Objective: To determine whether forms of Tourette syndrome (TS) first manifesting in adolescence (age 12 or older) are different from forms of TS occurring in childhood (< 12yr).

Background: Although TS is defined by the occurrence of tics before the age of 18yr, typically tics appear significantly younger, around the age of 6 years old.

Method: Children and adolescents with primary tic disorders have been prospectively included in our Registry in Calgary, Canada, since 2017. In this study, sex, age at tic onset, Yale Global Tic Severity Scale (YGTSS) scores including detailed tic inventory, comorbidities and treatment were compared between youth whose tics appeared before 12yr and those whose tics appeared at 12yr or older.

Results: Youths whose age at tic onset was unknown (n=7/316, 2.2%) were excluded from the analyses. Therefore, a total of 309 children and adolescents with primary tic disorders were included (76.4% males, 81.5% with TS, mean age at first clinical assessment: 10.6yr, 95%CI=10.3-11.0). Mean age at tic onset was 6.6yr (95%CI=6.2-6.9). Latency from tic onset to first visit was 4.0yr (95%CI=3.6-4.5). The subset of adolescents aged ≥ 12yr at tic onset represented only 7.4% (n=23) of the total sample. Age at tic onset followed a normal distribution between the ages of 1 and 12. There was no difference in sex ratio between the younger group and the older group, nor in comorbidities except for a slightly higher proportion of ADHD in the adolescents (69.6% vs 48.3%, p=0.049). There was no significant difference in severity of motor tics, phonic tics, tic-related impairment, number of simple or complex tics and motor or phonic tics. Adolescents were treated more often with botulinum toxin (n=1, 4.4%) than children (n=1, 0.4%) (p=0.021).

Conclusion: Tics first appear at the age of 12 or over in a small proportion of youths with TS. We found no significant clinical difference between youths whose tics appeared before age 12 and those whose tics appeared later. It cannot be excluded that adolescents and their parents reporting a tic onset after the age of 12 may have overlooked the appearance of tics before that age, or inaccurately recalled age at onset. Given the higher proportion of ADHD in the adolescent group, future studies should examine in this subgroup the severity of ADHD symptoms and that of other comorbidities, which can sometimes overshadow tic symptoms.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/exploring-youth-with-tourette-syndrome-whose-tics-first-manifested-after-age-12/