For most people with Tourette syndrome, tics do get better with age. Roughly half to two-thirds of children experience a significant reduction or complete resolution of tics during adolescence, and by age 18, nearly half report being tic-free in any given week. That said, improvement isn’t guaranteed. About one-third of people continue to have bothersome tics well into adulthood, and a smaller subset see tics stay moderate to severe.
The Typical Timeline of Tics
Tics usually first appear between ages 4 and 8, with most children noticing them around age 5 or 6. Severity then climbs steadily, peaking between ages 10 and 12. In one long-term study, the average age of worst-ever tic severity was 10 to 11 years old, though for some individuals the peak came as late as 19.
After that peak, tics generally begin to fade during the mid-to-late teenage years. A large prospective study found that tic severity dropped by roughly 0.8 points per year on a standard clinical scale throughout adolescence. By the time participants were over 16, about 18% had no tics at all, nearly 60% had only minimal or mild tics, and about 23% still had moderate or severe symptoms.
A CDC-funded study that followed youth with Tourette syndrome over time paints a similar picture. At age 18, almost half had been completely tic-free in the previous week. About 1 in 10 had minimal tics, roughly 3 in 10 had mild symptoms, and just over 1 in 10 still had moderate-to-severe tics. So while the overall trend is clearly toward improvement, the range of outcomes is wide.
Why Tics Tend to Fade
The improvement appears to be rooted in brain development. As the prefrontal cortex matures through adolescence, it gains increasing control over the motor pathways that generate tics. Research using brain imaging shows that people with Tourette syndrome recruit their prefrontal cortex more heavily when suppressing movements, essentially building a stronger “braking system” over time. In those whose tics fade, the excitability of motor pathways gradually normalizes. In those whose tics persist into adulthood, that heightened motor excitability remains.
This also helps explain why many adults with Tourette syndrome report better ability to suppress tics compared to when they were children, even if the tics haven’t fully disappeared. The underlying urge may still be there, but the brain’s capacity to manage it grows stronger with maturity.
What Predicts Whether Tics Will Persist
Not everyone follows the same trajectory, and researchers have identified several childhood factors that predict who is more likely to carry tics into adulthood. The two strongest predictors are sex and childhood tic severity. Girls and women with Tourette syndrome tend to have less reduction in tic severity over time compared to boys and men. Children whose parents report more severe tics early on are also more likely to have significant tics as adults.
A few other factors matter. Children who experience stronger premonitory urges (that uncomfortable sensation that builds before a tic) tend to see smaller reductions in severity over time. Poorer family functioning during childhood is associated with greater tic-related impairment in adulthood. On the other hand, higher levels of externalizing behaviors in childhood (things like hyperactivity or conduct issues) were actually linked to greater improvement over time, a finding that surprised researchers.
Importantly, some of these predictors are modifiable. Addressing family stress, managing premonitory urges through behavioral therapy, and treating tics early may improve the long-term outlook.
Co-occurring Conditions Don’t Always Follow the Same Path
Tourette syndrome rarely travels alone. Most people with the condition also have ADHD, OCD, anxiety, or other related challenges. While these co-occurring conditions do tend to improve alongside tics during adolescence, they often persist more stubbornly. In one large study, 63% of participants still had at least one comorbid condition during follow-up, even as their tics declined.
This is worth knowing because for many adults with Tourette syndrome, the tics themselves may become a secondary concern. The anxiety, obsessive-compulsive tendencies, or attention difficulties that accompanied the tics in childhood can end up being the more impactful issues in daily adult life.
When Tics Persist or Worsen in Adulthood
For the roughly one-third of people whose tics remain bothersome into adulthood, the experience often looks different than it did in childhood. Adult tics tend to wax and wane in intensity over weeks or months. They rarely stay at a constant level, which can make it hard to tell whether things are truly getting worse or just cycling through a more active period. Stress, fatigue, and illness commonly trigger flare-ups.
In rare cases, tics can actually worsen in adulthood. The CDC notes that while most people improve, some experience an increase in tic severity as adults. Complete remission, where tics vanish entirely and never return, also appears to be uncommon. Most adults who feel “tic-free” still experience occasional mild tics that they can easily suppress or that go unnoticed by others.
Treatment Options for Adults With Persistent Tics
Adults whose tics remain disruptive have several options. The American Academy of Neurology recommends a behavioral approach called Comprehensive Behavioral Intervention for Tics (CBIT) as a first-line treatment, even ahead of medication. CBIT teaches you to recognize the urge that precedes a tic and respond with a competing action that makes the tic harder to execute. The standard protocol is eight sessions, though more complex cases may need a longer course.
For tics that are localized to a specific muscle group, such as a persistent neck jerk or eye blink, botulinum toxin injections can reduce both the tic itself and the premonitory urge associated with it. This approach works best when one or two specific tics are causing the most trouble rather than a broad pattern of many tics.
Where legal, cannabis-based treatments have shown limited evidence of reducing tic severity in adults, though they’re not recommended for children or adolescents due to potential effects on brain development. For the most severe cases that don’t respond to other treatments, deep brain stimulation is an option that some specialized centers offer, though it’s reserved for truly refractory situations.
The overall message from the research is cautiously optimistic. The natural trajectory of Tourette syndrome bends toward improvement for the majority of people, with the teenage years representing a turning point. For those whose tics do persist, effective management strategies exist, and the brain’s growing ability to regulate tics means that even persistent symptoms often become more manageable over time.