Tic Disorders Clinic & Research Unit

The Tic Disorders Clinic & Research Unit at Massachusetts General Hospital provides state-of-the-art outpatient care for people with Tourette Syndrome (TS) and Chronic Tic Disorder (CTD).

We offer both cognitive behavioral therapy, including habit reversal therapy and medication treatment. We also provide one-time consultations, evaluations and follow-up care. Treatment delivered in the context of research studies is usually provided at no cost to our patients.

About Tic Disorders

What Is a Tic?

A tic is a sudden, rapid, repetitive, involuntary muscle movement (a motor tic) or vocalization (a vocal tic). Tics are classified as "simple" or "complex".

"Simple" tics include:

• Eye blinking
• Neck or shoulder jerking
• Sniffing
• Picking
• Grunting, barking or chirping

"Complex" tics can include:

• Arm flapping
• Facial grimacing
• Coprolalia (the involuntary uttering of obscene words or phrases)
• Palilalia (involuntary repetition of one's own words) and echolalia (involuntary repetition of another person's words or phrases)

Contrary to many portrayals in the media, coprolalia is rare and occurs in fewer than 10% of people with tic disorders.

Tic disorders are categorized according to age of onset, severity, duration of symptoms and presence of vocal and/or motor tics. However, distinguishing between one tic disorder and another can be difficult.

Types of Tic Disorders

Transient tic disorders typically begin in childhood and are seen in as many as 5-24% of school children. To receive a diagnosis, the individual must experience tics for at least four weeks, but not for more than one year. Motor tics (e.g., eye blinking, grimacing) are more frequently observed than vocal tics (e.g., throat clearing). As with all tic disorders, transient tics tend to worsen during times of increased stress, excitement or lack of sleep.

Chronic motor or vocal tic disorder differs from transient tic disorders in that the tics persist for more than one year. Single or multiple motor or vocal tics (though not both) must be present, and the onset of the illness must occur before the age of 18.

Tourette syndrome (Gilles de la Tourette Syndrome or TS) is a neurological disorder characterized by multiple motor tics and at least one vocal tic, though both types of tics do not necessarily need to be present at the same time.

Developmental Course

The first symptom of TS is usually a simple motor tic (e.g., eye blinking). After that an individual may develop tics involving other parts of the body, including the neck, shoulders, trunk, and limbs. Sometimes the tics become complicated and complex, involving the entire body, such as with kicking or twirling. TS sufferers often report feeling a "premonitory urge"—a strong, irresistible urge to perform a tic—followed by a momentary feeling of relief once the tic is performed. Other tics can happen without warning.

The symptoms of TS vary from person to person and range from very mild to very severe, although the majority of cases are mild. Symptoms typically wax and wane, with a peak severity between the ages of 10 and 12. Many individuals with tics experience a significant reduction of their tics as they enter adulthood. Associated problems may include impulsivity, attention difficulties (ADHD/ADD), learning disabilities and obsessive-compulsive behaviors.

How Do I Know If I Have a Tic Disorder?

If you answer yes to several of the following questions, you may have TS or chronic tic disorder:

• Have you ever had (or do you currently have) facial tics, jerking or any other unusual body movements? (motor tics)
• Have you ever made (or do you currently make) involuntary noises or grunts? Or do you say words involuntarily? (vocal tics)
• Have you found yourself performing these behaviors several times a day?
• When did you first begin having the tic(s)? Was it before the age or 18 and at least a year ago?
• Has there ever been a period of time when you were tic-free for more than 3 months?

Please note: Only a qualified clinician can provide you with a definitive diagnosis.

Our Research

In addition to providing clinical care, the Tic Disorders Clinic & Research Unit at Mass General conducts cutting edge research into tourette syndrome (TS) and chronic tic disorder (CTD). Our research program examines the causes, consequences and treatments for TS and CTD in patients of all ages. Participation in our treatment studies can often be a way to receive innovative clinical care with expert clinicians at no cost.

Participating in a research study is also a great way to give back to Tourette’s community by advancing our knowledge of these disorders.

Learn more about our current research.