Tourette's Disorder and Tics

What They Are, How They Affect Daily Life, and How Treatment Helps

Natalie Noel, LMHC | Anxiety & OCD Treatment Specialists | Tampa, FL

In-person sessions are provided in Tampa and virtual sessions are available throughout Florida and New York.

Quick Answer: What Is a Tic?

A tic is a sudden, repetitive, uncontrolled movement or sound. Tics are divided into motor tics (physical movements) and vocal tics (sounds or words). They are described as semi-voluntary most people feel a strong urge before a tic occurs and experience brief relief after. Tics are the defining feature of Tourette’s Disorder and other tic conditions. They are treated with Comprehensive Behavioral Intervention for Tics (CBIT) the evidence-based therapy with the strongest research support.

What Are Tics?

Tics are sudden, fast, repetitive movements or sounds that happen without a clear reason. They can involve almost any part of the body or any sound. Most people with tics describe a feeling that builds before the tic like an itch or pressure and is temporarily relieved when the tic happens.

This pre-tic feeling is called a premonitory urge. Understanding it is important for treatment because CBIT works by teaching people to recognize and respond to the urge before the tic occurs.

Tics are divided into two main categories:

Type	Motor Tic Examples	Vocal Tic Examples
Simple Tics (involve one muscle group)	Eye blinking, nose twitching, head jerking, shoulder shrugging, grimacing	Throat clearing, sniffing, grunting, snorting, squeaking
Complex Tics (involve multiple muscle groups)	Jumping, touching objects or people, repeating gestures, sustained postures, facial expressions	Saying words or phrases, repeating own words, echoing others' words, obscene words (rare)

Tics typically change over time in type, location, and severity. A child who blinks repeatedly may later develop a throat-clearing tic instead. This shifting is normal and part of how tic disorders behave.

Types of Tic Disorders

Not every person with tics has Tourette’s Disorder. The DSM-5 recognizes several different tic disorder diagnoses, depending on the types of tics present and how long they have been occurring.

Tic Disorder	What It Involves
Tourette's Disorder	Both motor AND vocal tics, present for more than 1 year, starting before age 18
Persistent (Chronic) Motor or Vocal Tic Disorder	Either motor OR vocal tics (not both), present for more than 1 year
Provisional Tic Disorder	Motor or vocal tics present for less than 1 year the most common type in children
Other Specified Tic Disorder	Tics that do not fit neatly into the above categories

Many parents hear the word ‘Tourette’s’ and picture severe, constant tics including the coprolalia (involuntary swearing) they have seen in movies or TV. In reality, coprolalia affects only about 10 to 15 percent of people with Tourette’s. Most people with Tourette’s have tics that are far less dramatic and many learn to manage them very effectively with the right treatment.

Tourette's Disorder

Tourette’s Disorder (TD) is the most well-known and most studied tic condition. It is diagnosed when a person has had both motor and vocal tics for at least one year, with onset before age 18. Tourette’s is not rare it affects approximately 1 in 160 school-age children.

Tourette’s is significantly more common in boys than girls, at a ratio of approximately 3 to 4 to 1. It typically begins between ages 5 and 7, peaks in severity in early adolescence usually around ages 10 to 12 and often improves significantly by late adolescence or early adulthood. However, for some people tics persist into adulthood and continue to require management.

What Tourette's Feels Like From the Inside

People with Tourette’s often describe the experience as feeling an irresistible urge to tic similar to the feeling before you sneeze. You can hold it back for a short time, but eventually it has to come out. Holding tics back takes significant mental energy sometimes called “tic suppression” and often leads to a rebound of tics when the person relaxes, like after school or at home.

This is why children with Tourette’s may hold tics together well at school and then release them in a wave at home. It is not intentional behavior. It is the result of sustained, exhausting suppression throughout the day.

Tics are not a choice. Children with Tourette’s are not misbehaving, seeking attention, or doing it on purpose. Telling a child to ‘just stop’ is like telling someone not to sneeze it does not work, and it adds shame and frustration on top of an already difficult experience.

Conditions That Often Come With Tourette's and Tics

Tourette’s Disorder rarely travels alone. The majority of people with Tourette’s also have at least one other condition. Understanding these co-occurring conditions is one of the most important parts of assessment and treatment because they often cause more day-to-day difficulty than the tics themselves.

OCD (Obsessive-Compulsive Disorder)

Approximately 50 percent of people with Tourette’s also have OCD. The connection is so strong that some researchers consider Tourette’s and OCD to be related conditions on the same neurological spectrum. OCD in the context of Tourette’s can look somewhat different from OCD alone often involving more “just right” compulsions and sensory-driven rituals rather than classic contamination or harm obsessions.

We specialize in both Tourette’s and OCD and are trained to treat them together when both are present.

ADHD (Attention Deficit Hyperactivity Disorder)

ADHD co-occurs with Tourette’s in approximately 50 to 60 percent of cases. This combination can create significant challenges at school tics draw attention, impulsivity causes social friction, and difficulty focusing affects academic performance. Treating both conditions together leads to better outcomes than treating either one alone.

Anxiety Disorders

Anxiety including generalized anxiety, social anxiety, and separation anxiety is common in people with Tourette’s. Social anxiety in particular can develop as a response to the experience of having visible tics in public. Fear of being stared at, teased, or misunderstood can cause children and teens to withdraw from school, social activities, and friendships. We assess and treat anxiety alongside tics as a standard part of our work.

Rage Attacks and Emotional Dysregulation

Some children with Tourette’s experience sudden, intense episodes of anger or frustration that are out of proportion to the situation sometimes called “Tourette’s rage” or explosive episodes. These are thought to be related to the same neurological differences that produce tics, not to character or parenting. Behavioral strategies can help significantly.

A Note on Social Media and Tic Disorders

Since 2020, clinicians have observed a significant increase in functional tic-like behaviors in adolescent girls a pattern thought to be linked to social media exposure and viral tic-related content online. These presentations are different from Tourette’s Disorder and other primary tic conditions in their onset, presentation, and treatment approach.

If your child or teen developed new tics suddenly and dramatically particularly after significant social media use a proper assessment is important to determine whether this is a primary tic disorder or a functional neurological presentation.
The distinction matters because the treatment approach differs significantly.

How Are Tic Disorders Diagnosed?

Tic disorders are diagnosed based on clinical observation and history not on a blood test, brain scan, or standardized test. A proper diagnosis requires a trained professional who can assess the type of tics, how long they have been present, when they started, and what other conditions may be present alongside them.
At Anxiety & OCD Treatment Specialists, our assessment process includes:

A detailed clinical interview. We gather a full history of the tics type, frequency, when they started, what makes them better or worse, and how they affect daily life.
Assessment for co-occurring conditions. We screen for OCD, ADHD, anxiety, and other conditions that frequently accompany tic disorders.
Parent and school input. For children, we gather information from parents and, when helpful, from teachers or school counselors.
Treatment planning. Based on the assessment, we build a personalized treatment plan that addresses tics and any co-occurring conditions together.

If a medical evaluation has not yet been completed, we may recommend that a pediatrician or neurologist rule out medical causes of tic-like movements before or alongside behavioral treatment. PANDAS/PANS (a sudden onset of tics related to streptococcal infection) is one example of a medical cause that warrants pediatric evaluation.

How Are Tic Disorders Treated?

Tic disorders are very treatable. At Anxiety & OCD Treatment Specialists, we use CBIT the most evidence-based behavioral treatment for tics available. For some people, medication is also part of the picture, and we coordinate closely with prescribing physicians when that is the case.

CBIT Comprehensive Behavioral Intervention for Tics

CBIT is the gold-standard behavioral treatment for Tourette’s Disorder and other tic conditions. It has the strongest research support of any non-medication treatment for tics and is recommended as the first-line treatment by the American Academy of Neurology.
CBIT is made up of three core components:

Psychoeducation. You and your family learn about tics what they are, why they happen, how premonitory urges work, and why suppression alone is not effective. This knowledge is the foundation for everything else.
Habit Reversal Training (HRT). The core of CBIT. You learn to identify the premonitory urge that comes before each tic and practice a competing response a physical behavior that is incompatible with the tic and can be held until the urge passes. Over time, this disrupts the tic cycle and reduces tic frequency and intensity.
Function-Based Intervention. We identify situations, settings, and emotional states that make tics worse and develop strategies to address them. This might include changes in the environment, relaxation techniques, or stress-reduction strategies.

What CBIT Looks Like in Practice An Example

A child has a frequent head-jerking tic. Before each jerk, they feel a tension in their neck.

In CBIT, the therapist and child work together to:

Identify the premonitory urge the neck tension that comes first
Choose a competing response pressing the chin gently downward and tensing the neck muscles in the opposite direction, holding until the urge fades
Practice the competing response every time the urge appears at home, at school, and during session

Over several weeks of practice, the urge becomes less frequent and less intense. The tic does not disappear overnight but it becomes significantly more manageable. Most children and teens see meaningful reduction in their target tics within 8 to 12 sessions.

Exposure and Response Prevention (ERP) for Tic-Related OCD

For people with both Tourette’s and OCD, ERP is used alongside CBIT to address obsessions and compulsions. The two treatments are compatible and are often delivered in the same course of therapy. Our specialists are trained in both and can integrate them seamlessly.

Medication for Tic Disorders

We are therapists, not psychiatrists, and do not prescribe medication. However, medication plays an important role in tic management for some people particularly those with moderate to severe tics, significant distress, or co-occurring ADHD or OCD.

Medications commonly used for tics include alpha-2 agonists (like guanfacine and clonidine), which are often the first medication tried for tics, particularly in children. Antipsychotic medications (like aripiprazole and fluphenazine) may be used for more severe tics. For co-occurring ADHD, stimulant medications may be used carefully. For co-occurring OCD, SSRIs are often recommended.

We work closely with pediatricians, psychiatrists, and neurologists to coordinate care when medication is part of the plan. A collaborative approach combining CBIT with medication when appropriate tends to produce the best outcomes.

Tourette's and Tics at School

For children and teens, the school environment can be one of the most challenging places to have tics. Tics can draw attention from peers, be misunderstood by teachers, and require significant energy to manage throughout the school day.

What Schools Need to Know

Tics are not voluntary behavior or attention-seeking
Suppressing tics takes enormous mental energy and can affect concentration
Children with Tourette's may qualify for a 504 Plan or an IEP depending on the impact on their education
Accommodations might include preferential seating, extra time on tests, permission to leave the room briefly, and a plan for tic-related disruptions
Teachers should never single out or draw attention to a student's tics in front of the class

How We Help With School

We provide documentation to support 504 Plans and IEPs when needed.
We can write letters to schools explaining the diagnosis and recommended accommodations.
We are happy to consult with school counselors or teachers with the family's permission.
We teach children and teens self-advocacy skills so they can communicate about their tics with teachers and peers in a way that feels comfortable and empowering.
We also work with parents on how to navigate conversations with school administrators.

Tics and Peer Relationships

Tics can attract unwanted attention from peers, lead to teasing or bullying, and cause significant social anxiety. Many children and teens with Tourette’s withdraw socially to avoid judgment or embarrassment.

Treatment addresses this directly. We help children and teens develop confidence in talking about their tics, practice managing tics in social settings, and build the social skills and resilience to navigate peer relationships successfully. Parent guidance is also part of this work.

What to Expect When You Work With Us

Free 10-minute phone consultation. We listen to what is going on and answer your questions with zero judgment.
Full assessment. We assess the type, severity, and history of tics, co-occurring conditions, and the impact on daily life at home, school, and with peers.
A personalized CBIT plan. We identify the specific tics to target, determine the right competing responses, and map the situations that make tics worse.
Treatment for co-occurring conditions. If OCD, anxiety, or ADHD is also present, we address it as part of the same treatment plan not as a separate, disconnected process.
Parent involvement. Parents are an active part of CBIT for children. We teach you how to coach your child between sessions, respond to tics supportively, and coordinate with school.
School coordination. We provide letters, documentation, and guidance for 504 Plans and IEPs when needed.

Most people see meaningful reduction in target tics within 8 to 12 sessions. Some see results sooner. Results depend on consistent home practice CBIT is most effective when the competing responses are practiced throughout the day, not just during sessions.

In-Person and Virtual Sessions

In-person

730 S Sterling Ave, Suite 306, Tampa, FL 33609

Virtual

Available throughout Florida

CBIT works very well via video sessions. Your therapist can observe tics, teach competing responses, and coach practice in real time through a video appointment. Many families find virtual sessions convenient sessions can happen at home where tics are most visible and where practice naturally occurs.

Frequently Asked Questions

What is the difference between Tourette's Disorder and a tic disorder?

Tourette’s Disorder requires both motor tics and vocal tics that have been present for more than one year, with onset before age 18. Other tic disorders involve either motor or vocal tics only, or tics that have been present for less than one year. All tic disorders are treated with the same core approach CBIT and all are helped by working with a specialist trained in tic conditions.

Will my child's tics go away on their own?

For many children, tics do improve significantly over time particularly from early adolescence through late adolescence. Some people see tics resolve almost completely by their late teens or early twenties. Others continue to have tics in adulthood, though often at a reduced level. CBIT does not cure tics, but it significantly reduces their frequency and intensity and gives people effective tools to manage them throughout life. Early treatment also tends to produce better long-term outcomes.

My child can hold their tics in at school. Does that mean they are doing it on purpose?

No. Tic suppression is real people with tics can hold them back for periods of time, though it takes significant effort and is not fully voluntary. The fact that your child suppresses at school and releases at home is actually very common and is a sign that the suppression is working but at a cost. It often means they are exhausted by the time they get home. Treatment helps reduce the overall tic burden, so suppression takes less energy.

Should my child see a neurologist before starting CBIT?

It depends. If tics appeared suddenly, if they are severe or unusual, or if there is a recent history of streptococcal infection, a medical evaluation is worthwhile before or alongside behavioral treatment. For most children with a typical, gradual onset of tics, behavioral treatment can begin without waiting for a neurology referral. We will discuss this with you at your first appointment and recommend a referral if one is clinically indicated.

Is Tourette's Disorder related to OCD?

Yes significantly. About half of all people with Tourette’s also have OCD, and the two conditions share neurological features. The connection is strong enough that some researchers consider them part of the same spectrum of conditions. When both are present, a specialist who treats both using CBIT for tics and ERP for OCD can integrate the treatment in a way that addresses the full picture. We do exactly this.

Can adults have Tourette's Disorder?

Yes. While Tourette’s begins in childhood, it does not always resolve. Some adults have had tics their whole lives and never received treatment. Others had tics as children, saw them improve, and then noticed them returning during stressful periods in adulthood. CBIT is effective for adults as well as children and teens. It is never too late to get help.

What is PANDAS and how does it relate to tics?

PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. It describes a sudden, dramatic onset of OCD or tic symptoms following a streptococcal infection like strep throat. If your child suddenly developed intense tics or OCD symptoms very quickly seemingly overnight or over a few days PANDAS should be evaluated by a pediatrician. Behavioral therapy plays a role in PANDAS treatment, but medical evaluation and treatment come first.

Tics Do Not Have to Run Your Child's Life or Yours.

Tourette’s Disorder and tic conditions are among the most misunderstood diagnoses in child mental health. Many families spend years searching for the right help. We are here to provide it.

Our team at Anxiety & OCD Treatment Specialists is trained in CBIT the most effective treatment for tics and in the OCD, anxiety, and ADHD conditions that so often come alongside. We understand Tourette’s from the inside out, and we are ready to help your family.