at the same appointment [3].

If you feel unable to keep yourself safe, call Samaritans free on 116 123, text SHOUT to 85258, or call NHS 111 and choose the mental health option. Call 999 if anyone is in immediate danger.

Common questions

Does everyone with Tourette syndrome swear?

No. Coprolalia, swearing as a tic, affects a minority, estimated at 10% to 30% [3][4]. It is the best known feature because it is the most noticeable, not the most common.

Do tics go away in adulthood?

Often they reduce. Tics are usually most severe between about the age of 8 and the teenage years, then improve after puberty [2]. About half of children with a diagnosis see a significant reduction by adulthood, while for others tics continue [3][10].

What is the difference between Tourette syndrome and functional tics?

Tourette syndrome tics begin gradually in childhood, come with a premonitory urge, and can be held back briefly [1][2][4]. Functional tics start suddenly and severely, after the age of 10 or 11 or in adulthood, often without a warning urge, and cannot be suppressed [9]. Treatment is psychological therapy or physiotherapy [9].

Clinical review pending

References

1. NHS. Tourette syndrome. NHS, 2025. https://www.nhs.uk/conditions/tourettes-syndrome/
2. NHS. Tics. NHS, 2023. https://www.nhs.uk/conditions/tics/
3. Tourettes Action. What is TS? Tourettes Action, 2026. https://www.tourettes-action.org.uk/67-what-is-ts.html
4. Tourettes Action. Symptoms of TS. Tourettes Action, 2026. https://www.tourettes-action.org.uk/19-symptoms-.html
5. Tourettes Action. Causes of TS. Tourettes Action, 2026. https://www.tourettes-action.org.uk/21-causes.html
6. Tourettes Action. Getting diagnosed with TS. Tourettes Action, 2026. https://www.tourettes-action.org.uk/20-getting-diagnosed.html
7. Tourettes Action. Behaviour therapies in TS. Tourettes Action, 2026. https://www.tourettes-action.org.uk/71-behavioural-therapies.html
8. Tourettes Action. Medication for TS. Tourettes Action, 2026. https://www.tourettes-action.org.uk/70-medication.html
9. Stone J and colleagues. Functional tics. Functional Neurological Disorder: neurosymptoms.org, 2026. https://www.neurosymptoms.org/en/symptoms/fnd-symptoms/functional-tics/
10. NHS inform. Tourette’s syndrome. NHS inform, Scotland, 2026. https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/tourettes-syndrome/