The primary characteristics associated with TS are multiple motor tics and one or more vocal tics. Motor and vocal tics may develop at about the same time or predominate at different times during the course of the disorder.
Initially, patients develop sudden, rapid, recurrent, involuntary movements (motor tics), particularly of the head and facial area. At symptom onset, motor tics usually consist of abrupt, brief, isolated movements known as simple motor tics, such as repeated eye blinking or facial twitching. Simple motor tics may also include repeated neck stretching, head jerking, or shoulder shrugging. Less commonly, motor tics are more "coordinated," with distinct movements involving several muscle groups, such as repetitive squatting, skipping, or hopping. These tics, referred to as complex motor tics, may also include repetitive touching of others, deep knee bending, jumping, smelling of objects, hand gesturing, head shaking, leg kicking, or turning in a circle. In addition to affecting the head and facial area, motor tics also affect other parts of the body, such as the shoulders, torso, arms, and legs. The anatomical locations of motor tics may change over time. Rarely, motor tics evolve to include behaviors that may result in self-injury, such as excessive scratching and lip biting.
Vocal tics are sudden, involuntary, recurrent, often relatively loud vocalizations. Vocal tics usually begin as single, simple sounds that may eventually progress to involve more complex phrases and vocalizations. For example, patients may initially develop simple vocal tics, including grunting, throat clearing, sighing, barking, hissing, sniffing, tongue clicking, or snorting. Complex vocal tics may involve repeating certain phrases or words out of context, one's own words or sounds (palilalia), or the last words or phrases spoken by others (echolalia). Rarely, there may be involuntary, explosive cursing or compulsive utterance of obscene words or phrases (coprolalia).
Most individuals with TS gradually develop a combination of different motor and vocal tics. These tics may occur a few or many times during the day, often in "clusters." Symptoms typically follow a waxing and waning course, periodically decreasing or increasing in frequency and intensity. Tics often subside during absorbing activities such as reading or working, decline during sleep, worsen with stress or fatigue, and may be voluntarily suppressed for brief periods. Although TS is considered lifelong, some patients may have weeks or even years with very few or no symptoms. Often tic frequency and severity diminish significantly during adolescence or adulthood. In addition, for many patients, symptoms may completely resolve by early adulthood.
People with TS who are being treated for this condition (clinical populations) also develop associated behavioral problems, particularly obsessive-compulsive behaviors during which certain repetitive actions or rituals are performed. For example, compulsions may include touching particular objects in a predetermined sequence, repeatedly counting, or engaging in repetitive hand washing. In addition, as many as 60% of children treated for TS may also have symptoms of attention-deficit hyperactivity disorder (ADHD). ADHD may include overactivity as well as difficulty maintaining attention. Affected children may also have impulse control difficulties and learning disabilities.
Tics may be embarrassing and may also significantly interfere with certain activities such as writing or reading as well as other activities of daily living. Because of anxiety about showing or displaying tics in public or social situations, patients may develop extreme self-consciousness or depression and choose to withdraw from professional or social situations. In addition, ADHD, impulsivity, learning problems, and obsessive-compulsive behaviors may interfere with social interactions and impair academic and occupational performance.