Talk:Tourette syndrome

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Featured article star Tourette syndrome is a featured article; it (or a previous version of it) has been identified as one of the best articles produced by the Wikipedia community. If you can update or improve it, please do.
News This page has been cited as a source by a media organization. See the 2007 press source article for details.

The citation is in: Bruce Holtgren. "Truth about Tourette's not what you think", The Cincinnati Enquirer, 2007.

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[edit] Size check

July 9th, 51 KB overall, 33 KB prose Sandy 05:49, 10 July 2006 (UTC)

September 16th, 54 KB overall, 34KB prose. Sandy 00:43, 17 September 2006 (UTC)

October 3rd, 61KB overall, 36KB prose. Sandy 16:18, 3 October 2006 (UTC)

October 25, 63 67 KB overall, 36 37 KB prose. Sandy (Talk) 20:44, 25 October 2006 (UTC)

October 29, 71KB overall, 40 KB prose. Sandy (Talk) 16:37, 29 October 2006 (UTC)

December 18, Created History of Tourette syndrome; 61KB overall, 33KB prose. Sandy (Talk) 23:47, 18 December 2006 (UTC)

[edit] Collage consensus/poll

Tourette syndrome is a common childhood-onset condition, with tics typically appearing around the ages of 5 to 7 and diminishing for most by adulthood. It occurs across all races, does not impact longevity or intelligence, and is diagnosed more often in boys than in girls.
Tourette syndrome is a common childhood-onset condition, with tics typically appearing around the ages of 5 to 7 and diminishing for most by adulthood. It occurs across all races, does not impact longevity or intelligence, and is diagnosed more often in boys than in girls.

Include the collage, or not. Some argue that nothing can be learned about Tourette syndrome from looking at a still image, that is looks unprofessional, and that it is so aspecific that it could be just as well on any other article. Others argue that it conveys that Tourette's is a common condition among people that are young, old, male, female, of all races, and provides an alternative to the "moldy old photos of chaps in powdered wigs hundreds of years ago," and that the US Dept of Health and Human services commissioned it to help defray fear and prejudice directed at those who have Tourette's. [citation needed] IMO, the best of all worlds would be for someone to find a better, contemporary depiction, but I don't see the harm in having an inoffensive image, and as pointed out by AOL anon, it does potentially do some good in conveying current info about people with TS. Sandy 19:54, 17 September 2006 (UTC)

[edit] Leave collage in

[edit] Take collage out

[edit] Dan Aykroyd

Speculation, most likely a joke, and thoroughly discussed at Sociological and cultural aspects of Tourette syndrome: should be reverted whenever added here, to keep this article to encyclopedic content. Sandy 02:57, 25 September 2006 (UTC)

[edit] Unvoluntary/involuntary

Although the term unvoluntary is well-defined in this article and in the literature, it is frequently changed to involuntary here, perhaps by well-meaning editors who believe it is a typo, and don't read the text.

Tics are described as semi-voluntary or "unvoluntary",[1] because they are not strictly involuntary—they may be experienced as a voluntary response to an unwanted, premonitory urge.

Please restore it whenever it is removed, as it is the correct usage. I will add an inline note. Sandy (Talk) 16:39, 24 October 2006 (UTC)

[edit] Pete Bennett

Content is often added here: is included already, along with contemporaries, at Sociological and cultural aspects of Tourette syndrome, this article discusses highly notables such as Mozart and Johnson, with others summarized in the daughter article. Sandy (Talk) 20:46, 25 October 2006 (UTC)

[edit] Infobox additions

I wanted to discuss the value of adding OMIM and the Diseases database to the infobox.

On the diseases database, the information is of little value because, although the DSM-IV-TR was published six years ago, they still show the old DSM-IV criteria, and they contain nothing else not already covered in the article. I'd like to delete them from the infobox, if no one disagrees. They also claim TS increases risk for suicide: I'd love to see that data, since I've never come across it.

OMIM is far more problematic, as it is rife with blatantly inaccurate information. I'll list just some, starting at the top, until I give up:

  • The first thing they list is "Gene map locus 13q31, 11q23". The gene(s) implicated in TS have NOT been identified - those two have been studied, possibly implicated, but they are not even close to being conclusively considered as *the* genes.
  • The next line is "... of evidence that Tourette syndrome can be caused by mutations in the SLITRK1 gene (609678) on chromosome 13q." The question is not necessarily that Tourette syndrome is *caused* by SLITRK1, but that a very rare (less than 2% of cases studied) *mutation* (eg, tourettism) may be caused by SLITRK1. The finding matters because this knowledge may help locate the mechanisms involved in TS, but the OMIM overstates the case. It is an advance in research, but it is not one of *the* genes to *cause* TS.
  • To make it three out of three for their first three statements, next we find: "Tourette syndrome is a neurologic disorder manifested particularly by motor and vocal tics and associated with behavioral abnormalities. About three-fourths of patients are male, with onset occurring usually between ages 2 and 14 years. About 10% of patients have a family history of the same condition. " Manifested "particularly" by? Tics are the hallmark of the condition - tics *are* the condition - what does "particularly" mean? Ten percent of patients have a family history? That is not a helpful statement at all; most TS is inherited, and most family history is undetected because of past lack of understanding of TS. The statement leaves the idea that 90% aren't genetic - very misleading.
  • "The initial symptom of Tourette syndrome is usually involuntary tic-like movements." Usually? If you don't have tics, you don't have a TS diagnosis.
  • "With progression of the disease, echolalia, grunting, and coprolalia may develop." Not a "disease", doesn't always "progress", and echolalia and coprolalia rarely develop - misleading.
  • "Although one of the most notorious symptoms of the Tourette syndrome, coprolalia is rather infrequent. Goldenberg et al. (1994) found only 8% of their 112 patients exhibited coprolalia. In a series of 114 patients, 43% had self-mutilation (Van Woert et al., 1977). Tourette syndrome occurs rather frequently in Ashkenazi Jews and rarely in blacks." At least they cleared up the coprolalia issue with correct data, but the VanWoert (very old) study on self-mutilation is extremely misleading and misrepresentative. Rarely in blacks is completely wrong as far as I know, and I'd like to know where they got that. Higher prevalence in Ashkenazi Jews isn't conclusive. (For both SLITRK1 and Jews, see PMID 17035247 as one example.)

Moving on from there, we find the source of the problems: the OMIM appears to rely heavily on old Comings' research. VERY little recent or well-accepted research is included here, and there is a preponderance of old Comings' research. The last edits made to the OMIM database are a year old: I could go on detailing the problems, but I suggest we delete these two entries; at best, they aren't helpful, at worst, they are misleading. Sandy (Talk) 18:46, 27 October 2006 (UTC)

Thanks for explaining here. I see the problems you have with these links, but I still think they are valuable resources, although outdated. DiseasesDB has links to other medical websites and OMIM is a good starting point for finding research on tourette, so I would like to keep them in the infobox. --WS 18:24, 30 October 2006 (UTC)

[edit] Question: pharmacologic vs. pharmacological

Is there a difference? Would it be better to be consistent? - Samsara (talk • contribs) 11:56, 29 October 2006 (UTC)

I really don't know - I'll ping Fvasconcellos and see if he knows. Thanks, Sandy (Talk) 14:20, 29 October 2006 (UTC)
Samsara, I spent some time in Google Scholar and PMID - the terms seem to be used interchangeably, so I'm not sure what to do. I guess we just pick one and go with it? Sandy (Talk) 18:33, 30 October 2006 (UTC)
Interchangeable, AFAIK... I think this is more of a linguistic question, I wouldn't know much about that then... If memory serves there is even a subspecialty of linguistics ("cognitive semantics" or something to that end, may be wrong though) which studies this sort of thing. In Portuguese it would be farmacológico, in French pharmacologique – I don't think Romance languages have this sort of problem (straying from topic though). Sorry I couldn't answer sooner, I hope a consensus was reached. Fvasconcellos 23:17, 30 October 2006 (UTC)
Thanks, Fvasconcellos - I'll see if Tony can help us choose one. Sandy (Talk) 23:18, 30 October 2006 (UTC)
I gag at the practice by some scientists of using "-ic" endings rather than "-ical", but I think that both are officially acceptable. I'd go for the latter as a personal preference, since non-experts will find it more natural. Tony 03:09, 31 October 2006 (UTC)
Done - thanks Tony, Samsara, and Fvasconcellos. Sandy (Talk) 03:14, 31 October 2006 (UTC)

[edit] Featured article

What a wonderful quality article. Great job to all those involved, and I'm sorry I couldn't weigh in before it got FA. :) - Francis Tyers · 01:54, 7 November 2006 (UTC)

[edit] Tourette syndrome edits

Regarding deletion of referenced text twice, copied from:

Sandy,

The information I deleted from the Tourette syndrome site was not reliable information. In addition to having TS, I am a certified expert in the field, having worked extensively with the National Institute of Mental Health; as well as an accomplished attorney. I'm not an ignorant 14 year old out to destroy the credibility of the site; I'm trying, rather, to enhance it's credibility. Anyone with TS will tell you, the dogmatic assertion that "reassurances alone are usually sufficient treatment" is both offensive and factually inaccurate. Please dictate as you wish; I shall leave Wikipedia and seek out a more competent source of information that is not beleaguered by idiosyncratic monologues.

hutchesc —The preceding unsigned comment was added by Hutchesc (talk • contribs).

Hutchesc, I removed your addition again [1] because it is the consensus supported by every important piece of published literature about TS. I could spend hours digging out and adding multiple sources to one statement, but having a string of references after one statement is unsightly, especially when the source I chose was an important, major review of all current literature about TS - it is not just "one study" or one researcher's opinion. It is a source endorsed by the TSA's Medical Advisory Board. A better alternative is for you to find one recent, credible, reliable source from a well-respected TS researcher who disagrees. As I know the literature well, I can tell you that you will be a long time looking. Please discuss your edits on the talk page, or provide a source for your opinion. If I could understand why you disagree, based on reliable, credible, published sources, we could adjust the wording accordingly. SandyGeorgia (Talk) 15:59, 5 January 2007 (UTC)
I'm concerned as well about this assertion that "reassurance" is "sufficient." To me, the article as it is now implies that reassurance will reduce the intensity and/or frequency of tics, but I believe the point is that tics may become more severe because of negative attention and stress. Stress, after all, can intensify ticcing; reassurance reduces the stress associated with having TS and thus can help relieve the tics as well. However, I don't see how that qualifies as "sufficient" because I don't know in whose eyes it's supposed to be sufficient. Is "reassurance" sufficient for people like me who have TS? Not necessarily, but it at least helps with coping, if not with the tics themselves. If someone can back that up with a source, though, that'll help. My university library unfortunately doesn't have recent enough works on TS, so I don't know how relevant of a counter-source I can provide. My personal experience isn't exactly a published source! Perhaps if the article clarified what it means for "reassurance" to be a "sufficient" treatment, that point wouldn't be so controversial? So much information about TS isn't aimed at people who actually live with it, especially adults, so it can be frustrating reading medical opinions that don't seem to reflect our personal experience with it.(Immora) 1:56, 3 Feburary 2007

There's a lot to sort out here, Immora. Digging in:

  1. To me, the article as it is now implies that reassurance will reduce the intensity and/or frequency of tics, but I believe the point is that tics may become more severe because of negative attention and stress.
    These are not mutually exclusive; both can be true.
  2. Stress, after all, can intensify ticcing;
    You're aware that there is research that contradicts this notion?
  3. However, I don't see how that qualifies as "sufficient" because I don't know in whose eyes it's supposed to be sufficient.
    The eyes of the most-respected TS researchers worldwide, who work daily with large numbers of persons with TS - it's a statistical reality for most people with TS; that doesn't preclude that a given individual, such as yourself, may have a different experience.
  4. If someone can back that up with a source, though, that'll help.
    There is just about no credible, reliable, recent research on TS that I don't have - if you can tell me specifically what wording you would want to include, I can tell you if it can be sourced. The wording that has been added in the past was definitely not citeable to reliable sources. Since the current statement is accurate, I'm not sure how to further clarify without getting into original research or repeating what is already stated in the article. Most people diagnosed with Tourette syndrome are in pediatric populations, because most children outgrow their tics and no longer warrant a diagnosis; current, accurate research reflects that reality. Perhaps what you're saying is that you want to add a statement about those adults who didn't outgrow their tics relative to reassurance and understanding? Again, if you can give me an idea of some wording you want to include, I can tell you if it can be sourced from the boatloads of reference material I have on TS. SandyGeorgia (Talk) 17:14, 3 February 2007 (UTC)

By the way, Immora, thank you for fixing that horrendous template that has been bugging me forever :-) SandyGeorgia (Talk) 17:17, 3 February 2007 (UTC)

Thanks for the reply, Sandy! Yeah, I don't want any changes that can't be cited; I want the article to stay high-quality and in line with current research! My impression of stress increasing tics is based on older research (grrr) and my neurologist's questions-- again, individual experiences and outdated sources, and my experience is colored by not being diagnosed until I was an adult. I'll think over what wording might be helpful, though, and read over the article again to see if I get a different sense of how it fits together. Is most current research done with pediatric populations? I've had difficulties finding information aimed at adults who still fit the diagnosis.
You're welcome! Which template was that? I spent a few hours fixing lots of templates the other night-- look out, templates, when I get on a TS compulsive "must make right!" kick! ;) Immora (Talk) 13:58, 3 February 2007 (EST)
{{User tourettes}} - it's been bugging me for more than a year, and you are so far the only editor on Wiki I've encountered who is using it "for real". Nice job ! Anyway, yes, there's a big problem with research samples vis-a-vis pediatric and adult populations (be sure to read the History article, the Controversies and research section). Since most children outgrow tics, most adults who show up in clinical samples with tics probably have more severe TS, and there aren't as many of them, so there are problems with ascertainment bias. (Also, remember that additionally having anxiety disorder can alter tic severity.) Hard to sort out - not enough good studies - more info relates to children - yes, there is a paucity of info relating to most adults with TS, and an emphasis on adults with more severe symptoms. I'm still not sold on the research showing that stress doesn't increase tics - more research needed, but that makes it hard to address in the article - best not to add new research until things settle down into medical consensus. Here's one study: PMID 15096084 Regards, SandyGeorgia (Talk) 19:17, 3 February 2007 (UTC)
That makes a lot of sense-- the stress thing does matter for me with the anxiety disorder, so that's probably more where the reassurance issue comes in for me. NOW I get it! Thanks very much for talking me through the research. I'll check the article out later, too. And-- Ahhh, yep! That template wasn't working right on my page, so I fixed it up based on a different working template :) Hope we get some more people using it "for real," though, because I think it's important for people comfortable with discussing their TS to be open about it. Immora (Talk) 14:25, 3 February 2007 (EST)

[edit] Vandalism

I'm new to editing beyond minor spelling corrections, so I don't know what the procedure is on this, but I would strongly suggest that this page be protected. I happened to Alt-X into this thing and of course it was loaded with profanity. Given the nature of the article, I'm kind of surprised the page wasn't protected long ago for precisely that reason. 66.236.8.30 03:12, 20 December 2006 (UTC)

Not sure when you came into the article, but a review of the history shows limited vandalism, almost always reverted within a minute. Sandy (Talk) 13:50, 20 December 2006 (UTC)
Hey, when I initially loaded this page I didn't see anything, then after two friends mentioned vandalism (I linked from a site), I checked with Safari and saw all of the profanity right where they described it (third paragraph first few sentences). I went in to edit it, and it wasn't there. Then I viewed the page and it was not there. I went into my cache and it definitely is there. So I don't know how someone did it, but something is happening and someone is vandalizing and being sneaky about it. And apparently it is visible in safari and explorer, not in firefox. Don't know who to check with on that. Thekeithlane 19:25, 20 December 2006 (UTC)
Also, I could throw up a screenshot of how it loads, but it is just a bunch of swearing as you can imagine. Thekeithlane 20:32, 20 December 2006 (UTC)
It sounds like you're describing this edit, which was reverted days ago: it is not visible in Explorer, and it sounds like you have a cache-clearing problem on Safari. Sandy (Talk) 20:41, 20 December 2006 (UTC)
As for the possibility of a cache issue, I never use Safari (and reformatted my computer not too long ago), and just opened it to check it when my firefox opened the page without the mentioned text, and I am pretty sure that my at least one of my friends viewed it with Explorer late yesterday or this morning (I don't know of her ever using a different browser and she is technically challenged). Additionally, the text that I have is similiar, yet different than what just posted in that link. Don't know what to say, other than that. Of course it could just be at least three instances (I checked it yesterday after one report of it and didn't see anything) in the past few days. Anyways, thanks for moderating and all! Thekeithlane 21:20, 20 December 2006 (UTC)
  • I have semi-protected to stop the rampant linkspamming. Hopefully that will help. Guy (Help!) 19:17, 5 January 2007 (UTC)
    • Thanks, Guy, it was needed - we'll see how it goes. SandyGeorgia (Talk) 02:26, 6 January 2007 (UTC)

Requested semi-protection because of all the vandalism this month, especially Feb 12. Declined for now. "There is not enough recent activity to justify protection at this time. Much of the recent vandalism was by one user. Give it a day or two - if vandalism increases or continues at same levels 12 February for more than 1 day, then tje answer will probsbly be different. --Robdurbar." I thought yesterday had three or more users vandalising. Anyway, hopefully it won't continue. Immora 17:34, 13 February 2007 (UTC)

Not really necessary just yet; I've been watching it. Based on what I'm seeing on a number of articles, I suspect it's school vacation week in lots of places, so we're seeing increased vandalism from kids out of school. It's still manageable, though. It SP is needed, I can ask an admin directly. SandyGeorgia (Talk) 17:36, 13 February 2007 (UTC)

[edit] NIH

Early versions of this article (like [2]) say information is from NIH (http://www.ninds.nih.gov/health_and_medical/disorders/tourette.html). If this means actual content, they should be cited specially as a source. It is legal to use copy public domain material from the government outright, but all sources of content should be attributed. I'm not sure what that remark meant, though, or whether the article still uses the same info. Superm401 - Talk 04:23, 17 January 2007 (UTC)

No, I've completely rewritten the article since then, using better and more diversified sources, going to the original journal-published literature rather than the NIH summary. They are cited as a source in a couple of places where I couldn't find a better source. Also, even the old NIH info was never as bad as the old TS article here, so I don't think that's a common source - there were some very particular phrases in the old article here, that could only have been written by a layperson. SandyGeorgia (Talk) 04:28, 17 January 2007 (UTC)
  • NIH, currently ref no. 39 in the article.
  • NIH from 2004 - internet archive
  • K12
    • They first show up in the internet archive in May
  • Jan 13 2006 Wiki article - version before I rewrote it - it has some tortured prose the NIH wouldn't use, and K12 appears identical.

Neither the old Wiki version nor the K12 seem to come from NIH - K12 is a Wiki mirror. SandyGeorgia (Talk) 04:49, 17 January 2007 (UTC)

Here's a an example of poor prose and a grammar error in Wiki, repeated verbatim in K12: "only approximately 10% TS patients suffer from this aspect of the malady." Here's another one that would never come from the NIH (or any professional writer), featuring redundant prose that is duplicated exactly in the K12 article: "What is recognized is that the control which can be exerted from seconds to hours at a time may merely postpone and exacerbate outbursts of symptoms. " Tortured prose - surely a K12 copy from Wiki, not from NIH. SandyGeorgia (Talk) 05:11, 17 January 2007 (UTC)

[edit] Diagnosis and DSM edition

The article text says "According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)". Strictly speaking, this is "the text-revision of the fourth edition of ..." or perhaps more succinctly "the revised fourth edition of ...".

Correct - I thought it was covered by mention of the "TR", but can expand the text as you suggest. SandyGeorgia (Talk) 17:21, 25 January 2007 (UTC)

According to Schapiro (2002), the controversial "marked distress" clause not present in DSM-III-R. The Summary of Practice-Relevant Changes to the DSM-IV-TR confirms this as an addition in DSM-IV and explains its removal. The article text says "Previous editions of the DSM included" this clause. If only the unrevised DSM-IV had the clause, then the plural "editions" is erroneous.

Correct - it was only in IV (not III), so edition can be reworded to singular - except - I'm not sure on earlier versions - my knowledge only goes as far back as III. Will find some wording that covers. SandyGeorgia (Talk) 17:21, 25 January 2007 (UTC)

The above Summary document says that this clause "was added to the criteria sets of a majority of disorders in DSM-IV (Tic Disorders among them) in order to emphasize that a mental disorder should not be diagnosed in trivial cases (i.e., when the disturbance is so mild that it has little impact on the patient)". Given the controversy and the nature of how the addition occurred, I wonder if any authority on TS supported the clause. Schapiro claims that many ignored it. So, if this clause was merely a (more or less) careless addition to one revision of the manual, in use between 1994 and 2000, how important is it today? Does the discussion of the clause just muddy the waters for the reader by mentioning an expired controversy? If still of historical interest, could it be moved elsewhere in the article (or daughter article). Or is this mistaken clause still causing problems today? Colin°Talk 17:08, 25 January 2007 (UTC)

You're wondering if any authority on TS supported which - III, IV, or IV-TR? In either case, yes, its mention is very relevant today, because a GREAT deal of oft-cited research conducted during the IV years included impairment or distress. (In reviewing TS literature, it's crucial to determine what diagnostic criterion were used.) This knowledge is crucial context for reviewing an enormous body of research which was generated in those years. The clause in IV had a large impact on research that is still oft-cited and quoted today, and the context is important. During those years - because of the problem - the TSA Study Group came up with their own set of diagnostic criterion, which was used in *some* studies. Not sure if that answers your query? SandyGeorgia (Talk) 17:21, 25 January 2007 (UTC)
Have a look at the change I just made - tweak as needed. Another issue - there are still a surprising number of laypersons, practioners, and websites that still reflect DSM-IV and aren't aware of the text revision - another reason for explicitly mentioning it in Diagnosis. Apparently, not everyone has the text revision or is aware of it. The revision affected only a few diagnoses, and I guess it's not automatic that practitioners get a copy? SandyGeorgia (Talk) 17:28, 25 January 2007 (UTC)

That clarifies things. I noticed that Schapiro (2002) mentions the controversy but not the revised edition (published 2000). What I didn't want was some old argument, of interest only to historical pedants, to confuse the current diagnostic criteria. I still wonder if it would be better for the lead paragraph of this section to concentrate on the actual criteria and move any erroneous criteria to a later paragraph. BTW: I've just spotted that the DSM change is mentioned again in the History section, where it uses a different and weaker source.

I can't emphasize enough the significance and relevance of this issue. First (as you correctly noted), Schapiro missed it - almost *all* publications (even in reputable journals and journal research) did for many years. Only Roger Freeman was putting the word out early and often, and largely it was the core researchers on the US TSA Medical Advisory Board who were on this issue early on in their research. (This means, for example, that European research often has to be interpreted accordingly.) Second, it is pervasive throughout the literature and research. You will note that many of the review articles - even in this article, where I took great care - do not reflect the correct diagnostic criteria at the time of publication; hence, don't reflect current understanding and consensus on TS research. (That's without getting into some of the problems with the Schapiro paper - TS research and understanding is advancing quite fast these days. One thing Schapiro does well is separate out study populations; that is, TS from TS when it is accompanied by comorbids.) The practical relevance of this is that most older - and even some newer - published research focuses on a definition of TS that reflected the worst-case scenario, contrary to current understanding. It is not an issue only of interest to historical pedants: it is an issue which profoundly affected research and understanding of TS for many years - even years after the text revision - whose impact is still felt today. Third, you only need look up a few entries on this talk page to see the kind of misunderstanding still engendered by the older diagnostic criterion, which only encompassed patients with distress or impairment from severe symptomatology, leaving out those people now understood to be the majority, who don't necessarily "suffer" impairment from tics.

I've searched for the text of the DSM-IV-TR criteria and found Gilles de la Tourette’s syndrome and its impact in the UK, which I assume has a faithful transcription. Comparing this with the text in the article, I find two minor issues:

  • The first criterion is "Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently." I read this to mean the presence of both kinds of tics need not be concurrent. The current article text could be read to mean that a vocal tic need not be concurrent with a motor tic (i.e. a movement and a vocalisation at the same time).
  • The first half of the second criterion is missing: "The tics occur many times a day (usually in bouts) nearly every day or intermittently throughout a period of more than one year". This rule is (to me) slightly ambiguous but I assume the "or intermittently" is an alternative to "nearly every day" rather than the whole of "may times a day ... nearly every day". The latter interpretation would seem to make the rule somewhat pointless.

The precise wording of a definition or set of diagnostic criteria is important and no doubt agonised over by the experts. Should this article just quote all four of the criteria verbatim? It is quoting or using much of the text already. The reader would then have confidence that these weren't just an interpretation of the criteria.

When I first came to Wiki, I came across some raging debate somewhere about the seriousness with which the DSM copyright was enforced - something I verified with professionals in the TS field. I was left with the indelible impression that I must find a way to paraphrase, or Wiki would be sued :-) I thought I had solved that dilemma by linking to Behavenet, which gives the verbatim version. I'm afraid to repeat it verbatim based on what I know of the strength of their copyright issues - what do you think?

I've also found that the DSM-III-R had 21 as the cut-off age rather than 18. Is the significance of this worth mentioning? Colin°Talk 18:27, 25 January 2007 (UTC)

ugh - I never followed that debate too much, as I thought it somewhat arbitrary in either case. I've never thought it worth mentioning, since the older cutoff date is 1) very old, and 2) doesn't carry the implications the "significant distress" issue has in terms of blatant misunderstanding of the core condition. If you want me to dig up more info on that issue, I can? The problem is the following: many adult diagnoses are made in retrospect anyway, subject to memory. Lots of parents realize - at the time their children are diagnosed - that they had tics as children. Today, it's less common for people not to be aware of their children's tics, which tend to peak at around the age of 10. I'm not sure what I can say about the age change, but I suspect I can find it in the TSA Study Group Classification paper if you think we need something. SandyGeorgia (Talk) 18:56, 25 January 2007 (UTC)
Dug out the books, found info that coincides with my feeling on the age issue: Leckman/Cohen book (ref'd in article), p. 36 (section on nosological controversies):
"Another minor but substantive difference between the DSM-IV and the Tourette Syndrome Classification Group criteria is the age of onset criterion (tic onset prior to age 18 years in DSM-IV and prior to 21 years in the Tourette Syndrome Classification Group). Until a more objective diagnostic test is developed, this difference is likely to remain unresolved. However, as the vast majority of individuals report the onset of their tic symptoms in the first decade of life, this 3-year difference is unlikely to have much practical impact."
That was my sense - not worth worrying about - most come to attention at around 10 anyway. Between 18 and 21, a doctor should be considering drug use. SandyGeorgia (Talk) 19:11, 25 January 2007 (UTC)
Almost identifical info printed in Advances in Neurology, vol 99, 2006, p. 10, so it still appears that the age cutoff is of little import. Eighteen makes more sense than 21; who knows why they used 21 before - perhaps because it took so long to get accurately diagnosed in the past? If you really want to know, I'd have to use some silver bullets and write some letters of inquiry - would rather save my silver bullets for more important matters. SandyGeorgia (Talk) 19:17, 25 January 2007 (UTC)

Many thanks for answering my tedious questions; sorry if they've cropped up before. If found several old discussion on DSM copyright, the main one being Wikipedia:Administrators' noticeboard/IncidentArchive57#DSM-IV-TR Copyright question. The article Dissociative identity disorder has handled this quite explicitly if inelegantly. Several editors commented that paraphrasing isn't ideal as it leads to errors and weakened definitions. It does, however, look like we can't quote the 100 or so words in the definition. This is galling since the definition is the result of review and consensus so to claim ownership of the results is a bit rich. "The primary purpose of the DSM is to facilitate communication" – hm?

Re: the age limit. You are obviously a better judge on whether this is important, esp. compared to the "significant distress" issue. The latter sounds like it is actually deserves more attention in the article than currently. That Summary document contains a fairly lame excuse for the introduction of the criterion. Colin°Talk 22:26, 25 January 2007 (UTC)

That's the same discussion I mentioned! Glad to answer the questions: I always wonder if people will question why I quote x from a specific journal review and not y. Well, because of the changing criterion and recent research advances, it's very important in the field to know what results are based on good (controlled, replicated, large sample size) research; what has been refuted, what has been replicated, and what is outdated. I had to quote some of the older review papers in spite of them having numerous inaccuracies vis-a-vis current knowledge - glad to have the opportunity to explain. It's a hard area to sum up, and that is why I put so much effort into the Current Research Controversies section in History - it all speaks to the "core conundrum" of "what is TS"? SandyGeorgia (Talk) 23:18, 25 January 2007 (UTC)

[edit] Recent additions

I have reverted a recent addition by an anon diff and feel compelled to provide a rationale, lest it appear I'm enforcing "ownership" of the article. As for late onset of TS, Chouinard and Ford (2000) studied 411 adults and found only seven could be diagnosed as having a true idiopathic, new-onset tic disorder, which is not defined as TS; rather, they maintain

The clinical evidence suggests that adult tic disorders are part of a range of illness that includes childhood onset tics and Tourette's syndrome.

(Chouinard S, Ford B (2000). "Adult onset tic disorders". J Neurol Neurosurg Psychiatry 68 (6): 738-43. PMID 10811697. )

As for the remaining additions: in the "Characteristics" section, the statement altered to read "the tics of Tourette's are sometimes temporarily suppressible and are at times preceded by a premonitory urge, although sometimes they occur spontaneously and without any warning" is, as such, no longer supported by the cited reference. The inserted paragraph "Although in some cases, for certain tics, the premonitory urge is entirely absent..." is unsourced and, quite frankly, sounds unlikely as it was presented; that is, however, just my humble opinion.

I don't mean to attack the validity of these additions, but please cite them or at least discuss further if you wish to re-add, so that other editors may verify them. Thanks, Fvasconcellos 23:48, 3 February 2007 (UTC)

Also, TS is diagnostically defined as having onset in childhood, so part of the addition was not only unsourced, but inaccurate. Another problem was the redundant prose, which has to be avoided if the article is to maintain featured status - the premonitory urge adddition said nothing that isn't already said more succinctly. If I could figure out what the editor wanted to say - that isn't already said in the article - I could source it, since I know the literature. SandyGeorgia (Talk) 23:53, 3 February 2007 (UTC)

[edit] Semi-protection

Thanks to Riana dzasta for semi-protecting the article. My previous request was denied by a different person, and I was intending to request again after yesterday's fresh increase. The daily vandalism got tiring, and it's been bothering me that people are so immature and negative about TS. Anyway, thanks again. -- Immora 06:16, 22 February 2007 (UTC)

The article was vandalized by three IPs in two days; doesn't really warrant protection, and easily reverted. SandyGeorgia (Talk) 14:35, 22 February 2007 (UTC)
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