Childhood Disorders: Tic Disorders
Phenomenology and Diagnostic
Criteria
The cardinal features of Tourette’s disorder and
the other tic dis-orders are motor and vocal tics. Motor tics are usually
brief, rapid and stereotyped movements, but can also be slower, more
rhyth-mical, or even dystonic in nature. Simple motor tics are move-ments of
individual muscle groups and include brief movements such as eye blinking, head
shaking and shoulder shrugging. Com-plex motor tics involve multiple muscle
groups, such as a simul-taneous eye deviation, head turn and shoulder shrug.
Some com-plex tics appear more purposeful, such as stereotyped hopping,
touching, rubbing, or obscene gestures (copropraxia). Vocal tics are usually
brief, staccato-like sounds, but can also be words or phrases. Simple vocal
tics, often caused by the forceful movement of air through the nose and mouth,
include sniffing, throat clear-ing, grunting, or barking-type sounds. Complex
vocal tics usu-ally include words, phrases, or the repetition of one’s own
words (palilalia) or the words of others (echolalia). Coprolalia (repetition of
obscene phrases), often incorrectly considered essential for the diagnosis of
Tourette’s disorder, is an uncommon symptom with only 2 to 6% of Tourette’s
disorder cases so affected.
Tics most often begin early in childhood, wax and
wane in severity, and change in character and quality over time. Tics are
exacerbated by excitement and tension, and can attenuate during periods of
focused, productive activity and sleep. Tics are invol-untary, yet because they
are briefly suppressible or can be trig-gered by environmental stimuli, they
may appear as volitional acts. Patients describe tension developing if a tic is
resisted, which only subsides by completion of the tic. In some individu-als,
tics are preceded or provoked by a thought or physical sensa-tion referred to
as a premonitory urge
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