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Tourette’s Syndrome: Other Concerns and Conditions

This information was taken directly from the Centers for Disease Control and Prevention

Tourette Syndrome (TS) often occurs with other related conditions (also called co-occurring conditions). These conditions can include attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and other behavioral or conduct problems. People with TS and related conditions can be at higher risk for learning, behavioral, and social problems.

The symptoms of other disorders can complicate the diagnosis and treatment of TS and create extra challenges for people with TS and their families, educators, and health professionals.

Findings from a national Centers for Disease Control and Prevention (CDC) study1 indicated that 86% of children who had been diagnosed with TS also had been diagnosed with at least one additional mental health, behavioral, or developmental condition based on parent report.

Among children with TS:

  • 63% had ADHD.
  • 26% had behavioral problems, such as oppositional defiant disorder (ODD) or conduct disorder (CD).
  • 49% had anxiety problems.
  • 25% had depression.
  • 35% had an autism spectrum disorder
  • 47% had a learning disability
  • 29% had a speech or language problem.
  • 30% had a developmental delay.
  • 12% had an intellectual disability

Because co-occurring conditions are so common among people with TS, it is important for doctors to assess every child with TS for other conditions and problems.


Attention-Deficit/Hyperactivity Disorder (ADHD)

In this national CDC study, ADHD was the most common co-occurring condition among children with TS. Of children who had been diagnosed with TS, 63% also had been diagnosed with ADHD. 1

Children with ADHD have trouble paying attention and controlling impulsive behaviors. They might act without thinking about what the result will be and, in some cases, they are also overly active. It is normal for children to have trouble focusing and behaving at one time or another. However, these behaviors continue beyond early childhood (0-5 years of age) among children with ADHD. Symptoms of ADHD can continue and can cause difficulty at school, at home, or with friends.


Obsessive-Compulsive Behaviors

People with obsessive-compulsive behaviors have unwanted thoughts (obsessions) that they feel a need to respond to (compulsions). Obsessive-compulsive behaviors and obsessive-compulsive disorder (OCD) have been shown to occur among more than one-third of people with TS.2, 3, 4

Sometimes it is difficult to tell the difference between complex tics that a child with TS may have and obsessive-compulsive behaviors.


Behavior or Conduct Problems

Findings from the CDC study indicated that behavior or conduct problems, such as oppositional defiant disorder (ODD) or conduct disorder (CD), had been diagnosed among 26% of children with TS.1


Oppositional Defiant Disorder (ODD)

People with ODD show negative, defiant and hostile behaviors toward adults or authority figures. ODD usually starts before a child is 8 years of age, but no later than early adolescence. Symptoms might occur most often with people the individual knows well, such as family members or a regular care provider. The behaviors associated with ODD are present beyond what might be expected for the person’s age, and result in major problems in school, at home, or with peers.

Examples of ODD behaviors include:

  • Losing one’s temper a lot.
  • Arguing with adults or refusing to comply with adults’ rules or requests.
  • Getting angry or being resentful or vindictive often.
  • Annoying others on purpose or easily becoming annoyed with others.
  • Blaming other people often for one’s own mistakes or misbehavior.

Conduct Disorder (CD)

People with CD have aggression toward others and break rules, laws, and social norms. Increased injuries and difficulty with friends also are common among people with CD. In addition, the symptoms of CD happen in more than one area in the person’s life (for example, at home, in the community, and at school).

CD is severe and highly disruptive to a person’s life and to others in his or her life. It also is very challenging to treat. If a person has CD it is important to get a diagnosis and treatment plan from a mental health professional as soon as possible.


Rage

Some people with TS have anger that is out of control, or episodes of “rage.” Rage is not a disorder that can be diagnosed. Symptoms of rage might include extreme verbal or physical aggression. Examples of verbal aggression include extreme yelling, screaming, and cursing. Examples of physical aggression include extreme shoving, kicking, hitting, biting, and throwing objects. Rage symptoms are more likely to occur among those with other behavioral disorders such as ADHD, ODD, or CD.

Among people with TS, symptoms of rage are more likely to occur at home than outside the home. Treatment of rage can include learning how to relax, social skills training, and therapy. Some of these methods will help individuals and families better understand what can cause the rage, how to avoid encouraging these behaviors, and how to use appropriate discipline for these behaviors. In addition, treating other behavioral disorders that the person might have, such as ADHD, ODD, or CD can help to reduce symptoms of rage.


Anxiety

There are many different types of anxiety disorders with many different causes and symptoms. These include generalized anxiety disorder, OCD, panic disorder, post-traumatic stress disorder, separation anxiety, and different types of phobias. Separation anxiety is most common among young children. These children feel very worried when they are apart from their parents.


Depression

Everyone feels worried, anxious, sad, or stressed from time to time. However, if these feelings do not go away and they interfere with daily life (for example, keeping a child home from school or other activities, or keeping an adult from working or attending social activities), a person might have depression. Having either a depressed mood or a loss of interest or pleasure for at least 2 weeks might mean that someone has depression. Children and teens with depression might be irritable instead of sad.

To be diagnosed with depression, other symptoms also must be present, such as:

  • Changes in eating habits or weight gain or loss.
  • Changes in sleep habits.
  • Changes in activity level (others notice increased activity or that the person has slowed down).
  • Less energy.
  • Feelings of worthlessness or guilt.
  • Difficulty thinking, concentrating, or making decisions.
  • Repeated thoughts of death.
  • Thoughts or plans about suicide, or a suicide attempt.

Depression can be treated with counseling and medication.


Other Health Concerns

Children with TS can also have other health conditions that require care. Findings from the recent CDC study found that 43% of children who had been diagnosed with TS also had been diagnosed with at least one additional chronic health condition.

Among children with TS:

  • 28% had asthma.
  • 13% had hearing or vision problems
  • 12% had a bone, joint, or muscle problems.
  • 9% had suffered a brain injury or concussion

The rates of asthma and hearing or vision problems were similar to children with TS, but bone, joint, or muscle problems as well as brain injury or concussion were higher for children with TS. Children with TS were also less likely to receive effective coordination of care or have a medical home, which means a primary care setting where a team of providers provides health care and preventive services.


Educational Concerns

As a group, people with TS have levels of intelligence similar to those of people without TS. However, people with TS might be more likely to have learning differences, a learning disability, or a developmental delay that affects their ability to learn.

Many people with TS have problems with writing, organizing, and paying attention. People with TS might have problems processing what they hear or see. This can affect the person’s ability to learn by listening to or watching a teacher. Or, the person might have problems with their other senses (such as how things feel, smell, taste, and movement) that affects learning and behavior. Children with TS might have trouble with social skills that affect their ability to interact with others. As a result of these challenges, children with TS might need extra help in school.

Many times, these concerns can be addressed with accommodations and behavioral interventions (for example, help with social skills).

Accommodations can include things such as providing a different testing location or extra testing time, providing tips on how to be more organized, giving the child less homework, or letting the child use a computer to take notes in class. Children also might need behavioral interventions, therapy, or they may need to learn strategies to help with stress, paying attention, or other symptoms.


For More Information

CDC is working with the Tourette Syndrome Association to provide information about TS and other concerns and conditions to health care providers, educators, and families, so that children with TS can get the best available treatment and support. To learn more about other concerns and conditions related to TS, please visit the Tourette Syndrome Association website.


Continue to Risk Factors and Causes


Return to Treatments for Tourette’s or Special Needs ==Citations==

Resource

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. 2014.

Citations

1 Bitsko, RH, Holbrook, JR, Visser, SN, Mink, JW, Zinner, SH, Ghandour, RM, Blumberg, SJ (2014). A National Profile of Tourette Syndrome, 2011-2012. J Dev Behav Pediatr 35(5), 317-322.

2 Centers for Disease Control and Prevention. Prevalence of diagnosed Tourette Syndrome in persons aged 6-17 years - United States, 2007. MMWR Morb Mortal Wkly Rep. 2009;58(21):581–5.

3 Kompoliti K, Goetz CG, Morrissey M, Leurgans S. Gilles de la Tourette Syndrome: patient's knowledge and concern of adverse effects. Mov Disord. 2006;21(2):248–52.

4 Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P. An international perspective on Tourette Syndrome: Selected findings from 3500 individuals in 22 countries. Devel Med Child Neurol. 2000;42(7):436–47.

5 Janik P, Kalbarczyk A, Sitek M. Clinical analysis of Gilles de la Tourette Syndrome based on 126 cases. Neurol Neurochir Pol. 2007;41(5):381–7.