have tics may not be aware that they have them. a study that used video to record tics in adults found that nine out of ten adults still had tics, and half of the adults who considered themselves tic-free displayed evidence of mild tics. quality of life people with tourette's are affected by the consequences of tics and by the efforts to suppress them. head and eye tics can interfere with reading or lead to headaches, and forceful tics can lead to repetitive strain injury. severe tics can lead to pain or injuries; as an example, a rare cervical disc herniation was reported from a neck tic. some people may learn to camouflage socially inappropriate tics or channel the energy of their tics into a functional endeavor. a supportive family and environment generally give those with tourette's the skills to manage the disorder. outcomes in adulthood are associated more with the perceived significance of having tics as a child than with the actual severity of the tics. a person who was misunderstood, punished or teased at home or at school is likely to fare worse than a child who enjoyed an understanding environment. the long-lasting effects of bullying and teasing can influence self-esteem, self-confidence, and even employment choices and opportunities. comorbid adhd can severely affect the child's well-being in all realms, and extend into adulthood. factors impacting quality of life change over time, given the natural fluctuating course of tic disorders, the development of coping strategies, and a person's age. as adhd symptoms improve with maturity, adults report less negative impact in their occupational lives than do children in their educational lives. tics have a greater impact on adults' psychosocial function, including financial burdens, than they do on children. adults are more likely to report a reduced quality of life due to depression or anxiety; depression contributes a greater burden than tics to adults' quality of life compared to children. as coping strategies become more effective with age, the impact of ocd symptoms seems to diminish. epidemiology tourette syndrome is a common but underdiagnosed condition that reaches across all social, racial and ethnic groups. it is three to four times more frequent in males than in females. observed prevalence rates are higher among children than adults because tics tend to remit or subside with maturity and a diagnosis may no longer be warranted for many adults. up to 1% of the overall population experiences tic disorders, including chronic tics and transient (provisional or unspecified) tics in childhood. chronic tics affect 5% of children and transient tics affect up to 20%. many individuals with tics do not know they have tics, or do not seek a diagnosis, so epidemiological studies of ts "reflect a strong ascertainment bias" towards those with co-occurring conditions. the reported prevalence of ts varies "according to the source, age, and sex of the sample; the ascertainment procedures; and diagnostic system", with a range reported between 0.15% and 3.0% for children and adolescents. sukhodolsky, et al. wrote in 2017 that the best estimate of ts prevalence in children was 1.4%. both robertson and stern states that the prevalence in children is 1%. the prevalence of ts in the general population is estimated as 0.3% to 1.0%. according to turn of the century census data, these prevalence estimates translated to half a million children in the us with ts and half a million people in the uk with ts, although symptoms in many older individuals would be almost unrecognizable. tourette syndrome was once thought to be rare: in 1972, the us national institutes of health (nih) believed there were fewer than 100 cases in the united states, and a 1973 registry reported only 485 cases worldwide. however, numerous studies published since 2000 have consistently demonstrated that the prevalence is much higher. recognizing that tics may often be undiagnosed and hard to detect, newer studies use direct classroom observation and multiple informants (parents, teachers and trained observers), and therefore record more cases than older studies. as the diagnostic threshold and assessment methodology have moved towards recognition of milder cases, the estimated prevalence has increased. because of the high male prevalence of ts, there is limited data on females from which conclusion about gender-based differences can be drawn; caution may be warranted in extending conclusions to females regarding the characteristics and treatment of tics based on studies of mostly males. a 2021 review stated that females may see a later peak than males in symptoms, with less remission over time, along with a higher prevalence of anxiety and mood disorders. history jean-martin charcot was a french neurologist and professor who named tourette syndrome for his intern, georges gilles de la tourette. in a clinical lesson at the salpêtrière (1887), andré brouillet portrays a medical lecture by charcot (the central standing figure) and shows de la tourette in the audience (seated in the first row, wearing an apron). a french doctor, jean marc gaspard itard, reported the first case of tourette syndrome in 1825, describing the marquise de dampierre, an important woman of nobility in her time. in 1884, jean-martin charcot, an influential french physician, assigned his student and intern georges gilles de la tourette, to study patients with movement disorders at the salpêtrière hospital, with the goal of defining a condition distinct from hysteria and chorea. in 1885, gilles de la tourette published an account in study of a nervous affliction of nine people with "convulsive tic disorder", concluding that a new clinical category should be defined. the eponym was bestowed by charcot after and on behalf of gilles de la tourette, who later became charcot's senior resident. following the 19th-century descriptions, a psychogenic view prevailed and little progress was made in explaining or treating tics until well into the 20th century. the possibility that movement disorders, including tourette syndrome, might have an organic origin was raised when an encephalitis lethargica epidemic from 1918 to 1926 was linked to an increase in tic disorders. during the 1960s and 1970s, as the beneficial effects of haloperidol on tics became known, the psychoanalytic approach to tourette syndrome was questioned. the turning point came in 1965, when arthur k. shapiro—described as "the father of modern tic disorder research"—used haloperidol to treat a person with tourette's, and published a paper criticizing the psychoanalytic approach. in 1975, the new york times headlined an article with "bizarre outbursts of tourette's disease victims linked to chemical disorder in brain", and shapiro said: "the bizarre symptoms of this illness are rivaled only by the bizarre treatments used to treat it." during the 1990s, a more neutral view of tourette's emerged, in which a genetic predisposition is seen to interact with non-genetic and environmental factors. the fourth revision of the dsm (dsm-iv) in 1994 added a diagnostic requirement for "marked distress or significant impairment in social, occupational, or other important areas of functioning", which led to an outcry from ts experts and researchers, who noted that many people were not even aware they had ts, nor were they distressed by their tics; clinicians and researchers resorted to using the older criteria in research and practice. in 2000, the american psychiatric association revised its diagnostic criteria in the fourth text revision of the dsm (dsm-iv-tr) to remove the impairment requirement, recognizing that clinicians often see people who have tourette's without distress or impairment. society and culture main article: societal and cultural aspects of tourette syndrome samuel johnson c. 1772. johnson is likely to have had tourette syndrome. not everyone with tourette's wants treatment or a cure, especially if that means they may lose something else in the process. the researchers leckman and cohen believe that there may be latent advantages associated with an individual's genetic vulnerability to developing tourette syndrome that may have adaptive value, such as heightened awareness and increased attention to detail and surroundings. accomplished musicians, athletes, public speakers and professionals from all walks of life are found among people with tourette's. the athlete tim howard, described by the chicago tribune as the "rarest of creatures—an american soccer hero", and by the tourette syndrome association as the "most notable individual with tourette syndrome around the world", says that his neurological makeup gave him an enhanced perception and an acute focus that contributed to his success on the field. samuel johnson is a historical figure who likely had tourette syndrome, as evidenced by the writings of his friend james boswell. johnson wrote a dictionary of the english language in 1747, and was a prolific writer, poet, and critic. there is little support for speculation that mozart had tourette's: the potentially coprolalic aspect of vocal tics is not transferred to writing, so mozart's scatological writings are not relevant; the composer's available medical history is not thorough; the side effects of other conditions may be misinterpreted; and "the evidence of motor tics in mozart's life is doubtful". likely portrayals of ts or tic disorders in fiction predating gilles de la tourette's work are "mr. pancks" in charles dickens's little dorrit and "nikolai levin" in leo tolstoy's anna karenina. the entertainment industry has been criticized for depicting those with tourette syndrome as social misfits whose only tic is coprolalia, which has furthered the public's misunderstanding and stigmatization of those with tourette's. the coprolalic symptoms of tourette's are also fodder for radio and television talk shows in the us and for the british media. high-profile media coverage focuses on treatments that do not have established safety or efficacy, such as deep brain stimulation, and alternative therapies involving unstudied efficacy and side effects are pursued by many parents. research directions research since 1999 has advanced knowledge of tourette's in the areas of genetics, neuroimaging, neurophysiology, and neuropathology, but questions remain about how best to classify it and how closely it is related to other movement or psychiatric disorders. modeled after genetic breakthroughs seen with large-scale efforts in other neurodevelopmental disorders, three groups are collaborating in research of the genetics of tourette's: the tourette syndrome association international consortium for genetics (tsaicg) tourette international collaborative genetics study (tic genetics) european multicentre tics in children studies (emtics) compared to the progress made in gene discovery in certain neurodevelopmental or mental health disorders—autism, schizophrenia and bipolar disorder—the scale of related ts research is lagging in the united states due to funding. notes according to dale (2017), over time, 15% of people with tics have only ts (85% of people with tourette's will develop a co-occurring condition). in a 2017 literature review, sukhodolsky, et al. stated that 37% of individuals in clinical samples had pure ts. denckla (2006) reported that a review of patient records revealed that about 40% of people with tourette's have ts-only. dure and dewolfe (2006) reported that 57% of 656 individuals presenting with tic disorders had tics uncomplicated by other conditions. there were no changes in the fifth text revision of 2022, dsm-5-tr. the ygtss is considered the gold standard in tic assessment. movement disorders without an organic cause have been referred to over time using terms such as hysterical, psychogenic and psychogenic movement disorders; dsm-5 classifies them under functional neurological symptom disorder/conversion disorder. a prevalence range of 0.1% to 1% yields an estimate of 53,000 to 530,000 school-age children with tourette's in the united states, using 2000 census data. in the united kingdom, a prevalence estimate of 1.0% based on the 2001 census meant that about half a million people aged five or older would have tourette's, although symptoms in older individuals would be almost unrecognizable.prevalence rates in special education populations are higher. the discrepancy between current and prior prevalence estimates arises from several factors: the ascertainment bias caused by samples that were drawn from clinically referred cases; assessment methods that failed to detect milder cases; and the use of different diagnostic criteria and thresholds. there were few broad-based community studies published before 2000, and most older epidemiological studies were based only on individuals referred to tertiary care or specialty clinics. people with mild symptoms may not have sought treatment and physicians may have avoided an official diagnosis of ts in children due to concerns about stigmatization. studies are vulnerable to further error because tics vary in intensity and expression, are often intermittent, and are not always recognized by clinicians, individuals with ts, family members, friends or teachers.