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Tourette Syndrome (TS) is a neurodevelopmental disorder that typically begins in early childhood, often between the ages of 2 and 15, with an average onset around six years. Affecting approximately 0.3% to 1% of the global population, TS is more prevalent among boys than girls. Despite its neurological basis, it remains poorly understood and frequently misdiagnosed, particularly in school settings where symptoms are mistaken for behavioural issues.

Nature and Classification of Tics

Tourette Syndrome is characterised by tics—sudden, repetitive, and involuntary movements or vocalisations. These are classified as:

• Simple tics, such as eye blinking, facial grimacing, throat clearing, or sniffing, involve a single muscle group or sound.
• Complex tics are more coordinated, involving actions like hopping, touching objects, or uttering phrases. Rarely, individuals may display coprolalia, the involuntary use of obscene language.

Tics often intensify with stress or excitement, diminish during calm periods, and usually disappear in deep sleep. External stimuli such as excessive screen exposure have also been linked to an increase in tics, particularly in children.

Causes and Co-morbidities

While the exact cause of TS remains unknown, researchers point to a combination of genetic predisposition and neurobiological factors, including abnormalities in brain regions such as the basal ganglia and frontal lobes. Environmental triggers—like low birth weight, perinatal complications, and post-infectious conditions (e.g., streptococcal infections)—may also contribute.

Tourette’s often coexists with other conditions such as Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD), anxiety, depression, and learning disabilities. The presence of these co-morbidities complicates diagnosis and management.

Management and Treatment Approaches

Treatment is individualised and not always pharmacological. Many children with mild, non-disruptive tics do not require medication. Instead, Cognitive Behavioural Therapy (CBT) and behavioural interventions have shown significant efficacy. These therapies help children manage their symptoms while also training families to provide supportive environments that reduce stress and tic frequency.

Medications may be considered in severe cases where tics hinder daily functioning. Importantly, suppression or punishment of tics is counterproductive, often exacerbating symptoms due to built-up tension.

Social Stigma and the Need for Awareness

The primary challenge in managing TS lies not in the disorder itself, but in the societal misunderstanding surrounding it. Children with TS are often labelled as attention-seeking or disruptive, leading to social isolation and emotional distress. As seen in the case of a child from Kochi, delayed diagnosis and stigma worsened his condition until it was recognised as Tourette’s.

Educating teachers, parents, and peers is crucial. Early diagnosis, empathetic engagement, and inclusive school environments are essential to ensuring that children with TS are treated with dignity and compassion.