What is Tourette syndrome and what causes tics?

Tourette syndrome (TS) is a neurodevelopmental condition characterised by multiple motor tics and at least one vocal tic, present for more than one year, with onset before age 18. Tics are sudden, repetitive, involuntary movements or sounds. Motor tics range from simple (eye blinking, shoulder shrugging, head jerking) to complex (touching objects, jumping, making obscene gestures). Vocal tics range from simple (sniffing, throat clearing, grunting) to complex (repeating words, echolalia, or in a minority of cases, coprolalia, the involuntary use of offensive or inappropriate words). Coprolalia is the most widely known but least common TS symptom, affecting only 10 to 15% of people with TS; it is highly over-represented in media depictions. Tics are caused by dysfunction in the basal ganglia-thalamocortical circuits in the brain, involving dopamine regulation. Tics typically begin between 5 and 7 years of age, peak in severity in early adolescence (around 10 to 12), and improve significantly in adulthood for the majority of people.

What co-occurring conditions are common with Tourette syndrome?

Co-occurring conditions are present in the majority of people with Tourette syndrome and are often more functionally impairing than the tics themselves. The most common co-occurring conditions are: ADHD (attention deficit hyperactivity disorder), present in approximately 50 to 60% of people with TS; affects attention, impulse control, and executive function. OCD (obsessive-compulsive disorder), present in approximately 50% of people with TS; intrusive thoughts and compulsive behaviours that are distinct from, though sometimes resembling, tics. Anxiety disorders, including generalised anxiety and social anxiety; significantly common. Learning difficulties, including dyslexia and written expression difficulties. Rage attacks and emotional dysregulation, sometimes termed 'TS rage', which are intense, sometimes unpredictable emotional outbursts not explained by ADHD or OCD alone. Sleep disorders, including delayed sleep phase and restless leg syndrome. When planning support for a person with TS, understanding which co-occurring conditions are present is essential, as they often require distinct interventions.

Does Tourette syndrome qualify for NDIS?

Tourette syndrome can qualify for NDIS when it causes substantial functional impairment that is likely permanent. TS is a lifelong neurodevelopmental condition, satisfying the permanence criterion. For many people with mild to moderate TS, the tics alone may not cause substantial enough functional impairment to meet NDIS criteria; however, severe TS with significant tics, or TS with severe co-occurring ADHD, OCD, or anxiety, may meet the criteria. The NDIS access request must document the functional impact, not just the diagnosis. If the primary functional impairment arises from co-occurring OCD or ADHD, these conditions can be the basis of NDIS access in their own right. A paediatrician or psychiatrist report, combined with a functional assessment from an OT or psychologist documenting specific areas of impairment, forms the basis of the access request.

What are effective tic management strategies?

Several evidence-based strategies help manage tics. Comprehensive Behavioral Intervention for Tics (CBIT) is the most evidence-supported behavioural treatment for TS. CBIT involves: tic awareness training (learning to recognise the premonitory urge that precedes tics); competing response training (performing a behaviour incompatible with the tic when the urge arises, which prevents the tic from being expressed); and function-based interventions (identifying and modifying factors that worsen tics). CBIT is delivered by a psychologist trained in the approach over typically 8 to 10 sessions. Habit reversal training (HRT) is a component of CBIT. Medication options include: alpha-2 agonists (clonidine, guanfacine) which reduce tic severity with a relatively mild side effect profile; antipsychotic medications (aripiprazole, risperidone) for more severe tics; and others. Medication is prescribed by a paediatrician or psychiatrist. Relaxation and stress management reduce tic severity (tics typically worsen with stress and anxiety). Understanding and working with the waxing and waning pattern of tics (tics naturally fluctuate in severity) reduces distress about periods of increased tic activity.

What school adjustments help students with Tourette syndrome?

School is often the most challenging environment for children with TS because tics are more difficult to suppress in front of peers and the social consequences of tics can be significant. School adjustments fall into two categories: adjustments for tics themselves, and adjustments for co-occurring conditions. For tics: a private space where the person can release suppressed tics (tic release breaks); allowing the student to leave and return to the classroom discreetly; seating away from the front of the classroom to reduce the pressure of performing in front of everyone; teacher and peer education about TS; and not requiring the student to suppress tics during examinations (tic suppression is effortful and reduces concentration). For co-occurring ADHD or OCD: extended time; reduced distraction environment; written instructions; executive function support. Teacher education is often the most impactful intervention: a teacher who understands TS creates a compassionate classroom environment; one who does not may inadvertently shame the student for their tics.

How does Tourette syndrome affect workplace participation?

TS can affect workplace participation in several ways. Tics: visible or audible tics may attract unwanted attention or misconceptions from colleagues unfamiliar with TS; the effort of suppressing tics in professional settings is cognitively and physically tiring. Co-occurring ADHD: difficulties with organisation, time management, sustained attention, and completing tasks can significantly affect job performance without appropriate supports or job design. Co-occurring OCD: intrusive thoughts and compulsions may occupy attention and time. Social anxiety: relationships with colleagues and performance in social work situations (presentations, meetings, social events) may be more challenging. Workplace supports include: reasonable adjustments under the Disability Discrimination Act 1992 (quiet workspace, flexible scheduling, assistive technology, modified duties); disclosure to an employer or HR if reasonable adjustments are needed (disclosure is a personal decision and should not be assumed to be required); Employment Assistance Fund (EAF) for funding workplace modifications; and NDIS employment supports for eligible people. Organisations like JobAccess Australia provide practical information and funding for workplace adjustments.

What is CBIT and how is it accessed in Australia?

Comprehensive Behavioral Intervention for Tics (CBIT) is the most effective non-medication treatment for TS, with randomised controlled trial evidence supporting its efficacy. CBIT is delivered by a psychologist trained in the approach. The treatment teaches the person to recognise the premonitory urge (the uncomfortable sensation that precedes the tic), perform a competing response behaviour that makes the tic physically impossible to complete, and identify and address factors in the environment and behaviour that worsen tics. CBIT is delivered over 8 to 10 sessions, initially weekly then fortnightly. The treatment requires active engagement and practice between sessions. Accessing CBIT in Australia: the Tourette Syndrome Association of Australia maintains a directory of CBIT-trained therapists in Australia; not all psychologists have received this specific training, and it is worth verifying training before committing. CBIT is funded through NDIS Capacity Building (psychology sessions) for eligible people, or through Medicare-funded psychology sessions via a GP Mental Health Care Plan (10 sessions per year).

What peer support is available for people with Tourette syndrome in Australia?

Peer support is particularly valuable for people with TS given the isolation and misunderstanding many experience. The Tourette Syndrome Association of Australia provides: peer support groups in some states; an online community connecting people with TS across Australia; information and advocacy; and resources for schools and workplaces. Online international communities (Tourette Association of America online forums, Reddit communities for TS) provide connection with a larger peer group for people who cannot access local support. For children and teenagers, peer support in the school environment through peer education programs (where selected peers are educated about TS to create a more understanding classroom environment) can significantly reduce social difficulties. For families, parent peer support groups through the Tourette Syndrome Association of Australia provide connection with other families navigating similar challenges.

Tourette Syndrome in Daily Life: School, Work, and Social Participation Support Options in Australia

Key Points

Tourette syndrome involves involuntary motor and vocal tics; coprolalia (offensive words) affects only 10 to 15% of people with TS, contrary to media depictions; tics typically improve significantly in adulthood
Co-occurring conditions (ADHD in 50 to 60%, OCD in 50%) are often more functionally impairing than the tics; support planning must address the full picture, not just tics
CBIT (Comprehensive Behavioral Intervention for Tics) is the most evidence-supported non-medication treatment; it should be delivered by a psychologist with specific CBIT training; the Tourette Syndrome Association of Australia maintains a therapist directory
School adjustments are often the most impactful intervention; teacher education about TS, tic release breaks, and co-occurring condition accommodations are the priorities
NDIS may be appropriate for people with severe TS or significant co-occurring conditions causing substantial functional impairment; functional impact documentation is more important than diagnosis alone
Workplace participation can be supported through reasonable adjustments under the Disability Discrimination Act and the Employment Assistance Fund; JobAccess Australia provides information and funding guidance

Tourette Syndrome: Daily Life and Support

Tourette syndrome is a condition that most people think they understand from media portrayals, and most portrayals are wrong. The image of a person shouting offensive words is both rare in reality and harmful to the many people with TS who live full, productive lives while managing a condition that is largely invisible to those around them.

What is less visible is the effort that tic suppression demands, the social navigation required when tics occur in public, the fatigue from managing a brain that is also, in the majority of cases, dealing with ADHD, OCD, or both. The supports that make a difference for people with TS are rarely dramatic; they are teacher education, a private space for tic release, appropriate workplace flexibility, and access to CBIT.

This guide covers the daily life implications of TS, what support looks like in school and work settings, co-occurring condition management, NDIS access, and how to find providers who genuinely understand Tourette syndrome.

Understanding Tics

What Tics Feel Like

Tics are preceded by a premonitory urge: a building, uncomfortable sensation (described as pressure, an itch, an urge to complete a movement) in the part of the body about to tic. The tic provides temporary relief from this urge. This is why tic suppression is both possible and exhausting: the person can resist the tic, but the urge builds and the mental effort required is significant. After a period of suppression, tics often emerge in a burst when the person reaches a safe environment.

Understanding the premonitory urge is important for support workers and teachers: the person is not choosing to tic at inconvenient moments and not choosing to suppress at other times out of laziness. The effort of suppression is real and has a cost.

The Waxing and Waning Pattern

Tics naturally fluctuate in frequency and severity. They typically worsen with:

Stress and anxiety
Excitement
Fatigue
Hot environments
Attention being drawn to the tics

They typically reduce during:

Focused, absorbing activities
Calm, relaxed states
Sleep

Understanding this pattern prevents the misinterpretation that a person who has more tics in one situation than another is performing tics deliberately or for attention. Environmental factors are a consistent driver.

New Tics Replacing Old Ones

The type and location of tics change over time; it is common for a tic to resolve only to be replaced by a new tic in a different body part or a different sound. This is the natural history of TS and does not indicate that treatment has failed or that the condition is worsening.

Co-Occurring Conditions: The Full Picture

ADHD

ADHD co-occurring with TS affects executive function, attention, and impulse control. In many people with TS, ADHD is the primary driver of academic difficulty, job performance challenges, and daily organisation problems. ADHD management includes:

Medication (stimulant medications are effective for ADHD in TS; some evidence suggests stimulants may worsen tics in some individuals, though current guidelines support their use; the prescribing paediatrician or psychiatrist monitors for tic changes)
CBIT addresses tics; ADHD requires separate interventions
Executive function coaching (OT-based or through a psychologist)
Environmental supports (visual schedules, reminders, reduced distractions)

OCD

OCD co-occurring with TS requires ERP therapy delivered by a psychologist with OCD training. The distinction between tics (which have a premonitory urge and provide sensory relief) and OCD compulsions (which are driven by anxiety reduction) is clinically important; treatment differs. Some behaviours in TS can look like OCD but are actually complex tics (sometimes called tic-related OCD or tourettisms); a psychologist experienced in both TS and OCD can distinguish between them.

Rage and Emotional Dysregulation

TS rage (also called explosive episodes or disruptive behaviour outbursts) refers to intense, rapid-onset emotional dysregulation that resolves quickly. It is distinct from ADHD impulsivity and from OCD-related distress, though it may co-occur with both. Management involves:

Identifying and avoiding triggers (frustration, unexpected changes, sensory overload)
Regulation strategies taught by a psychologist
A de-escalation plan for when episodes occur
A behaviour support plan if the episodes are severe and frequent (developed by a registered behaviour support practitioner)

School Support

Teacher Education: The Most Impactful Step

Most teachers have had no training in TS and may be unfamiliar with even the basic features of the condition. A brief, factual education session (often provided by the school counsellor based on Tourette Syndrome Association of Australia resources, or delivered by the school psychologist) transforms the classroom environment.

Key points for teacher education:

Tics are involuntary; the child is not doing them for attention
Asking the child to stop is not only ineffective but increases distress and tic severity
Tic suppression is effortful and depletes cognitive resources available for learning
Co-occurring ADHD or OCD requires specific academic adjustments

Practical School Adjustments

Tic release breaks: Access to a quiet, private space (counsellor’s room, empty classroom) where the student can release suppressed tics without an audience. This break should be available on request without requiring explanation to classmates.

Seating: Away from the front of the classroom if the student finds being observed worsening their tics; near the front if ADHD-related attention difficulties benefit from proximity to the teacher.

Examination accommodations: Extended time if ADHD co-occurs; separate room if tic suppression during examination conditions is exhausting the student.

Peer education: With the student’s consent, a class-level education about TS (presented by the counsellor or via age-appropriate resources) reduces peer reactions and can transform the social environment.

Student Support Plan: Documenting all adjustments formally ensures consistency across teachers and years.

Work and Employment

Rights Under the Disability Discrimination Act

The Disability Discrimination Act 1992 (DDA) requires employers to make reasonable adjustments for employees with disabilities, which can include TS with significant co-occurring conditions. Reasonable adjustments do not have to be disclosed to colleagues; the conversation is between the employee and the employer/HR.

Reasonable adjustments for TS may include:

Flexible working arrangements (including working from home if the office environment significantly worsens tics due to stress or observation)
A quiet workspace with reduced social observation
Flexible meeting attendance (presenting options other than standing up in front of the full team)
Breaks for tic release
Modified work organisation to accommodate ADHD (clear task structures, written instructions, regular check-ins)

Employment Assistance Fund

The Employment Assistance Fund (EAF) provides funding for workplace modifications and equipment for employees with disability, including TS. Employers and employees can apply jointly. JobAccess Australia (jobaccess.gov.au) manages the EAF and provides free advice on workplace adjustments.

Supported Employment

For people with severe TS or significant co-occurring conditions who need more support in the workplace, NDIS Employment Supports and Disability Employment Services (DES) provide job coaching, employer education, and ongoing workplace support.

NDIS for Tourette Syndrome

When NDIS Is Appropriate

TS qualifies for NDIS when:

Tics are severe, causing significant physical injury risk (self-injurious complex tics) or complete disruption of daily functioning
Co-occurring ADHD, OCD, or other conditions cause substantial, likely permanent functional impairment
The combination of TS and co-occurring conditions substantially limits participation across multiple life domains

What NDIS Funds

For people who access NDIS with TS:

Psychology: CBIT, OCD/ERP therapy, ADHD management strategies (Capacity Building)
Behaviour support: For significant behavioural presentations including TS rage (Capacity Building)
OT: Functional assessment, daily living support, executive function coaching (Capacity Building)
Support workers: If daily living assistance is needed due to functional impairment (Core)
Community access: Support worker hours for community participation (Core)

Provider Team

Provider	Role	Funding
Paediatrician / neurologist / psychiatrist	Diagnosis, medication management, co-occurring conditions	Medicare
Psychologist (CBIT-trained)	CBIT for tics; ERP for OCD; ADHD coaching	NDIS, Medicare MHP
GP	Ongoing management, referrals, Mental Health Care Plan	Medicare
OT	Functional assessment, daily living, executive function	NDIS, Medicare CDM
Behaviour support practitioner	PBS plan if severe TS rage or behavioural presentations	NDIS Capacity Building
School counsellor	Teacher education, Student Support Plan	Education system
JobAccess advisor	Workplace adjustments, EAF funding	Free government service
Support workers	Daily living, community access (if NDIS eligible)	NDIS Core

Key Resources

Tourette Syndrome Association of Australia - peer support, CBIT therapist directory, and school/workplace resources
NDIS - psychosocial disability access information
JobAccess Australia - workplace adjustments, Employment Assistance Fund, and Disability Employment Services
Medicare Mental Health Care Plan - 10 psychology sessions per year via GP referral
OCD and Anxiety Australia - ERP therapist directory for co-occurring OCD

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Andre Smith All articles

Co-founder & CEO

Andre is the co-founder and CEO of Carevo. He holds a Bachelor of Commerce, majoring in Marketing, and a Bachelor of Arts from UNSW Sydney, where his majors were International Relations, Politics, Information Systems, and Media and Communications, graduating in 2014, and went through the UNSW 10x Founders accelerator in 2023.

Tourette Syndrome in Daily Life: School, Work, and Social Participation Support Options in Australia

Key Points

Tourette Syndrome: Daily Life and Support