Tourette Syndrome: Why Do Females Face Diagnostic Delays?
Females with Tourette syndrome face delayed diagnoses and distinct symptoms, impacting timely care and outcomes.

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Why are females with Tourette syndrome (TS) diagnosed later and less frequently than males?
A new study reveals sex-based disparities in TS diagnosis and presentation. Female individuals are not only diagnosed later than males, but also experience delayed recognition of their symptoms, according to a study from Massachusetts General Hospital published in Neurology, the medical journal of the American Academy of Neurology.
Understanding TS and similar disorders
TS is a neurodevelopmental disorder characterized by the presence of both motor and vocal tics that persist for more than one year. Motor tics are sudden, rapid, recurrent, non-rhythmic movements, while vocal tics involve involuntary sounds produced by the individual.
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Subscribe for FREEFor a TS diagnosis, an individual must exhibit multiple motor tics and at least one vocal tic, with onset before the age of 18. Persistent (chronic) motor or vocal tic disorder (PMVT) is another tic disorder; however, unlike TS, PMVT is diagnosed when an individual experiences either motor tics or vocal tics, but not both, for more than one year.
TS and PMVT are diagnosed through a comprehensive clinical evaluation that involves detailed patient history and symptom observation. There are no definitive laboratory tests or biomarkers for either condition. Instead, clinicians rely on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), ruling out other potential causes for tics, such as neurological or medical conditions.
Treatment for both conditions varies based on the severity of the symptoms and their impact on daily functioning.
“Treatment options include education, behavioral therapies, medication and watchful waiting, as tics often improve with time,” said lead author Dr. Marisela Elizabeth Dy-Hollins, pediatric neurologist and clinical director of the Pediatric Movement Disorders Clinic at Massachusetts General Hospital.
Medications such as antipsychotics, alpha-agonists or selective serotonin reuptake inhibitors may be prescribed to reduce tic severity or address co-occurring conditions like obsessive-compulsive disorder (OCD) or attention-deficit/hyperactivity disorder (ADHD).
TS is diagnosed approximately three times more frequently in males than in females. This disparity raises questions about potential underdiagnosis or misdiagnosis in females, as well as differences in symptom presentation between sexes. Understanding these sex-based differences is crucial, as delayed or missed diagnoses can impact the effectiveness of interventions and the overall quality of life for those affected. By exploring these disparities, healthcare professionals can develop more tailored screening and treatment approaches, ensuring that all individuals receive appropriate and timely care.
Sex disparities in the diagnosis of TS
The study analyzed data from the Tourette Association of America International Consortium for Genetics (TAAICG), which included 4,150 individuals with tic disorders and their family members. The researchers focused on 2,403 participants: 2,109 with TS and 294 with PMVT. Participants underwent comprehensive assessments for tic severity, age of onset, diagnosis timing and comorbidities such as OCD and ADHD. Statistical models were used to examine sex-based differences while accounting for factors such as age and familial relationships.
The study revealed significant sex disparities in the diagnosis of TS. Female individuals were less likely to have been formally diagnosed with TS before participating in the research, with only 61% of females receiving a prior diagnosis compared to 77% of males. Females were also diagnosed later in life, at an average age of 13 years compared to 11 years for males. The time taken from symptom onset to diagnosis was also longer for females, with a median duration of three years versus two years for males.
Female participants exhibited lower tic severity across various measures, including motor, vocal and total tic severity scores. The study also found notable differences in comorbidities between sexes. OCD was more prevalent among female participants, affecting 55% of females with TS compared to 49% of males. Conversely, ADHD was more common in males, with 56% of males with TS diagnosed compared to only 39% of females.
The study also found sex-based differences in the age of symptom onset. Among participants with TS, females experienced later onset of symptoms (average 6.5 years) compared to males (6.0 years). In contrast, females with PMVT exhibited earlier symptom onset than their male counterparts, averaging 7.9 years versus 8.9 years.
Implications for care and future research
“These results suggest that healthcare professionals and parents should be screening female individuals with tics and seeking care for them to give them a better chance of managing tics over time,” said Dy-Hollins.
The diagnostic delays observed in female individuals with TS suggest that healthcare professionals may be overlooking or misinterpreting symptoms, potentially due to the lower severity of tics and the higher prevalence of co-occurring conditions such as OCD. Early and accurate diagnosis is critical, as it allows for timely intervention, which can improve an individual's ability to manage tics and associated challenges.
The lower tic severity observed in females may lead some to dismiss symptoms as less impactful; however, the higher prevalence of co-occurring disorders and the distinct symptom profiles in females suggest that their needs may differ from those of males. A comprehensive, personalized approach should be prioritized to ensure that treatment plans address the physical and emotional aspects of tic disorders.
“More research is needed to understand these differences between female and male individuals in these tic disorders, as well as research involving racial and ethnic populations,” said Dy-Hollins.
Reference: Dy-Hollins ME, Chibnik LB, Tracy NA, et al. Sex differences in natural history and health outcomes among individuals with tic disorders. Neurology. 2025;104(3):e210249. doi: 10.1212/WNL.0000000000210249
This article is a rework of a press release issued by the American Academy of Neurology. Material has been edited for length and content.