An article by Daniel P. Jones, Durham University, UK
Overview
In this paper, Dr. Cavanna invites further research into the risks and benefits of pharmaceutical medication for Tourette Syndrome, with a particular focus on children and adolescents. Drawing on existing research, Dr. Cavanna explores how, when and why medication is prescribed for Tourette Syndrome. The paper highlights the complexity of treatment decisions and calls for a more precise understanding of individual treatment needs, the effectiveness of medication over time, and its longer-term outcomes.
Key points from the paper
- Only a small portion of children and adolescents with tics seek clinical care.
- Tics can cause both physical and emotional harm, through pain and injury of the tics themselves or depression and loneliness through the stigmatisation and bullying of people with tics.
- Available medications deal with the impacts of ticcing, such as pain, depression and anxiety rather than the tics themselves. This is because tics can be influenced by co-occurring conditions, and vice versa.
- Tics can restrict everyday activities, including interrupting speech, sleep and focus resulting in lower academic performance on average. Medication tends to be prioritised when tics cause significant injury, aggression, medical complications, interruptions to daily-life, or life-threatening consequences. Clinicians use tools such as a ‘quality of life’ scale to help make these decisions.
- More research is needed to assess the usefulness of quality-of-life scales in helping clinicians to treat Tourette Syndrome. One example might be research that assesses how effective medications are on a long-term-scale, considering side effects and focusing on the needs of patients individually.
Critical reflections
As a researcher of Tourette Syndrome who also is diagnosed with Tourette Syndrome, I was particularly interested in the paper’s observation that only a small proportion of children and adolescents with tics seek clinical care. It is important to ask why this might be the case, and whether clinical data alone gives us the full picture.
Through my work with the regional charity TIC-Yorkshire (UK) over several years, we have seen a gap between the number of people with tics recorded in many healthcare settings and the number of people actually accessing community support. For example, some NHS GP practices across East Yorkshire and Humber have reported having ‘zero’ patients with tics, despite significant numbers of people accessing support through TIC-Yorkshire. This raises an important question: does this mean that there are no patients with tics, or that people are simply not being recognised, diagnosed, or referred correctly for support?
We also need to consider that some people may not feel comfortable seeking clinical care, particularly if they have had negative experiences with healthcare services or do not trust them to meet their needs. Others may receive a diagnosis but not be told about the support available to them, partly because healthcare professionals themselves may not know what local services exist. This means that clinical data alone may not tell us how many people are seeking clinical support or how they manage tics in their day-to-day lives.
With this in mind, we need to also look at what people do when medication is not prescribed, not helpful, or is not something they want to try. This includes community support, self-management, self-medication and other treatment approaches. Understanding these experiences would give us a fuller picture of how people with Tourette Syndrome find support and manage their tics over time.
I was pleased to see the paper consider the contexts in which tics happen. Whilst not all tics should be understood as context-specific, some research presents tics as random events that happen without any connection to a person’s surroundings. Social science research offers another perspective: tics do not happen in a vacuum. The situations people find themselves in, their social interactions and factors such as weather conditions can all shape their experiences of ticcing. Paying more attention to these contexts could help us better understand what living with Tourette Syndrome is actually like, and would allow clinicians to better assess when pharmacotherapy is a suitable option for the patient.
Finally, I strongly agree with this paper’s call for more research into the long-term impacts of Tourette Syndrome and its treatments. Much of the existing research focuses on children and teenagers, while adults are oftentimes overlooked. Adults may have spent many years trying different treatments, developing ways to manage their tics, and working out what helps them. Their experiences are valuable, and we need more research that takes them seriously. Listening to adults with Tourette Syndrome could help us better understand how treatments work over time, including what people find helpful, what they find difficult and what support they need as they age.
Overall, Dr. Cavanna’s paper raises important questions about how we make decisions about medication for Tourette Syndrome. However, I argue that we need to look beyond prescribing decisions to understand the wider support available to people with Tourette Syndrome, including those who do not access clinical care. This means recognising the limitations of healthcare data, paying attention to the different situations in which people experience tics, and taking seriously the knowledge that people with Tourette Syndrome develop through their own experiences.
Summary of:
Cavanna, A. E. (2026). When is pharmacotherapy necessary for Tourette Syndrome? The risks vs reward. Expert Opinion on Pharmacotherapy, 27(1), 21-25. https://doi.org/10.1080/14656566.2026.2629472