Tic Disorders: Course and Natural History

Course and Natural History

In Tourette’s disorder, tic symptoms usually begin in childhood; mean age at onset is 7 years. Motor tics of the eyes and face are the most common and earliest presenting symptoms. In many pa-tients, the motor tics remain isolated in the face. When motor tics do progress, there is a tendency for additional tics to present sequentially from the head and face to the neck, shoulders, trunk and extremities. Vocal tics tend to follow the development of motor tics. Complex tics of both types tend to follow the development of simple tics. Longi-tudinal studies suggest that tic severity is greatest in most patients during the latency and early teenage years. Most patients experience a decline in tic severity as they get older and only a small percentage of patients (10%) experience a severe or deteriorating course.

Obsessive–compulsive symptoms in persons with Tourette’s disorder generally begin somewhat later than ADHD and tics and may actually progress differentially from tic symptoms. Tic symptoms tend to improve into adulthood; obsessive–compulsive symptoms may actually increase in severity. Long-term studies of the course of obsessive–compulsive symptoms in persons with Tourette’s disorder have not been made. The course of ADHD symp-toms is similar in persons with and without Tourette’s disorder.