Abstract:

Authors:

Hall SS, Rattu NR, Hall CL, et al

Year published:

2026

Further details:

BMJ Open

Abstract:

Authors:

Nikita R. Rattu, Olivia Hastings, Charlotte L. Hall, Kelly-Marie Prentice, Rebecca Woodcock, Emma McNally, Paul Stevenson, Suzanne Parsons, Madeleine J. Groom and Camilla M. Babbage

Year published:

2026

Further details:

Springer Nature Link

Abstract:

Authors:

Nikita R Rattu, Sophie S Hall, Charlotte L Hall, Tara Murphy, Joseph Kilgariff, Nadya James, Emma McNally, Alexia Jeayes, Kareem Khan, Suzanne Rimmer, Louise Thomson, Madeleine Jane Groom

Year published:

2025

Further details:

BMJ Mental Health

Abstract:

Authors:

Babbage CM, Davies EB, Jones DP, Stevenson P, Salvage J, Anderson S, McNally E & Groom MJ

Year published:

2025

Further details:

BMJ Mental Health

Abstract:

Authors:

Hall, C. L., Le Novere, M., Murphy, T., McNally, E., Hollis, C., & Hunter, R.

Year published:

2024

Further details:

BMJ Mental Health, 27(1), Article e301241.

Abstract:

Authors:

Ella C Ford, Neil S Coulson, E Bethan Davies

Year published:

2025

Further details:

JMIR Publications

Abstract:

Authors:

Hollis, C., Hall, C. L., Khan, K., Le Novere, M., Marston, L., Jones, R., Hunter, R., Brown, B. J., Sanderson, C., Andrén, P., Bennett, S. D., Chamberlain, L. R., Davies, E. B., Evans, A., Kouzoupi, N., McKenzie, C., Heyman, I., Kilgariff, J., Glazebrook, C., … Murphy, T.

Year published:

2023

Further details:

Health Technology Assessment (Winchester, England), 27(18), 1–120

Abstract:

Tics are common in children and young people and may persist into adulthood. Tics can cause challenges with social, occupational, physical, and academic functioning. The current study explores the perceptions of adults with tics and parents/carers of young people with tics regarding their experience of accessing support from professionals in primary care in the UK.

Authors:

Marino, C., Khan, K., Groom, M. J., Hall, S. S., Anderson, S., Mcnally, E., Murphy, T., & Hall, C. L.

Year published:

2023

Further details:

BMC Health Services Research, 23(1), 788.

Abstract:

Since the onset of the coronavirus (COVID-19) pandemic, clinicians have reported an increase in presentations of sudden and new onset tics particularly affecting teenage girls. This population-based study aimed to describe and compare the incidence of tics in children and young people in primary care before and during the COVID-19 pandemic in England.

Authors:

Jack, R. H., Joseph, R. M., Coupland, C. A. C., Hall, C. L., & Hollis, C.

Year published:

2023

Further details:

eClinicalMedicine, 57, 101857.

Abstract:

Co-occurring psychiatric conditions are very common in tic disorders and Tourette syndrome. These additional symptoms are often detrimental to quality of life and may impact upon the implementation and efficacy of evidence-based behavioural therapies (BT) for tics. Combining a review of the available literature, relevant theory, and expert clinical practice, we present a guideline for implementing behavioural and psychosocial interventions when common comorbidities are present. These include attention-deficit hyperactivity disorder (ADHD), obsessive–compulsive disorder (OCD), anxiety, disruptive behaviour, autism spectrum disorder (ASD) and depression. Practical recommendations are provided for assessment, formulation and management of specific and multiple comorbidities in BT for both children and adults. Despite comorbidities being common in tic disorders, few studies have comprehensively addressed how they may influence the efficacy or implementation of existing therapies or how such treatments may need to be modified or sequenced. We outline recommendations for future research, including randomised control trials of BT for those with specific or multiple comorbidities, as well as adequately powered sub-group analyses within larger scale trials or naturalistic study designs. Transdiagnostic models of psychiatric disorders and treatment, including modular cross-diagnostic therapies, which recognise the dimensionality of psychiatric disorders are also highlighted as an important focus in treatment development in tic disorders.

Authors:

Sanderson, C., Verdellen, C., Debes, N., Tárnok, Z., van de Griendt, J., Zimmerman-Brenner, S., & Murphy, T.

Year published:

2022

Further details:

European Child & Adolescent Psychiatry.

Abstract:

Individuals with Tourette syndrome (TS) frequently have co-occurring symptoms of attention-deficit/hyperactivity disorder (ADHD). ADHD is a neurodevelopmental condition characterized by persistent, developmentally inappropriate and impairing symptoms of inattention, hyperactivity and impulsivity. Importantly, ADHD is strongly associated with impairments in cognitive control. Since the self-regulatory processes that constitute cognitive control are implicated in tic control and response to behavioral tic therapies in individuals with TS, it is crucial to understand how co-occurring ADHD affects these processes. In this chapter we review and critically evaluate the literature that has investigated this issue. We specifically focus on studies that examined effects of co-occurring ADHD on electrophysiological correlates of cognitive control in TS since these measures are particularly sensitive to the underlying neurocognitive mechanisms of cognitive control.

Authors:

Shephard, E., Groom, M. J., & Jackson, G. M.

Year published:

2022

Further details:

In M. E. Lavoie & A. E. Cavanna (Eds.), International Review of Movement Disorders (Vol. 3, pp. 423–441). Academic Press.

Abstract:

Tic disorders (TDs) are complex neurological conditions characterized by involuntary, persistent vocalizations and motor movements called tics. Tics involve brief muscle movements and can impair many aspects of daily functioning and quality of life in patients – and their physical nature can cause pain. Understanding individuals' experiences of tic-related pain and pain management could help explore this under-researched area and identify additional support needs for this population. The aim of this study was to investigate experiences of pain and use of pain management techniques in people with tic disorders.

Authors:

Taylor, E., Anderson, S., & Davies, E. B.

Year published:

2022

Further details:

Frontiers in Psychiatry, 13.

Abstract:

Exposure and Response Prevention (ERP) is a form of behavioural therapy for tics; however, its effectiveness remains uncertain. We aimed to evaluate the effectiveness of internet-delivered, therapist-supported, and parent-assisted ERP for treatment of tics in children and young people with Tourette syndrome or chronic tic disorder.

Authors:

Hollis, C., Hall, C. L., Jones, R., Marston, L., Novere, M. L., Hunter, R., Brown, B. J., Sanderson, C., Andrén, P., Bennett, S. D., Chamberlain, L. R., Davies, E. B., Evans, A., Kouzoupi, N., McKenzie, C., Heyman, I., Khan, K., Kilgariff, J., Glazebrook, C., … Murray, E.

Year published:

2021

Further details:

The Lancet Psychiatry, 8(10), 871–882.

Abstract:

Since the onset of the COVID-19 pandemic, paediatricians and child mental health practitioners have noticed an increase in tic symptoms in some children and adolescents already diagnosed with tic disorders.1 Interestingly, clinicians have also seen a marked increase in presentations of sudden and new onset of severe tics and ‘tic-like’ attacks.

There is an urgent need to collate systematic data on this group as this is a rare and unusual subtype of tics and Tourette syndrome, differing in age and type of onset and expected patterns of tics. Typically, childhood tics start around 5–7 years and show a waxing and waning course of predominantly motor tics, more commonly affecting boys in a ratio of 4:1. The new surge of referrals consists of adolescent girls with sudden onset of motor and phonic tics of a complex and bizarre nature. In London, UK specialist tic clinics at each of the two children’s hospitals, each centre received four to six referrals per year (out of a total of approximately 200 in 2019/2020), which were acute onset tics in teenage girls. In the last 3 months (end of 2020–January 2021), both centres have been receiving three to four referrals per week of this nature which, if it continues, would amount to 150–200 cases per year and effectively double the referral rate.

Initial impressions are that these adolescent girls fall into two groups: the first present with explosive functional tic-like movements on a background of diagnosis of, or vulnerability to, motor and phonic tics. The second group comprises florid, completely new onset tic-like disorder that appears functional in nature. Both groups may have undiagnosed neurodevelopmental impairment, autism spectrum disorder (ASD), specific learning difficulties and attention deficit hyperactivity disorder (ADHD). Distinguishing these two subtypes can be challenging; however, the likelihood is that in either case the precipitating factor for symptomatology and impairment is anxiety (probably in part COVID-19 related), and importantly, the same management strategies are suggested for both of these groups.

Authors:

Heyman, I., Liang, H., & Hedderly, T.

Year published:

2021

Further details:

106(5), 420–421.

Abstract:

Impaired habit-learning has been proposed to underlie the tic symptoms of Tourette syndrome (TS). However, accounts differ in terms of how habit-learning is altered in TS, with some authors proposing habit formation is impaired due to a deficient ‘chunking’ mechanism, and others proposing habit-learning is overactive and tics reflect hyperlearned behaviours. Attention-deficit/hyperactivity disorder (ADHD) frequently co-occurs with TS and is known to affect cognitive function in young people with co-occurring TS and ADHD (TS + ADHD). It is unclear, however, how co-occurring ADHD symptoms affect habit-learning in TS. In this study, we investigated whether young people with TS would show deficient or hyperactive habit-learning, and assessed the effects of co-occurring ADHD symptoms on habit-learning in TS. Participants aged 9–17 years with TS (n = 18), TS + ADHD (n = 17), ADHD (n = 13), and typical development (n = 20) completed a motor sequence learning task to assess habit-learning. We used a 2 (TS-yes, TS-no) × 2 (ADHD-yes, ADHD-no) factorial analysis to test the effects of TS, ADHD, and their interaction on accuracy and reaction time indices of sequence learning. TS was associated with intact sequence learning, but a tendency for difficulty transitioning from sequenced to non-sequenced performance was suggestive of hyper-learning. ADHD was associated with significantly poorer accuracy during acquisition of the sequence, indicative of impaired habit-learning. There were no interactions between the TS and ADHD factors, indicating young people with TS + ADHD showed both TS- and ADHD-related atypicalities in habit-learning.

Authors:

Shephard, E., Groom, M. J., & Jackson, G. M.

Year published:

2019

Further details:

Journal of Neuropsychology, 13(3), 529–549.

Abstract:

Authors:

Kim, S., Jackson, S. R., Groom, M., & Jackson, G. M.

Year published:

2018

Further details:

Cortex, 109, 50–59.

Abstract:

Altered reinforcement learning is implicated in the causes of Tourette syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD). TS and ADHD frequently co-occur but how this affects reinforcement learning has not been investigated. We examined the ability of young people with TS (n = 18), TS + ADHD (N = 17), ADHD (n = 13) and typically developing controls (n = 20) to learn and reverse stimulus-response (S-R) associations based on positive and negative reinforcement feedback. We used a 2 (TS-yes, TS-no) × 2 (ADHD-yes, ADHD-no) factorial design to assess the effects of TS, ADHD, and their interaction on behavioural (accuracy, RT) and event-related potential (stimulus-locked P3, feedback-locked P2, feedback-related negativity, FRN) indices of learning and reversing the S-R associations. TS was associated with intact learning and reversal performance and largely typical ERP amplitudes. ADHD was associated with lower accuracy during S-R learning and impaired reversal learning (significantly reduced accuracy and a trend for smaller P3 amplitude). The results indicate that co-occurring ADHD symptoms impair reversal learning in TS + ADHD. The implications of these findings for behavioural tic therapies are discussed.

Authors:

Shephard, E., Jackson, G. M., & Groom, M. J.

Year published:

2016a

Further details:

International Journal of Developmental Neuroscience, 51, 17–27.

Abstract:

The ability to withhold unwanted behaviours is one of several self-regulatory processes that facilitate voluntary control over thought and action, referred to by the term ‘cognitive control’. As a group, young people with uncomplicated TS (those without co-occurring symptoms of other disorders) show equivalent (Baym, Corbett, Wright, & Bunge, 2008; Roessner, Albrecht, Dechent, Baudewig, & Rothenberger, 2008) or enhanced (Jackson, Mueller, Hambleton, & Hollis, 2007; Jackson et al., 2011; Jung, Jackson, Nam, Hollis, & Jackson, 2015; Mueller, Jackson, Dhalla, Datsopoulos, & Hollis, 2006) cognitive control performance compared with typically developing participants (but see Crawford, Channon, & Robertson, 2005). Furthermore, within TS samples those with the poorest cognitive control have the most severe tics (Baym et al., 2008; Jackson et al., 2007, 2011; Jung et al., 2015) and show the smallest reductions in tic severity with behavioural therapy (Deckersbach, Rauch, Buhlmann, & Wilhelm, 2006), suggesting an association between cognitive control and tic control. In support of this, cognitive control performance in TS is associated with increased activity in pre-frontal cortex (Baym et al., 2008; Jackson et al., 2011; Serrien, Orth, Evans, Lees, & Brown, 2005) and changes in white matter integrity in frontal cortex (Jackson et al., 2011), suggesting compensatory neural adaptation may underlie the enhanced cognitive control in TS (Jung, Jackson, Parkinson, & Jackson, 2013). Together, these findings indicate that lower tic severity, greater tic control, and a positive response to behavioural tic treatments are associated with cognitive control, behaviourally and neurally. Interestingly, several studies have reported cognitive control impairments in adults with TS (Rankins, Bradshaw, & Georgiou-Karistianis, 2006; Watkins et al., 2005). These individuals represent the minority of patients in whom tics do not remit in late adolescence/early adulthood. It is possible that poor cognitive control in these individuals reflects an inability to gain control of their tics, which might explain the non-remittance of their symptoms.

Authors:

Shephard, E., Jackson, G. M., & Groom, M. J.

Year published:

2016b

Further details:

Journal of Neuropsychology, 10(2), 223–238.

Abstract:

The study found that antipsychotics, noradrenergic agents and habit reversal training/comprehensive behavioural intervention for tics are effective in reducing tics in children and young people with Tourette syndrome. The balance of benefits and harms favours the most commonly used medications: risperidone (Risperdal, Janssen), clonidine (Dixarit, Boehringer Ingelheim) and aripiprazole (Abilify, Otsuka).

Authors:

Hollis, C., Pennant, M., Cuenca, J., Glazebrook, C., Kendall, T., Whittington, C., Stockton, S., Larsson, L., Bunton, P., Dobson, S., Groom, M., Hedderly, T., Heyman, I., Jackson, G. M., Jackson, S., Murphy, T., Rickards, H., Robertson, M., & Stern, J.

Year published:

2016

Further details:

Health Technology Assessment, 20(4), 1–450.

Abstract:

Tourette syndrome (TS) among young people is associated with psychosocial difficulties and parents play an important role in the management of the condition. Clinical guidelines have been developed for the treatment of TS and tics, but little is known about how young people and their parents perceive their treatment options or their desired outcomes of treatment. The aim of this study is to explore perceptions of treatments for tics among young people with TS and their parents.

Methods: In-depth interviews with 42 young people with TS and a mixed-methods, online survey of 295 parents of young people with TS. Participant recruitment was conducted through Tourettes Action (TA): a non-profit UK organisation for the support of people with TS. Interview transcripts were analysed using thematic analysis and responses to survey open-ended questions were analysed using content analysis. Triangulation of qualitative and quantitative data from the parents’ survey and qualitative data from the interviews with young people was used to increase the validity and depth of the findings.

Authors:

Cuenca, J., Glazebrook, C., Kendall, T., Hedderly, T., Heyman, I., Jackson, G., Murphy, T., Rickards, H., Robertson, M., Stern, J., Trayner, P., & Hollis, C.

Year published:

2015

Further details:

BMC Psychiatry, 15, 46

Abstract:

Chronic tic disorders (CTD) are characterized by motor and/or vocal tics. Existing data on the impact of tics in adulthood is limited by small, treatment-seeking samples or by data aggregated across adults and children. The current study explored the functional impact of tics in adults using a nationwide sample of 672 participants with a self-reported CTD. The impact of tics on physical, social, occupational/academic, and psychological functioning was assessed. Results suggested mild to moderate functional impairment and positive correlations between impairment and tic severity. Notable portions of the sample reported social or public avoidance and experiences of discrimination resulting from tics. Compared to previously reported population norms, participants had more psychological difficulties, greater disability, and lower quality of life. The current study suggests that CTDs can adversely impact functioning in adults and highlights the need for clinical interventions and systemic efforts to address tic-related impairments.

Authors:

Conelea, C. A., Woods, D. W., Zinner, S. H., Budman, C. L., Murphy, T. K., Scahill, L. D., Compton, S. N., & Walkup, J. T.

Year published:

2013

Further details:

Community Mental Health Journal, 49(1), 110–120. 

Abstract:

Children with neurological disorders may follow unique developmental trajectories whereby they undergo compensatory neuroplastic changes in brain structure and function that help them gain control over their symptoms [1–6]. We used behavioral and brain imaging techniques to investigate this conjecture in children with Tourette syndrome (TS). Using a behavioral task that induces high levels of intermanual conflict, we show that individuals with TS exhibit enhanced control of motor output. Then, using structural (diffusion-weighted imaging) brain imaging techniques, we demonstrate widespread differences in the white matter (WM) microstructure of the TS brain that include alterations in the corpus callosum and forceps minor (FM) WM that significantly predict tic severity in TS. Most importantly, we show that task performance for the TS group (but not for controls) is strongly predicted by the WM microstructure of the FM pathways that lead to the prefrontal cortex and by the functional magnetic resonance imaging blood oxygen level-dependent response in prefrontal areas connected by these tracts. These results provide evidence for compensatory brain reorganization that may underlie the increased self-regulation mechanisms that have been hypothesized to bring about the control of tics during adolescence.

Authors:

Jackson, S. R., Parkinson, A., Jung, J., Ryan, S. E., Morgan, P. S., Hollis, C., & Jackson, G. M.

Year published:

2011

Further details:

Current Biology, 21(7), 580–585.