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What Might Happen with Tics Over Time

Researchers and doctors refer to this as the course of Tourette syndrome (TS) –  i.e., what do tics do at different times throughout a person’s life. The most common course of TS begins with initial tics being noticed at ages 4–6. Sometimes it takes much longer before a TS diagnosis is given or suspected because many parents, and even a lot of doctors, are not experts at recognizing tics. Once they start, tics tend to increase and decrease over time – a phenomenon called “waxing and waning" –  with days, weeks or months with lower or higher tics. New tics may emerge and other tics may disappear; sometimes tics vanish forever and sometimes they reemerge at a later point. 

There is some predictability in the amount and severity of tics over time. Early tics are often more mild and can include eyeblinking, small facial movements, puffs of air or little squeaking or humming sounds. Even as tics wax and wane, there is a tendency for tics overall to increase throughout early and middle childhood. As time goes on, tics can become more frequent and more complex (e.g., more involved body movements; a larger repertoire of sounds; see List of Tics for more information). A majority of adults with TS report that their worst tic periods occurred between the ages of 10 and 14 (often 11-12 is the highest peak period). As a child moves through middle and late adolescence, tics will slowly decrease in a lot of individuals –  again, waxing and waning throughout. By adulthood, about 1/3 of adults have no noticeable tics, about 1/3 of adults have substantially reduced tics (that are typically quite mild), and about 1/3 of adults continue to have tics in the same waxing and waning fashion. 

Keep in mind that the above-described trend is not a hard-and-fast rule.  Everyone is different: There is great variability in the course of TS in different individuals. The severity of tics in early and middle childhood is not considered a good predictor of who might have tics in adulthood; there are no great predictors of this. While many parents find comfort in the hope that tic symptoms will decline in their child, it is best to realize that the future course of an individual with TS is unclear. Learning to live with tics through acceptance, social support and/or supportive counseling, or learning to manage Tourette syndrome with Habit Reversal Therapy or medication is my recommended long-term plan.  

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