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Question 41: what was the easiest way to get Dx, without the doc missing the Tourettes? [Also] You have said that TS is like having a little kid in your head that copy and repeats movements which ends up being tics. Does this apply to verbal/phonic tics? I can see how complex phonic tics could be like that. But I can't see how this works with simple phonic tics. R.J., CA, USA.

Hi R.J.:

Often the reason doctors 'miss' the diagnosis is because they don't realize that a person can suppress or hide tics. Hence the individual comes in, says they have TS, but the doctor doesn't see any movements or noises. One of the ways to avoid this is to keep a logbook of your symptoms (what they are, when they occur, what makes them increase/decrease, how long you've had each symptom, etc.). Another thing to do is to tape or video some of your tics so that even if your tics go away at the doctor appointment (something that is not unusual at all) you can still show the doctor some 'evidence'. Finally, many doctors who work with TS regularly know about this "doctor's office syndrome", and have various 'tricks' for seeing the tics anyway (such as peeking at you in the waiting room, keeping you in the office a long time so that your TS gets used to the place and comes out, giving you a frustrating task that increases your stress and therefore your tics, asking you to purposely hold in the tics to see if this makes the tics worse after you no longer have to hold them in, etc.)

Regarding your second question, definitely that 'little kid' analogy works with phonic tics too -- even simple ones. Take a sniff, or throat-clearing, for example (two common simple tics). Like blinking your eyes, you sniff or clear your throat a LOT in a day (especially in the winter or if you have a cold) and you tend to do it the same way each time. This might sometimes get the attention of that little kid! Even certain noises that occur a lot
in your speech (some syllables or phonemes such as 'ah' or 'uh') can grab that kid's interest! I used to say 'kay' all the time (short form for "OK"). It became a tic that you can hear in the Museum of Tics or by clicking here.

Have a good weekend R.J.! cheers,

Dr. Dunc.

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