Many people associate Tourette’s Syndrome with childhood, often picturing young individuals displaying involuntary movements and sounds. This common perception leads to questions about whether such symptoms can emerge later in life. While Tourette’s Syndrome has specific diagnostic criteria typically linked to childhood, the appearance of tics in adulthood is a distinct phenomenon that warrants a closer look.
Typical Tourette’s Syndrome Onset
Tourette’s Syndrome (TS) is a neurodevelopmental disorder characterized by both multiple motor tics and at least one vocal tic. These tics are sudden, rapid, and repetitive, often preceded by a sensory urge. For a diagnosis of TS, these tics must have been present for more than one year, fluctuating in frequency and severity.
The onset of tics in TS typically occurs before the age of 18, with symptoms most commonly beginning between 5 and 10 years old. Simple motor tics, such as eye blinking or head jerking, often appear first, with vocal tics developing later. While tic severity can peak around 10 to 12 years of age, many individuals diagnosed in childhood experience a reduction in tic symptoms as they move into late adolescence and early adulthood.
Adult-Onset Tic Disorders
While Tourette’s Syndrome itself is generally diagnosed with an onset before age 18, tics can indeed appear for the first time in adulthood. When tics emerge in adulthood, they are usually classified differently than Tourette’s Syndrome. These adult-onset tics might be categorized as “other specified tic disorder” or “unspecified tic disorder” if they don’t meet the full criteria for Tourette’s or chronic tic disorders, especially regarding the age of onset.
The emergence of tics in adulthood is less common than childhood onset. It is crucial to distinguish between a new diagnosis of Tourette’s Syndrome in adulthood, which is rare, and tics developing as a symptom of other underlying conditions. Some adult-onset tics may also be a reactivation of mild, previously unnoticed childhood tics.
Potential Causes of Adult Tics
The appearance of tics in adulthood often points to underlying factors rather than a new onset of Tourette’s Syndrome. One category is “secondary tic disorders,” where tics are caused by other neurological conditions. These can include neurodegenerative diseases like Huntington’s disease or Parkinson’s disease, or conditions resulting from stroke, head trauma, or encephalitis. Brain lesions, particularly in areas like the basal ganglia, have also been linked to adult-onset tics.
Certain medications can also induce tics as a side effect, known as “medication-induced tics.” These may occur with stimulants, antipsychotics, or some anti-epileptic drugs. Illicit substance use, such as cocaine, can similarly trigger tic-like movements, falling under “substance-induced tics.”
“Psychogenic non-epileptic tics” are influenced by psychological factors like stress or anxiety, rather than a neurological cause. These tics may show inconsistencies with typical organic tics, such as lacking premonitory sensations or increasing when observed. Other medical conditions, including autoimmune disorders, infections, or metabolic imbalances, can also manifest with tic-like movements in adulthood.
Evaluating and Managing Adult Tics
When tics appear in adulthood, a thorough medical evaluation is conducted. This diagnostic process includes a detailed medical history, a comprehensive neurological examination, and often additional tests. Imaging studies, such as an MRI of the brain, or various blood tests may be performed to rule out other medical conditions.
Accurate diagnosis is important because management strategies are tailored to the specific cause of adult-onset tics. If an underlying medical condition or medication is identified, treating or adjusting that factor can reduce or resolve the tics. For tics that persist or have no identifiable secondary cause, symptomatic relief is the focus.
Behavioral therapies, such as Comprehensive Behavioral Intervention for Tics (CBIT), can be effective. CBIT helps individuals become aware of their tics and the urges that precede them, teaching competing responses to suppress or redirect movements. Medications may also be considered to reduce tic severity, particularly if tics significantly interfere with daily life. These include dopamine-blocking agents or other medications that influence neurotransmitter systems.