Autism and Co-occurring Conditions: Tourette’s Syndrome

CC BY-NC by TheLadyKris

Tourette’s Syndrome is a neurological disorder characterized by physical and vocal tics. Tics are defined as sudden, repetitive, non-rhythmic, involuntary movements or utterances that involved discrete muscle groups. Motor tics are movement-based, while vocal tics are involuntary sounds produced by moving air through the nose, mouth, or throat.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV-TR), the patient must exhibit multiple motor and at least one vocal tic over the period of a year, with no more than three consecutive tic-free months. Tourette’s Syndrome is usually diagnosed between the ages of five to seven, with severity of tics peaking around the age of ten. Most patients will exhibit a decrease in tics through adolescence.

There are several differences between autism and Tourette’s Syndrome, though they can occur simultaneously. Autism is generally diagnosed at an earlier age, and it’s severity generally does not decrease with age. Individuals with Tourette’s Syndrome do not suffer from communication or social difficulties, though they may feel self-conscious about their tics.

Many parents of children with autism wonder if some of their self-stimulatory behaviors may be caused by tics. There are, however, some key differences between tics and the self-stimulatory behaviors that characterize autism spectrum disorders. The most common tics include movements such as eye-blinking, facial movements, sniffing, and throat-clearing, which tend to come from the center or midline of the body. Self-stimulatory behaviors, by contrast, are often seen in the extremities, for example, hand flapping or jumping. Self-stimulatory behaviors also start earlier in life, and they tend to be more symmetrical and bilateral than tics. Stims and tics also differ in that stims are self-soothing movements and behaviors, while tics are involuntary and sudden.

Unlike tics in other disorders, patients with Tourette’s report feeling an urge to express the tic, similar to the urge to sneeze or scratch an itch. Patients describe this urge as a build-up of tension that needs to be released. Some patients suffer from coprolalia (the uncontrollable utterance of obscenities) or copropraxia (the uncontrollable urge to use obscene gestures), though this is rare, affecting approximately 30 percent of patients with Tourette’s Syndrome.

Clearly, it can be challenging to diagnose Tourette’s Syndrome in a child with autism, especially if there are communication issues present. The main symptoms to look for are sudden, involuntary movements or sounds that begin suddenly and do not respond to behavioral or sensory interventions. These can also be signs of a seizure disorder, so it’s important to find a qualified pediatric neurologist who has experience with autism and other neurological disorders.

Tourette’s Syndrome is usually treated with psychobehavioral therapy aimed at helping the patient manage the most debilitating tics. Relaxation training and biofeedback can also be helpful. There are no medications that can cure tics, but some typical or atypical neuroleptics, antihypertensive agents, or stimulant medications have been found to be helpful. All medications can cause side effects, and should be carefully monitored by a qualified medical professional.

To read other articles in this series on autism and co-morbidity click here