Symptoms include multiple motor and one or more vocal tics present at some time during the disorder although not necessarily simultaneously; the occurrence of tics many times a day (usually in bouts) nearly every day or intermittently throughout a span of more than one year; the periodic change in the number, frequency, type and location of the tics, and in the waxing and waning of their severity; symptoms disappearing for weeks or months at a time; and onset before the age of 18.
Vocal tics may fall into various categories, including echolalia (the urge to repeat words spoken by someone else after being heard by the person with the disorder), palilalia (the urge to repeat one's own previously spoken words), lexilalia (the urge to repeat words after reading them) and, most controversially, coprolalia (the spontaneous utterance of socially objectionable words, such as obscenities and racial or ethnic slurs). However, according to the Tourette Syndrome Association, Inc., only approximately 10% TS patients suffer from this aspect of the malady. There are many other vocal tics besides those categorized by word repetition - in fact, a TS tic can be almost any possible short vocal sound, with the most common tics resembling throat clearing, short coughs, coughing, grunts, or moans. Motor tics can be of endless variety and may include hand-clapping, neck stretching, shoulder shrugging, eye blinking, and contorted facial grimacing.
The term "involuntary" used to describe TS tics is a source of confusion since it is known that most people with TS do have some control over the symptoms. Before tic onset, individuals with TS experience what is called a "premonitory urge," similar to the feeling that precedes yawning. What is recognized is that the control which can be exerted from seconds to hours at a time may merely postpone and exacerbate outbursts of symptoms. Tics are experienced as irresistible as a yawn and must eventually be expressed. People with TS often seek a secluded spot to release their symptoms after delaying them in school or at work. Typically, tics increase as a result of tension or stress (but are not caused by stress) and decrease with relaxation or concentration on an absorbing task. In fact, neurologist and writer Oliver Sacks has described a man with severe TS who is both a pilot and a surgeon.
Tourette Syndrome patients sometimes exhibit other symptoms to accompany their physical or vocal "tics" in the form of Attention Deficit Disorder (ADD), Attention Deficit Hyperactivity Disorder (ADHD), Obsessive-Compulsive Disorder (OCD), Non-OCD Anxiety Disorders, Executive Dysfunction, Depression, Bipolar Disorder, Autism Spectrum disorders including Asperger's Disorder, "Rage Attacks," as well as Sensory Integration issues, and Sleep Disorders. Tourettes in this form is described as the disorder "Tourette Syndrome Plus", which was a term coined to explain that not all of the symptoms experienced by persons with tics are related to Tourette's. Studies have shown no correlation with tic severity and the onset of puberty, and most tics remit or subside as one passes through adolescence. Some well-known persons with Tourette's are Dr. Samuel Johnson, Jim Eisenreich, and Tim Howard.