Talk:Tourette syndrome/Archive 11

Practical Neurology

Review article doi:10.1136/practneurol-2017-001755 JFW | T@lk 09:11, 15 July 2018 (UTC)

Thanks so much, Jfdwolff. I will get on it next week. Best, SandyGeorgia (Talk) 12:51, 15 July 2018 (UTC)

It's not a major journal but sometimes it's got nuggets of gold. JFW | T@lk 12:33, 17 July 2018 (UTC)

Jfdwolff, I am still planning to get to this ... soon :) Although the subarachnoid hemorrhage resolved, the physical effects of having a tree fall on me impact my ability to sit at a computer for long periods of time. I hope I can get to this over the holidays-- it looks like a good article, and I am happy to see someone other than Robertson pitching in on TS! SandyGeorgia (Talk) 18:23, 30 November 2018 (UTC)

Wow. Get well soon. JFW | T@lk 22:50, 4 December 2018 (UTC)

Thanks! SandyGeorgia (Talk) 18:10, 22 January 2019 (UTC)

A review article from Child and Adolescent Psychiatry and Mental Health

Comorbidity with ASD can now be added to the list. doi:10.1186/s13034-017-0196-x

199.200.120.135 (talk) 01:40, 25 July 2018 (UTC)

This article points out the specific problems with the shortage of good studies in this area, further complicated by (their words):

In particular, a further bias caused by the different quality of the studies evaluated, could lie in the absence of specific assessments performed by clinicians expert in the field, thus resulting in a possible overestimation of the rates of comorbidities, such LD and ASD [46].

That is, tics are part of the ASD spectrum, and are frequently explained by ASD. Sorting out whether a TS diagnosis is always correct in the presence of ASD plus tics is tricky. Unless this connection is mentioned in a broad review of TS specifically, I suggest it is undue here. SandyGeorgia (Talk) 18:15, 30 November 2018 (UTC)

Antihypertensive medication

Are not a treatment. Clonidine may help with tics but this does not refer to the class of medications. Doc James (talk · contribs · email) 05:36, 1 November 2018 (UTC)

Doc James, both you and ATC are right. This seems to be a problem of trying to use an infobox to summarize nuanced info. I don't like having infoboxes in articles, like them even less in medical articles (for this reason and others), so don't have a strong opinion as to how this can be fixed ... will defer to you. SandyGeorgia (Talk) 17:53, 30 November 2018 (UTC)

Doc, per ATC's desire to add clonidine and guanfacine to the infobox, how about if rather than calling them "antihypertensives", we refer to them as "noradrenergic"? I can cite that ... SandyGeorgia (Talk) 21:11, 30 November 2018 (UTC)

User:SandyGeorgia sounds reasonable. Doc James (talk · contribs · email) 19:14, 1 December 2018 (UTC)

Semi-protected edit request on 27 November 2018

"studies have shown that the overwhelming majority of cases of Tourette's are inherited, although the exact mode of inheritance is not yet known and no gene has been identified" This line I find to be highly bias toward the author's broad belief that it is genetic without evidence. When contrary evidence of ingestion co exist. Environmental factors are found throughout history. Ingestion of countless things have spurred countless conversations with non physical entities. They do note environmental factors but only as an antagonist when clearly on more than one occasion environment was a likely culprit of Tourette's syndrome. I feel the broad term studies is inaccurate and believe there are other reasons for symptoms being conveyed to future generations. Rockpooljill (talk) 13:44, 27 November 2018 (UTC)

Agree. This article reeks of much of the same NPOV issues as the dyslexia article regarding supposed genetic origin. This is an encyclopaedia, not a self-help wiki. Blitterbug 01:18, 21 January 2019 (UTC) — Preceding unsigned comment added by Blitterbug (talk • contribs)

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. —KuyaBriBri^Talk 15:06, 27 November 2018 (UTC)

Concur. SandyGeorgia (Talk) 18:24, 30 November 2018 (UTC)

Gluten

I have removed this content about gluten to the Causes and origins of Tourette syndrome article, which is not a Featured Article. This FA uses summary style and relies on broad secondary reviews of the condition-- the daughter articles may explore text for which there is less broad support. There is no broad secondary review of TS that I am aware of that supports a gluten hypothesis. There is support for the general idea that anything that lessens the overall burden on the body (dietary, stress, exercise, etc) helps make one better able to manage tics. If anyone has a broad secondary review of TS that gives credence to a gluten connection, pls provide-- I have not seen one. Best regards, SandyGeorgia (Talk) 17:57, 30 November 2018 (UTC)

Semi-protected edit request on 29 January 2019

The article says Tourette is a common neuropsychiatric disorder, which is what other conditions like Depression, and Mania are classified as. - Tourette Syndrome (GTS) was reclassified as a neurodevelopmental disorder as of the DMS-5 (2013) Luminary 16:49, 29 January 2019 (UTC)

oh my. That one escaped my attention when I did the DSM-5 updates; now fixed, and thank you! SandyGeorgia (Talk) 17:00, 29 January 2019 (UTC)

Copy edit March 2019

Gog the Mild thank you for the helpful copyedit. When the article was presented to WP:FAC years ago, it was copy-edited by the one and only Tony1, but changes have crept in over time.

I restored a few of your changes:

• Obsessive–compulsive disorder uses an WP:ENDASH: [1]
• We need to give the reader a bit more explanation in this article of the distinction between motor and vocal tics, so they aren't obligated to click out to another article to understand here.[2] (I appreciate that what was there before and that you deleted was uncited.)

More significantly, you unlinked a number of terms. It was decided in the FAC that it was OK/preferable to re-link a few technical terms when they re-occurred at some distance from their first occurrence. Readers unfamiliar with medical terminology felt that duplicating those few links further down in the article was helpful. I could re-instate those links if you don't object.

Thanks again, SandyGeorgia (Talk) 19:31, 24 March 2019 (UTC)

Hi Sandy. I'm just the copy editor, feel free to make whatever changes you wish.

On the dup links, you may have noticed that I left some in, where I thought that it may be useful to remind a reader. Obviously the extent to which one does this is subjective, but from memory there were four links to comorbid and to sleep disorder, which seemed to me excessive. But, as I say, these things are subjective.

I often feel that my work on these high level articles a copy editors role is as much to provoke discussion and a relook at certain aspects as to insert a definitive reading; part of the reason why I am relatively relaxed as to any reversions you may make. Thank you for the courtesy notification.

A couple of things. You are no doubt aware that in addition to the sentence I removed there are two other unreferenced statements. Both seemed useful to a reader and in line with referenced statements elsewhere, so I left them.

To my mind there is an awful lot of repetition of the same facts in section after section. Obviously this is a valid approach, and so I left it; but you may find it helpful to go through the article with that in mind.

I found the article informative and very clearly written. Well towards the upper end of FAs I have come across.

Gog the Mild (talk) 19:56, 24 March 2019 (UTC)

Ah, if you noticed and left some links, then I think we can leave it at that. Some reviewers just felt they needed more wikilinks further into the article (and that also explains some repetition), but if you didn't feel that way on a complete run-through, I will not worry about it. Thanks for the kind words! Best, SandyGeorgia (Talk) 20:07, 24 March 2019 (UTC)

Ho, ho, ho/oh oh! I have realised whose work I have been critiquing . Gah! Fortunately the Wikipedia article assures me that it is not possible for embarrassment to cause actual physical damage. Keep up the fantastic work. Gog the Mild (talk) 00:16, 25 March 2019 (UTC)

Thank you, kind person Gog the Mild; you keep up the good work as well ! If you were to stalk me into some Venezuelan topics, you would find some of the most dreadful prose ever ! SandyGeorgia (Talk) 00:43, 25 March 2019 (UTC)

Some queries:

• "characterized by multiple motor tics and at least one vocal (phonic) tic"—does it mean "characterized by multiple types of motor tics and at least one type of vocal (phonic) tic"? At the moment, it looks as though one vocal tic pops out and your classified. Side note: You know, on reading the opening, I think I had a mild form of Tourette when I was a kid, from about 8–13 years old, except that I had no vocal tics—just blinking hard and a rapid head movement. Tony (talk) 08:41, 25 March 2019 (UTC)

Hi, Tony. No, not "types of"; yes, just one vocal tic, along with motor, gets you TS. Tons of kids have tics that they grow out of! And most TS is what people refer to as "mild". Best, SandyGeorgia (Talk) 11:25, 25 March 2019 (UTC)

Oh the ignominy. Oh the honour. Permission to abase myself before the master? Now corrected. User:SandyGeorgia, you will want to check. Gog the Mild (talk) 11:33, 25 March 2019 (UTC)

I guess my response wasn't very clear. It's just multiple tics, not "types of". In fact, I don't even know what "types of" would mean in this context. Tony1, your beautifully crafted lead was long ago taken apart so that what was left could be more easily translated. Every time I remember the old lead, compared to the new, I still get knots in my stomach LOL !!! :( :( SandyGeorgia (Talk) 11:36, 25 March 2019 (UTC)

• "Extreme Tourette's in adulthood, though sensationalized in the media, is a rarity; tics are often unnoticed by casual observers." Do the two components of this sentence flow thematically? Adulthood ... unnoticed. Tony (talk) 05:20, 26 March 2019 (UTC)

  Thanks, Tony; adjusted. SandyGeorgia (Talk) 16:38, 26 March 2019 (UTC)

This given reference contains identical text to the article Tourette syndrome (TS) is characterized by multiple motor tics plus one or more vocal (phonic) tics, which characteristically wax and wane. against our lead -characterized by multiple motor tics and at least one vocal (phonic) tic"

Copyvio anyone? ClemRutter (talk) 08:51, 7 May 2019 (UTC)

I am looking now; with many revisions to go through, and a very old article, the tools are slow. SandyGeorgia (Talk) 14:37, 7 May 2019 (UTC)

@ClemRutter: Here is where that wording was inserted; and yes, the cited source was already in the article at that point. Since there are limited ways to say this, and this same wording is found in most TS sources, I would not characterize this as a serious problem. I doubt that all of Tim Vickers work needs review, or that this small matter warrants scrubbing the history. In medical articles, there are very few ways to state basic facts; I don't believe Tim Vickers inserted copyvio broadly into all of his work. Let me know if you agree, and then we can vary the wording. SandyGeorgia (Talk) 14:44, 7 May 2019 (UTC)

Also, if this provides any reassurance, I remember that time period clearly. I was traveling, away from Wikipedia for a week or more, and came home to find that someone had submittted this article to Good articles, Tim had reviewed (and I think passed it), and I was not pleased since I Don't Do Good Articles. But because I was traveling, I would not have reviewed these edits closely at the time. SandyGeorgia (Talk) 14:46, 7 May 2019 (UTC)

Today's Featured Article

This has been a FA since 2006, and I believe it to be the oldest FA to never be featured on the main page as TFA. Is this page never going to make it to the front page ever? Seems a bit silly to have a FA doomed to never make the prime time. I understand that this page would be a prime focus for vandalism, but I think with some extra due diligence, it can be managed. Harizotoh9 (talk) 09:02, 22 April 2019 (UTC)

The moment when it coulda, shoulda, woulda been TFA (when the FA process had a director) was missed. I was always saving it for that moment, but the way TFA is run now, there is zero flexibility to be able to use an article when the timing is perfect-- such as happened when Tim Howard set his record in 2014, bringing increased attention to TS. I guess ask @Ealdgyth: if TFA will forevermore be stuck in programming TFAs weeks and months in advance, and never again able to have the flexibility to run a timely TFA, so that this article could be run when TS is in worldwide focus, as it was when Tim Howard did his soccer thing. That has been one of the many disappointing changes in the FA process since the director was chased away; the flexibility to run a very timely TFA is missed, at least by me. (But then, since I'm no longer working ten hours a day to support the FA crowd in their quest for stars, I understand nobody GAF what I think anyway :) You stop working for them, and the talk page stalkers who were once willing to help drop from 600 to one, thank you, Johnbod for sticking with me! ) SandyGeorgia (Talk) 16:51, 22 April 2019 (UTC)

We can change things out - we just don't often get requested changes. To be frank, it's a lot less stressful to schedule out a month in advance. If I had to do the scheduling every couple of days, I'd quit. It's always possible to ask if something can go in on short notice - ideally a couple of days but it can be done reasonably quickly if needed. The idea of scheduling out is to give the editors a chance to look over the blurbs and get them right without the stress of deadlines. And to allow other editors to find errors without the blurb pages being only editable by admins. Ealdgyth - Talk 16:53, 22 April 2019 (UTC)

Yes, it was quite amazing what Raul654 was able to accomplish all by himself, wasn't it?!?! Not that anyone will look back and appreciate the moment at which the FA process was murdered :) Now we have four schedulers to do less than what Raul (and Bencherlite) did entirely alone, writing every blurb and doing all the scheduling and he was able to maintain flexibility! Let me know, Ealdgyth, if you think the beaurocracy that now exists at TFA can find it in themselves to run TS as TFA when TS is in the worldwide spotlight-- that was always my hope, and it was entirely doable, feasible, and likely under the "former FA administration". SandyGeorgia (Talk) 17:04, 22 April 2019 (UTC)

I know I won't spot the perfect time, so you'll have to drop me a note if you see it. I'll do my best to get it run - I'll admit I haven't run it yet because I knew you wanted it to run at a "good time". Ealdgyth - Talk 17:06, 22 April 2019 (UTC)

Thank you, you're a dear :) SandyGeorgia (Talk) 17:11, 22 April 2019 (UTC)

@Harizotoh9: I hope I answered your question :) It is personally troubling to me, having given the better part of my Wiki-career and life to promoting Featured Articles for other editors, who turned their back on the process for what I consider to be largely selfish reasons, so that I have watched the process die, and that TFA-- that was once an example of how Wikipedia could quickly adjust the main page to keep up with the world-- is now set in stone days in advance. Raul654 sometimes put up the TFA literally within an hour of it running, and I liked that we had that ability to highlight topical FAs of current interest. I have held out hope that this article could be used spontaneously, at the right time, as was once the case, when the mainpage highlighted not only our "best work", but also an ability to be current with top content. Yes, I was once fearful of the fuckity-fuck-fuck inevitable vandalism, but I think I got over that years ago! I am also a strong believer that the way TFA is run now is bad for the entire FA process. FAR is moribund, and at least half of our FAs are not. When people did not know when their article might run on the main page, they did a better job of keeping them up to snuff. Now they have warning so far in advance, that they can ignore FAs until they get notice. And, running TFAs that were not up to snuff helped feed the FAR process, too. Lots of reasons why I am not happy to see the FA process dead in the water. SandyGeorgia (Talk) 17:34, 22 April 2019 (UTC)

@SandyGeorgia: I remember well the days when you were a stalwart of FAC, doing such excellent work to keep standards up. And the tireless work of Raul654 in writing the TFAs every day. I don't remember the Great Stitch Up to which you refer, though. Without dragging up too much dirt, what happened? My recollection was that Raul pretty much stepped away from the wheel of his own accord at some point, and without much explanation. Which of course was his prerogative per WP:VOLUNTEER, but other people had to sort of pick up the pieces after that... (much as I've done over at WP:POTD, a process which does still run as mostly a one-person-band).  — Amakuru (talk) 10:50, 25 April 2019 (UTC)

@Amakuru:, the "excellent work" was teamwork—I do not get all or even most of the credit, except maybe to the extent that I focused on building a healthy team of truly respectable, knowledgeable, committed, and impartial judges of content. :) And you won't get me to name names or incidents, as that doesn't usually lead good places. But let's take this discussion up another day, and on my talk page rather than an article talk page. I don't want to see anyone else get blocked and this discussion had ended up at ANI, so better for another place and time. Best regards, SandyGeorgia (Talk) 16:49, 25 April 2019 (UTC)

@SandyGeorgia: alright thanks for the response, let's do that.  — Amakuru (talk) 16:51, 25 April 2019 (UTC)

Okay, so surely there's a day of national awareness for the syndrome right? The article could run that day. Alternatively maybe just find the exact date of the publication of "Study of a Nervous Affliction" and run it on that day. Harizotoh9 (talk) 23:14, 4 May 2019 (UTC)

@TFA coordinators I've been looking over the article, and you shouldn't even be thinking about putting it on the mainpage. I gave up here five years ago, because of ... other issues ... occurring at WPMED. In the interim, it has become more outdated than I realized. If I am allowed now to proceed without disruption, I can start working on a much-needed update. If not, someone should send it to @FAR coordinators: during my next WikiDisappearance, to put it and me out of our misery. SandyGeorgia (Talk) 15:14, 8 January 2020 (UTC)

Mozart

If there's no credible evidence to support Mozart having tourettes what is the point of mentioning it in this wikipage. HardeeHar (talk) 01:15, 25 October 2019 (UTC)

To give due weight to an issue frequently mentioned in the literature. SandyGeorgia (Talk) 15:02, 8 January 2020 (UTC)

Tourettes in media

Character Klunk from dick dastardly and his flying machine cartoon, has Tourette's HardeeHar (talk) 01:17, 25 October 2019 (UTC)

Adding that to this article would be WP:TRIVIA. If there are significant reliable sources that discuss the connection with TS, that information could belong at Societal and cultural aspects of Tourette syndrome. SandyGeorgia (Talk) 15:04, 8 January 2020 (UTC)

Suppressing Tics

The wikipage gives the impression that all persons with tourettes can "temporarily supress" their tics but many person with tourettes (such as myself) can't, the Tics just happen without warning. Also it gives the impression that all with tourettes have an urge prior to a tic but again that's not correct, many suffers )such as myself) have no urge, just tic without any warning it's going to happen HardeeHar (talk) 01:22, 25 October 2019 (UTC)

"In contrast to the abnormal movements of other movement disorders such as choreas, dystonias, myoclonus, and dyskinesias, the tics of Tourette's are temporarily suppressible, ... " That they are temporarily suppressible is a defining feature that distinguishes them from other movements of other disorders. Tics are vary in strength, severity, frequency and location; not everyone's tics are the same.

Tics are "often preceded by" (it does not say always) a premonitory urge, which is another hallmark of the tics of TS that help distinguish them from other conditions; as the article discusses, not everyone is aware of these urges.

Both of these factors, for example, might be used by a clinician to distinguish the tics associated with Tourette's from tics associated with autism or another condition. SandyGeorgia (Talk) 15:09, 8 January 2020 (UTC)

Citation style

When I wrote this article in 2006 and 2007, the citation templates were constantly changing, often yielding results that conflicted in style, so I used a manual citation method. I have at least a dozen newer reviews to include in this article, but with the citation templates more now more stable and standardized, would prefer to first convert all of the manual citations to the Diberri vanc format. I don't believe this will create a WP:CITEVAR problem, since I would be the only person to object to a change in citation style. If anyone does object, please let me know; the work involved will take quite some time for me to complete. SandyGeorgia (Talk) 15:00, 8 January 2020 (UTC)

If there is no disagreement, I will get to this over next two days. SandyGeorgia (Talk) 17:52, 12 January 2020 (UTC)

Done. SandyGeorgia (Talk) 23:23, 12 January 2020 (UTC)

Alt text

SUM1 because this is a Featured article, we should keep alt text in the image description: [3] Describing that image to a visually impaired person will take quite some work! SandyGeorgia (Talk) 17:32, 12 January 2020 (UTC)

@SandyGeorgia: Fair enough, didn't know that was a rule of featured articles. Only reason I removed it was because it was factually incorrect, stating that the "globus pallides" (sic) was not part of the basal ganglia. SUM1 (talk) 17:49, 12 January 2020 (UTC)

@SUM1: I suspect it is no longer enforced at FAC, but because this article did have them on every other image (dating to the days when it was enforced), I posted to WT:FAC for help. Thanks! I hope to just focus on getting the citation style updated, then adding new text, then summmarizing to lead ... lots to do here. SandyGeorgia (Talk) 17:51, 12 January 2020 (UTC)

@SandyGeorgia: Also, the former image itself labelled the putamen as the globus pallidus until I fixed it out of grace, but I intend to replace most instances of it with this newer, accurate image. Surprised such inaccuracies were allowed on a featured article. SUM1 (talk) 17:52, 12 January 2020 (UTC)

I Hate Images, and left them to Eubulides, who is now gone. How does the alt text read to you now? SandyGeorgia (Talk) 17:56, 12 January 2020 (UTC)

@SandyGeorgia: Looks okay, though I personally kill all double spaces on sight. SUM1 (talk) 23:09, 12 January 2020 (UTC)

@SUM1: will check that momentarily. I am almost done converting citations. When I am done ... Do you want to add new text (based on reviews above) to Pathophysiology, or should I? I am sure you are better equipped. Several of those reviews cover basal ganglia dysfunction in greater depth, and then give passing mention to immunological matters. If you want to do that when I'm done, I can later summarize to lead. I have a LOT of updating to do here, so if you use the reviews above, could you use the named refs as I've listed, so I can continue using them? SandyGeorgia (Talk) 23:17, 12 January 2020 (UTC)

@SandyGeorgia: I appreciate that you are working and responding very fast and very fervently. I was going to finish some other things before coming back to this topic, though if you wish to hand over those responsibilities, I'm more than willing and will see what I can do. SUM1 (talk) 00:20, 13 January 2020 (UTC)

SUM1 I have so much updating to do here, that I can gladly wait for you to work on the pathophysiology ... but only if you'd like to. If I get to it first, I can chunk in some text, that you may want to refine. I think I'm pooped out for the day! SandyGeorgia (Talk) 02:04, 13 January 2020 (UTC)

SUM1 I'm digging in today to start major updating. I can work on Pathophysiology. I prefer to do major updates to the body, and then re-summarize to the lead only when done, if that works with you. I probably have a good week or so of work ahead. Regards, SandyGeorgia (Talk) 14:09, 13 January 2020 (UTC)

@Sandy and SUM1: I'd suggest slightly cropping the present alt text to |alt=The basal ganglia at the brain's center with the thalamus next to it. Nearby related structures are: caudate nucleus, globus pallidus, putamen, subthalamic nucleus, amygdala, substantia nigra, ventral tegmental area, ventral pallidum, olfactory tubercle, and nucleus accumbens.

The reason is that the main use of the alt text will be screen readers, who really need just an idea of what the image that they can't see represents. Firstly, they will already have a heard a link to an image, so there's no point in telling them that it's an image. Secondly, they can't see the image so there's no point in descriptions like top-to-bottom or clockwise. If at some point they want to learn about the relative positions of the basal ganglia and related structures, they will be better off reading a dedicated article, rather than trying to work it out from the Tourette syndrome article.

It's still rather longer than I'd normally recommend, and it could be argued that the second sentence could also be cut without losing much relevant information, but that's a judgement call best made by someone like Sandy who is immersed in the article. Cheers --RexxS (talk) 01:05, 13 January 2020 (UTC)

Thanks so much, RexxS. How about: |alt=The basal ganglia at the brain's center with the thalamus next to it. Nearby related brain structures are also shown. SandyGeorgia (Talk) 02:03, 13 January 2020 (UTC)

Youtube

@Colin: See this section, for a Youtube video trailer, put up by the Tourette Association of America, about the documentary they produced in conjunction with HBO. Per NOTYOUTUBE, is this an appropriate use? SandyGeorgia (Talk) 09:49, 14 January 2020 (UTC)

The WP:NOTYOUTUBE essay is more concerned with embedded videos rather than external links, so Wikipedia:External links seems the relevant policy. Were you wondering if you could get the content on a free licence to embed? I watched the video, though it goes black after 6:37. It doesn't imo seem like content that belongs on WP in that format. We already embed some assembled clips from the video at File:Tourette's tic long medium 192kbps.ogv, which is relevant. I'm not an expert on external link policies. -- Colin°^Talk 16:02, 14 January 2020 (UTC)

On my way to a funeral, will look when home. SandyGeorgia (Talk) 16:08, 14 January 2020 (UTC)

@Colin: on reviewing WP:EL, I can't see any reason to exclude it from External links, so moved it there. It's not copyvio, it's put up by a reputable organization who was co-producer of an award-winning documentary, it's accurate, it's helpful to our readers to see what tics behave like, and it includes useful content that can't be covered in the article. What do you think? SandyGeorgia (Talk) 20:26, 14 January 2020 (UTC)

We already have that short assembled clips of what ticks look like embedded in the article. This youtube link is more about how it affects the kids social interactions, which is useful. I don't have any objections to it as a link. --Colin°^Talk 10:15, 15 January 2020 (UTC)

"Wax and wane"

Someone earlier complained that wax and wane was language too difficult for the lead, and wanted to change it to increase and decrease. But "increase and decrease" is not sufficient wording to encompass all that is meant:

Tics associated with Tourette's change in number, frequency, severity and anatomical location. Waxing and waning—the ongoing increase and decrease in severity and frequency of tics—occurs differently in each individual.

"Wax and wane" is standard terminology throughout the literature referring to the tics of TS. Tics change in number, location, frequency, and severity.

Is the term wax and wane too complicated for a lead, or is it standard language that anyone should be able to understand? SandyGeorgia (Talk) 14:14, 16 January 2020 (UTC)

It's true that outside the set phrase "wax and wane", neither verb has much place in current English. So the phrase might be thought of as an idiom (whether or not it technically is, I'm not sure, since the verbs each mean exactly what they say). And idioms are difficult for anyone who doesn't speak a language natively. Yet I can't think of a pithy replacement for it that means the same thing. I'd support keeping it, because the sources use it and because it remains current English—presumably because nothing expresses the same idea as succinctly!

Would an inline link to wiktionary's definition be sufficient? e.g. [[wikt:wax and wane|]] wax and wane. Outriggr (talk) 08:13, 17 January 2020 (UTC)

I didn't want to add an external link to the lead, so how about this? SandyGeorgia (Talk) 18:58, 17 January 2020 (UTC)

It was fine then and now. Wax and wane is commonly understood. Ceoil (talk) 17:32, 19 January 2020 (UTC)

New reviews

Done. SandyGeorgia (Talk) 22:48, 17 January 2020 (UTC)

I picked up a number of new reviews two days ago that I plan to incorporate; I will list them here as I catch up, but I also plan to update the citation style first. SandyGeorgia (Talk) 14:30, 12 January 2020 (UTC)  Done ref name= Baldermann Baldermann JC, Schüller T, Huys D, et al. (2016). "Deep brain stimulation for Tourette syndrome: a systematic review and meta-analysis". Brain Stimul (Review). 9 (2): 296–304. doi:10.1016/j.brs.2015.11.005. PMID 26827109.  Not done ref name= Barlow Barlow J, Bergman H, Kornør H, Wei Y, Bennett C (August 2016). "Group-based parent training programmes for improving emotional and behavioural adjustment in young children". Cochrane Database Syst Rev (Review) (8): CD003680. doi:10.1002/14651858.CD003680.pub3. PMC 6797064. PMID 27478983. 130 pages, cannot locate specific mention of TS, found other reviews that cover same territory. SandyGeorgia (Talk) 20:12, 13 January 2020 (UTC)  Done ref name= Dale2017 Dale RC (December 2017). "Tics and Tourette: a clinical, pathophysiological and etiological review". Curr. Opin. Pediatr. (Review). 29 (6): 665–73. doi:10.1097/MOP.0000000000000546. PMID 28915150.  Done ref name= Evans Evans J, Seri S, Cavanna AE (September 2016). "The effects of Gilles de la Tourette syndrome and other chronic tic disorders on quality of life across the lifespan: a systematic review". Eur Child Adolesc Psychiatry (Review). 25 (9): 939–48. doi:10.1007/s00787-016-0823-8. PMC 4990617. PMID 26880181.  Done ref name= Fernandez Fernandez TV, State MW, Pittenger C (2018). "Tourette disorder and other tic disorders". Handb Clin Neurol (Review). 147: 343–54. doi:10.1016/B978-0-444-63233-3.00023-3. PMID 29325623.  Done ref name= Frundt2017 Fründt O, Woods D, Ganos C (April 2017). "Behavioral therapy for Tourette syndrome and chronic tic disorders". Neurol Clin Pract (Review). 7 (2): 148–56. doi:10.1212/CPJ.0000000000000348. PMC 5669407. PMID 29185535. Already in article  Not done ref name= Furlong2013 Furlong M, McGilloway S, Bywater T, et al. (March 2013). "Cochrane review: behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years (Review)". Evid Based Child Health (Review). 8 (2): 318–692. doi:10.1002/ebch.1905. PMID 23877886. Huge article, could find no specific mention of TS, same territory covered by other articles. SandyGeorgia (Talk) 15:46, 14 January 2020 (UTC)  Done ref name= Ludlow2018 Ludlow AK, Rogers SL (March 2018). "Understanding the impact of diet and nutrition on symptoms of Tourette syndrome: A scoping review". J Child Health Care (Review). 22 (1): 68–83. doi:10.1177/1367493517748373. PMID 29268618. Already in  Done ref name= Morand Morand-Beaulieu S, Leclerc JB, Valois P, et al. (August 2017). "A review of the neuropsychological dimensions of Tourette syndrome". Brain Sci (Review). 7 (8). doi:10.3390/brainsci7080106. PMC 5575626. PMID 28820427.{{cite journal}}: CS1 maint: unflagged free DOI (link)  Done ref name= Pandley Pandey S, Srivanitchapoom P, Kirubakaran R, Berman BD (January 2018). "Botulinum toxin for motor and phonic tics in Tourette's syndrome". Cochrane Database Syst Rev (Review). 1: CD012285. doi:10.1002/14651858.CD012285.pub2. PMC 6491277. PMID 29304272. Nothing there, added to Treatment of Tourette syndrome SandyGeorgia (Talk) 23:10, 13 January 2020 (UTC)  Done ref name= PringHoller2019 Pringsheim T, Holler-Managan Y, Okun MS, et al. (May 2019). "Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders". Neurology (Review). 92 (19): 907–15. doi:10.1212/WNL.0000000000007467. PMID 31061209. BOOKS, cite page nos. Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis (PDF). Southampton (UK): NIHR Journals Library. 2016. doi:10.3310/hta20040. {{cite book}}: |work= ignored (help); Invalid |display-authors=3 (help); Unknown parameter |authors= ignored (help) Hollis is too long for home printer, read online.  Done Matson J, ed. (2017). "Tics and Tourette syndrome". Handbook of Childhood Psychopathology and Developmental Disabilities Treatment. Springer. pp. 241–56. doi:10.1007/978-3-319-71210-9_14. {{cite book}}: |work= ignored (help); Unknown parameter |authors= ignored (help)

Update

I am still working through these reviews. I am first updating the obvious outdated, next will completely rewrite the sections on Management and Mechanism, then will address repetitive text and prose, and lastly will look at the lead. SandyGeorgia (Talk) 15:17, 15 January 2020 (UTC)

@SandyGeorgia: are there any articles you couldn't get fulltexts of?Cas Liber (talk · contribs) 23:34, 15 January 2020 (UTC)

@Casliber:, no, thanks-- I'm good. Now it's just a matter of how much can I do in a day ! This article was way outdated. Tomorrow I will attempt to re-write Causes and Mechanism. Then review the lead. The next day, I will do a read-through to check prose and for repetition. Maybe, after all that, I can ask you to do a read-through, along with Yomangani and Outriggr? Right now, it's still in rough shape ... but while you're here, I had a hard time figuring out where to put Neuropsych findings, so added them to Characteristics. SandyGeorgia (Talk) 23:39, 15 January 2020 (UTC)

Hi Sandy; I'm happy to help with things like updating citation style (as per your first comment) if you want to fill me in on the deets. (That's "details", not the banned insecticide DDT, which is the definition of "deet" in Scrabble. :-) It is possible you've already done this. I will watch the page now... Outriggr (talk) 05:44, 16 January 2020 (UTC)

Thanks, Outriggr. I have the citations now to where I want them (unless you see something off). I hate SFNs, so have left the short citations to books without. I use VANC authors and shorten six or more author names to three et al, reduce titles to sentence case on all journals, and have left books in title case. I hope I have all of that consistently done now. I have a funeral this morning (story of my life), and will resume later today. I still have to completely rewrite Causes and Mechanisms, and then reduce a lot of repetitive text. Then copyedit and refine! Thanks, 'Riggr ! SandyGeorgia (Talk) 14:00, 16 January 2020 (UTC)

I think/hope the rewritten article is now at a somewhat stable place, where the copyedit gurus can have a look. @Outriggr and Yomangani: SandyGeorgia (Talk) 15:19, 18 January 2020 (UTC)

Mechanism rewrite

@Casliber, SUM1, and LeadSongDog: please have a look at the complete rewrite of Mechanism, here. SandyGeorgia (Talk) 17:59, 17 January 2020 (UTC)

(Causes next.) SandyGeorgia (Talk) 17:59, 17 January 2020 (UTC)

@SandyGeorgia: Looks like real improvement to me. There are still two sources that are not really current per wp:MEDDATE. PMID 31194327 and PMID 27777415 might be helpful on neuroanatomy (though the latter is a primary source). LeadSongDog come howl! 18:54, 17 January 2020 (UTC)

Thanks, LSD! I left those two older sources because they give plain vanilla information which is still true. Looking at your primary source next; maybe I will learn enough about brain structure to be able to do a better job at paraphrasing. I found I had to leave a lot of direct quotes in Mechanism, because I can't do it in my own words. SandyGeorgia (Talk) 19:03, 17 January 2020 (UTC)

Yes, I got one done. Need to muse on the others. Nice work. Cas Liber (talk · contribs) 20:19, 17 January 2020 (UTC)

Thanks, Cas; you should doubt everything I wrote there, since brain structure is over my head :) :) SandyGeorgia (Talk) 20:21, 17 January 2020 (UTC)

For the record - copyright question

One of the significant contributors to this article, SandyGeorgia, noted that some of the material in this article matches text at this site managed by USlegal.com.

The obvious concern, whenever there is matching text, is who borrowed from whom, and was that borrowing done appropriately. It is well-known that Wikipedia content can be reused but we require attribution. The USlegal.com site did not provide attribution. It is also well known that many editors, especially new editors who haven't been properly taught about copyright concerns, think it is okay to use wording from other sites on the Internet. This happens hundreds of times every week, and there are a few volunteers who search for and remove such copyright violations.

It is a little more challenging to deal with text that has been around for years. The Internet archive can help. If we can show that the text existed in a version of the US legal.com site that predates the Wikipedia article, it seems likely that Wikipedia borrowed from that site. The Internet archive does have a version of this page going back to 2012, but not earlier, so that doesn't help.

However, one solid piece of evidence supporting the contention that this text was original to Wikipedia and not powered from another site is to look at the development of the text over time. If the text in question comes in all in one edit, that's not conclusive proof. but it is cause for concern. On the other hand, if the current text developed organically over time, as a result of multiple edits, especially if they are by different people, it is virtually certain that the text is original to Wikipedia and was copied by the other website.

I did a crude study, looking for certain keywords in the relevant sentences to find when they were first added to the article. The following table documents the organic growth of the relevant sentences. The first three rows show the growth of the pair of sentences over time, the fourth row shows what the sentences look like in 2006, the fifth row shows a current version of the sentences, and the six row shows the text in the USlegal.com site.

While the study could be expanded with more detail, it is evident to me that this pair of sentences was developed by Wikipedia editors and copied by USlegal.com, rather than the reverse.--S Philbrick(Talk) 14:34, 18 January 2020 (UTC)

Item	Date	Editor	Link to diff or version	Key word	Text
1	20:54, 12 December 2005	12.105.167.235	Link	advantage	A third to half a lifetime of living with TS generally gives one survival skills to manage the disorder. The great majority of persons with Tourette's syndrome have learned to cover-up the more socially inappopriate tics; or use them to their advantage - such as in the case of musicians.
2	14:29, 14 January 2006	205.188.116.134	Link	supportive	Living with TS, with a supportive environment and family, generally gives one survival skills to manage the disorder. Many persons with Tourette's syndrome have learned to cover-up the more socially inappopriate tics; or use them to their advantage - such as in the case of musicians.
3	18:40, 4 February 2006	SandyGeorgia	Link	camouflage	Living with TS, with a supportive environment and family, generally gives one skills to manage the disorder. Many persons with Tourette's syndrome learn to cover or camouflage socially inappropriate tics or use them to their advantage - such as in the case of musicians. Some drummers, in particular, have found that tics give them a certain 'flair' or 'special sound' to their drumming.
4	21:52, 23 March 2006	NA	Link	NA	A supportive environment and family generally gives one skills to manage the disorder. Persons with Tourette's syndrome may learn to camouflage socially inappropriate tics or channel the energy of their tics into some other endeavor, to their advantage.
5	Current (17 January 2020)	NA	Link	NA	A supportive environment and family generally gives those with Tourette's the skills to manage the disorder. People with Tourette's may learn to camouflage socially inappropriate tics or to channel the energy of their tics into a functional endeavor.
6	Current (17 January 2020)		LINK to USLegal.com		A supportive environment and family generally gives those with Tourette's the skills to manage the disorder. People with Tourette's may learn to camouflage socially inappropriate tics or to channel the energy of their tics into a functional endeavor.

Thanks, SPhilbrick. Since it is only two sentences, it is probably not worth pursuing with legal, after my initial phone call went nowhere. I do plan to look through the US legal website to see if they have taken text from other Wikipedia articles. SandyGeorgia (Talk) 14:51, 18 January 2020 (UTC)

wording queries

1. The last paragraph in "Co-occurring conditions" begins People with "full-blown Tourette's" have significant comorbid conditions in addition to tics. This is a definition, a class, and the idea of these classes has already been presented in this section. So as a topic sentence for this short paragraph, it occurs too late in the section, having already been introduced. Can this whole paragraph be moved or integrated into earlier material? Outriggr (talk) 06:38, 20 January 2020 (UTC)

   Did that, and a bit more (thanks for the great changes!). SandyGeorgia (Talk) 15:11, 20 January 2020 (UTC)

2. "The first tics usually occur in midline body regions where there are many muscles, such as the head, neck and face". While it doesn't really contradict itself, the wording is a bit odd. Not many muscles in the head apart from in the face and neck which are called out anyway (tongue, I suppose) and the lateral lines of the head excluding the face would only be the ears? Also "body" suggests "torso" when head, neck and face are mentioned separately. Yomangani^talk 09:37, 21 January 2020 (UTC)

   Well, darn it all to heck. My Zinner article has gone missing, and I will not be in a medical library again until 21 Feb. I fear I misfiled it with the Autism/Asperger papers, which I tossed when I decided I will never again work on those articles. I will have to dig in to other sources. SandyGeorgia (Talk) 13:00, 21 January 2020 (UTC)

   Reminder to self, review commented-out text after I get a new copy of Zinner.[4] SandyGeorgia (Talk) 13:26, 21 January 2020 (UTC)

3. "There is evidence to support the clinical lore that children with pure TS have identified advantages". Evidence...lore...identified. These don't sit well together. Yomangani^talk 09:50, 21 January 2020 (UTC)

   Better? [5] SandyGeorgia (Talk) 13:38, 21 January 2020 (UTC)

   Much. Yomangani^talk 16:29, 21 January 2020 (UTC)

4. Not keen on the jolting start to the article proper "Tics are..." I think it would be best to define TS first, even if with just one sentence (though I apparently thought it was fine back in 2006, I'm so fickle). Yomangani^talk 10:16, 21 January 2020 (UTC)

   I will look at these after coffee; thank you both for the labor of love to disentangle my prose! SandyGeorgia (Talk) 11:27, 21 January 2020 (UTC)

   @Yomangani: on 2 and 3, I will go back to the original sources (later today) to re-jig.

   On 4, most likely you did not object in 2006 because the Classification section used to be before Characteristics, so TS was defined earlier. I moved Classification below Characteristics because so much of it depends on an understanding of the concepts in Characteristics. How to disentangle all that ... do you have a suggestion? I could move Classification back to first place, but then I have to figure out how to position the third paragraph. SandyGeorgia (Talk) 12:15, 21 January 2020 (UTC)

   See if it works now? I moved classification back, and define pure TS sooner. SandyGeorgia (Talk) 12:31, 21 January 2020 (UTC)

   Yes, that's a gentler start. Yomangani^talk 16:29, 21 January 2020 (UTC)

5. Regarding these two options, I was thinking of synonyms allowing us to dequote is all. Not hugely fussed either way. Meaning is often needing to be more exact in medical articles (vs movie reviews) so can see rationale. (so happy to leave how you want it) Cas Liber (talk · contribs) 02:17, 22 January 2020 (UTC)
6. NB: I think "having the appearance of "normal behaviors gone wrong"." would go better at the end of the second rather than first sentence as it then comes after a basic descriptor and makes more sense. Cas Liber (talk · contribs) 02:20, 22 January 2020 (UTC)

   I got that one. Casliber, please don't feel like you haven't to check in with me; all improvements are welcome! From the examples raised so far, it looks like I often get into trouble when trying to paraphrase very precise medical terminology, and in those cases, reverting to the exact quote seems to solve the prose problem. I am glad these instances are being identified! SandyGeorgia (Talk) 14:56, 22 January 2020 (UTC)

7. In context I didn't understand Even close family members may have different symptom severity, or no symptoms at all. Like, what is the context? We're already talking about family members, and I assumed immediate descendants, so what does "even close family members" mean? Like if the really love each other? Sorry. It's possible I'm missing the key idea. // Edit: before I changed it, it read Thus, not everyone who inherits the genetic vulnerability will show symptoms; even close family members may show different severities of symptoms, or no symptoms at all. I still don't understand "even close" though. // Edit: Is something like Siblings [who have inherited the vulnerability] may have different...] the idea? // Edit: If I seem really pedantic, it's not intentional!! Maybe the only problem is the word "even". Outriggr (talk) 10:45, 22 January 2020 (UTC)

   That was a mess for a number of reasons, so I removed it entirely. I think since I wrote that in 2006, we now know that we know much less than we thought we knew about the genetics of OCD v TS. SandyGeorgia (Talk) 15:15, 22 January 2020 (UTC)

8. Outriggr and all: DSM-5 requires "at least 2 motor tics and at least 1 vocal (phonic) tic" (tourette.org), so the wording is a bit messed up now. Another direct quote is "Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently" (Stern 2018). The important thing is that the requirement on vocal is only one tic (which is controversial and many researchers disagree), so we need to separate that. SandyGeorgia (Talk) 13:36, 23 January 2020 (UTC)

   Outriggr, on re-read, I see what confused me on the copyedit, and fixed it. All good. SandyGeorgia (Talk) 14:01, 23 January 2020 (UTC)

   Are you saying that the vocal tic doesn't have to occur for the same period (a year)? Because otherwise the original wording was clearer. And I suppose there must be some timespan for the occurrence of the phonic tic otherwise you can just clear your throat once and you've got it. Yomangani^talk 14:09, 23 January 2020 (UTC)

   Yea, this section is giving me fits :) Both must have been present during a year, but not both at the same time during that same year. I think your concern about clearing your throat once is covered by the definition of a tic including the word "repetitive". Yomangani have a look now-- I did considerable juggling. Sheesh, I had a mess in there! SandyGeorgia (Talk) 14:26, 23 January 2020 (UTC)

   Twice then. Ahem, ahem. I've re-ordered it again, because the "a/b" style would mean having to put "a)...for a period of one year, and b)...for a period of one year" which is even more clunky than the ever-so-natural phrasing I've replaced it with. Yomangani^talk 14:47, 23 January 2020 (UTC)

9. Outriggr Diagnosis does not require the presence of a comorbid condition, such as ADHD or OCD. (this is sort of a medical tautology isn't it? "Diagnosis of that defined as A, and only A, does not require the presence of that defined as B"). One would think so, yes ? But J Jankovic--recognized expert on movement disorders-- once published in a widely read The New England Journal of Medicine article that OCD, ADHD, and behavioral disorders were part of the diagnosis/condition, and the NEJM never retracted, although they were taken to task by other researchers. So, that's why that's there; the notion persists. SandyGeorgia (Talk) 13:46, 23 January 2020 (UTC)

   I am off to (yet another) funeral. I will come back later and explain more about why this matters. SandyGeorgia (Talk) 14:56, 23 January 2020 (UTC)

10. "SG: 'asthma in two places'." (edit summary) Yeah... I am not clear if the "asthma" mentions are redundant? [Cocaine is also mentioned twice (I, uh, noticed).] I believe you have since improved the order of the whole section. Outriggr (talk) 15:32, 23 January 2020 (UTC)

    Maybe all OK now? Have another look ... I was in a rush to get out the door to a funeral ... on iPhone now. See if current order is OK? SandyGeorgia (Talk) 15:35, 23 January 2020 (UTC)

11. "Compared to the successful efforts seen in other conditions (autism, schizophrenia and bipolar disorder), these efforts are underfunded in the US." This doesn't follow, because you aren't comparing like to like (successful efforts v research). I think you mean that these efforts are underfunded in the US when compared to research into other conditions such as autism, schizophrenia and bipolar disorder, which have had successes related to the generous(?)/relatively high(?)/adequate(?) level of funding given to them. Also, "underfunded" seems like a judgement unless funding levels are set and the US isn't meeting its commitment to the agreed levels. Also, two "efforts" (undertaking, accomplishment, endeavo(u)r). Yomangani^talk 00:09, 27 January 2020 (UTC)

    @Yomangani:, the source concludes with:

    Regardless of whether the focus is on discovering rare or common sequence or structural genetic variation, it is clear that large collections of biomaterials (likely in the tens of thousands) that are accessible by multiple research groups will be essential for success. Three consortia are now beginning to work toward this goal (TSAICG and TIC Genetics in the United States, and EMTics in the European Union); there is active collaboration among these groups, which will also be essential for success. However, the scale of the funded collection efforts, particularly in the United States, remains quite modest compared to other neuropsychiatric disorders in which there has been success in gene discovery.

    Yea, so I got that one really messed up. SandyGeorgia (Talk) 00:18, 27 January 2020 (UTC)

    Ugh. Not easy to reword and keep the sense (even if you can work out what they mean). Yomangani^talk 00:28, 27 January 2020 (UTC)

    I tried, but ... have a look? Also in the lead. SandyGeorgia (Talk) 00:30, 27 January 2020 (UTC)

    That looks OK. You have the same level of fudging as in the source. Yomangani^talk 14:18, 27 January 2020 (UTC)

12. "In past centuries, Samuel Johnson is a well-known example of a person who may have used obsessive–compulsive traits to his advantage." "In past centuries" is an ugly construction to begin with, but does it refer to Johnson or his OCD advantage-gaining behaviour being well known in past centuries, or him or OCD advantage-gaining behaviour being a well-known example from the past (centuries)? Is it Johnson or his OCD advantage-gaining behaviour that is well known? If it is the OCD advantage-gaining behaviour that is meant, is it really well known? I think the "In past centuries" phrase was perhaps supposed to act as an introduction to this paragraph rather than just to Johnson (as there is an abrupt change of subject from Johnson to Mozart later on) but it doesn't work like that because it is tied to Johnson. Also, what does the OCD advantage-gaining behaviour have to do with Tourette's? I'd drop that sentence completely and introduce the paragraph with some reference to "historical figures who may have had Tourette's" or rework it to say something like "Although a popular candidate for historical diagnosis Mozart probably didn't have it but Johnson probably did". Yomangani^talk 14:15, 27 January 2020 (UTC)

    Did that, because after reading the article, if you don't see the connection between OCD and TS by now, neither will our readers :) :) SandyGeorgia (Talk) 14:20, 27 January 2020 (UTC)

    I meant how does it help mentioning a comorbid condition as if it is evidence for Tourette's when the rest of the article makes a point of the importance of separating them. But it is gone now, so who cares. Yomangani^talk

    Yea, what was really needed there is mention of the abundance of evidence documenting his tics, but I am determined to get the article under 6,400 words, and that info is available in his article. :) :) SandyGeorgia (Talk) 14:39, 27 January 2020 (UTC)

    I knew better, but I really wanted to write "in centuries past". Outriggr (talk) 15:09, 27 January 2020 (UTC)

    Just so you could rhyme with ass(t)? SandyGeorgia (Talk) 15:10, 27 January 2020 (UTC)

    I accidentally pressed enter in the edit summary box (which is annoying) before I could type "asset to the project". But also it turns out I thought I was on someone's talk page in another tab, so as an edit summary here it makes even less sense. Oops! Outriggr (talk) 15:30, 27 January 2020 (UTC)

@Outriggr and Yomangani: since we are at the bottom of the article, that does mean you two are done? If so, I shall invite Colin, Gog, others ... but don't want others to get in your way yet. You have both made beautious changes! SandyGeorgia (Talk) 15:34, 27 January 2020 (UTC)

If Outriggr has finished, I'll have to go through and correct all his mistakes, but apart from that, yes. (It's a joke, jeez). Yomangani^talk 16:13, 27 January 2020 (UTC)

OK, some final comments. I've tried to be conservative here, as I noted in my correspondence of early January 2O2O. (This is against my very nature as a Bernie Bro. JK.)

• You can probably ignore this unless you find something useful (it's prob just me): I felt that the phrase biological vulnerability and adverse environmental events were seen to interact, coming late in the article, had a tone that was different from earlier ways of summarizing TS. "Biological" for example is not found elsewhere in the article, except for one "neurobiological". It seems that the article has favored "genetic" over "biological" before this: "genetic vulnerability" x 3 or 4. And "adverse environmental events" was a surprise to me, despite having read "Causes": is this referring to autoimmune stuff, and/or the pre- and post-natal information? It's a bit legalistic sounding.
• I found that some ideas were repeated quite a few times. I decided that this repetition was a conscious choice, so that the sections could function somewhat independently (i.e., so a reader who comes along and reads 2 or 3 sections gets more context).
  • Is Children with milder symptoms are unlikely to be referred to specialty clinics, so prevalence studies have an inherent bias towards more severe cases largely repetition of earlier information in that para? That is, The discrepancy between current and prior prevalence estimates arises from ... the ascertainment bias caused by samples that were drawn from clinically referred cases. Could that entire paragraph be tightened up? This sentence might be more beneficial elsewhere: About 20% of people with Tourette syndrome do not recognize that they have tics; perhaps screening or prognosis. Of course, it works where it is too, and this is where some of the overlap I talked about comes from.
  • Another example of repetition comes in the "supportive environment" idea. The word "supportive" occurs seven times.
• small question: is the video in "Tics" supposed to have custom markup? I tried it with a normal "File:" invocation and it seemed fine.

I didn't note where I experienced repetition, so I would need to read it again to point out where I noticed it. This shouldn't be necessary if others are reviewing. Outriggr (talk) 06:52, 28 January 2020 (UTC)

@Outriggr: on the custom markup on the video, see the TFA request in the section just below this one. I don't understand the technicalities, but I put in place the same thing installed there-- perhaps unnecessarily?

On the repetition in epidemiology, it has long bugged me, and I'm glad you honed in on ways to fix it. I made the changes you suggested; does that address that section? Reduced supporting. But on repetition overall, the constant need to distinguish between and explain the differences caused by pure TS v. TS plus comorbodities makes it difficult to eliminate some repetition as new sections are introduced. As explained in Classification, many top researchers think they should not be considered the same condition, so I have practically had to write two articles in one here. Pure TS is just not the same thing as TS accompanied by ADHD. And that takes lots of TSsplaining. SandyGeorgia (Talk) 15:12, 28 January 2020 (UTC)

Thanks for explaining. I like the "biological" sentence more now also.

The comorbidity is complicated and I expect it is confusing for a layperson to even understand what symptoms are attributable to "TS" as such. I learned a lot in reading this, and it's an achievement. Outriggr (talk) 06:11, 29 January 2020 (UTC)

I suspect that in a perfect world (meaning where it didn't take decades to get the DSM re-written), tics plus ADHD would fall under the ADHD umbrella (as in ADHD with hyperactivity, ADHD with inattention, and ADHD with tics), since it has been amply demonstrated that all of the "impairment" comes from the ADHD. I guess the genetic relationship would have to be better defined before that happens. But for now, we have to write the article as the condition is defined, even though every credible researcher says TS is not a "unitary condition" and does not fit into the current classification scheme.

There is also a separate, follow-the-money, factor. Years ago, the TSA got $18 million from the NIH for research; those days have ended. As research showed that TS wasn't really all that problematic, the money has flowed instead to autism and other conditions. The decline in good TS review articles was noticeable, as some of the top minds moved on to more lucrative research areas. So, in many cases in this article, the best-written sources are sometimes the older ones.

I am going to be traveling next week, so I will let all of the updates percolate until my return. Then I'll archive off the old, and invite others (Cas, Colin) to also go through, but when I am back and can re-focus. Thank you SO MUCH for everything, Yo-man and Riggrs! SandyGeorgia (Talk) 13:54, 29 January 2020 (UTC)

Speaking of "follow the money": billions for autism. So, where ten years ago reviews carefully sorted comorbid conditions, recent reviews are tending towards mentioning autism, even with tenuous supporting literature. SandyGeorgia (Talk) 13:39, 31 January 2020 (UTC)

Timely

Dearest Outriggr and Yomangani, I have not been able to figure out what is driving it, but this article got 61,000 hits in the last three days. You did your excellent copyediting at just the right time, and Wikipedia readers had a better experience! SandyGeorgia (Talk) 14:36, 30 January 2020 (UTC)

That was just Outriggr and me reloading it - Yomangani^talk 15:05, 30 January 2020 (UTC)

I'm told a lot of people, all kinds of people, most of the geniuses, follow us around silently on Wikipedia. Could be that. Outriggr (talk) 06:04, 31 January 2020 (UTC)

• https://www.kwqc.com/content/news/12-year-old-boy-overcomes--567317261.html
• https://www.cbc.ca/news/canada/ottawa/tourette-syndrome-bus-campaign-1.5442450
• https://dotesports.com/streaming/news/sweet-anita-on-tourettes-syndrome
• https://soapdirt.com/90-day-fiance-loren-brovarnik-how-pregnancy-impacts-her-tourettes-syndrome/
• https://www.nytimes.com/2020/01/29/nyregion/nxivm-lawsuit-keith-raniere.html
• https://workplaceinsight.net/universal-music-publishes-new-guide-to-neurodiversity-in-the-the-workplace/
• http://www.startribune.com/minnesota-parents-fight-schools-to-allow-children-access-to-cbd/567298452/

It looks like a combination rather than one specific thing. SandyGeorgia (Talk) 16:06, 30 January 2020 (UTC)

Have you guys finished polishing? I'd like to read this but happy to wait. -- Colin°^Talk 10:40, 31 January 2020 (UTC)

I've finished. By the way, I must tell you, it's already getting a huge reaction; an incredible reaction; really phenomenal. I'm hearing that many many people, smart people, the smartest, have said our copyediting is the best. Believe me, they've told me, the best they've ever seen. The best. And these are people that have seen a lot of copyediting. Right? Yomangani^talk 13:31, 31 January 2020 (UTC)

Colin if you start now, you'll ruin my vacation as I will feel compelled to respond quickly :) :) If you don't mind waiting a week, it would be the bees' knees. On the other hand, maybe the three of you are knowledgeable enough to move forward without me, and I can retire in peace :) SandyGeorgia (Talk) 13:41, 31 January 2020 (UTC)

More than happy to wait a week. I'm sure it is perfect anyway. Ping me when you are back. Enjoy your break. -- Colin°^Talk 15:21, 31 January 2020 (UTC)

@Colin: after an unpleasant flight delay and a late arrival, we are going to take it easy and stay in today, meaning I will have time to follow should you decide to do any review today (Saturday). (Except my sources that are not online are at home.) SandyGeorgia (Talk) 15:08, 1 February 2020 (UTC)

Thanks. I'm busy with family stuff today. There's no rush. I'd rather you had a break than worried about fixing minor stuff. -- Colin°^Talk 16:27, 1 February 2020 (UTC)

Catching up here now on a down day around the hotel: @Yomangani and Outriggr: you two should apply for citizenship and run for president. Oops, good luck with the first ! SandyGeorgia (Talk) 15:21, 1 February 2020 (UTC)

Revert

I reverted an edit that incorrectly linked motor tics, changed the citation style (WP:CITEVAR-- page number footnotes clutter the text and are not required for journal articles, I provided them in hidden comments only because those are long articles), and switched the word "are" to "include" when most sources discuss a very narrow, specific list of common first tics. Some good edits retained.[6] SandyGeorgia (Talk) 16:27, 30 January 2020 (UTC)

I didn't know that {rp} was the thing that produced superscript page numbers in running text -- now I know which template to blame.

While I'm here: I've taken some white space off File:Tourette2.jpg, the lead image. The white space was bloating the infobox area somewhat. There's still plenty I think, including some "buffer" for his head, but I'll happily revert it if you prefer original. Outriggr (talk) 06:02, 31 January 2020 (UTC)

In case you couldn't tell, I despise that citation method :) SandyGeorgia (Talk) 13:36, 31 January 2020 (UTC)

Despising this citation method... Is that not the going against exactly what you're citing WP:CITEVAR? Preferring certain citations styles over others over 'preference' SandyGeorgia. Sometimes I just wish to WP:IAR -.- comrade waddie96 ★ (talk) 21:42, 1 February 2020 (UTC)

But to avoid a trivial argument that will be devoid of consensus, please give me a concise point and summary as to why {{rp}} is unhelpful to the reader? comrade waddie96 ★ (talk) 21:52, 1 February 2020 (UTC)

Journal citations do not require page numbers; if we were to add them on one, we would need to add them on all. This article uses short form citations for page numbers on books; adding page numbers on journals changes the citation method. Perhaps in articles that use primarily book sources, the rp method is equally useful to short form citations, but based on how rarely they are used, the community does not seem to think so. We have in this thread a 15-year Wikipedia veteran who didn't even know what rp did (other than unnecessarily cluttering the text with numbers that even our readers might not know the meaning of). In any article-- and particularly a featured article-- changing a commonly accepted citation style (no page numbers for journals, short form for page numbers on books) requires consensus. There is no such consensus for this article (or any medical article that I am aware of). Also, see WP:OWN#Featured articles. Also, WP:CITEVAR instructs not to change an established citation style without consensus. SandyGeorgia (Talk) 23:12, 1 February 2020 (UTC)

Image query

@Colin and Nikkimaria: is there any reason for using File:Une leçon clinique à la Salpêtrière 02.jpg (dark, murky) here instead of File:Une leçon clinique à la Salpêtrière.jpg (better)? SandyGeorgia (Talk) 18:40, 1 February 2020 (UTC)

Not that I can see. Nikkimaria (talk) 18:53, 1 February 2020 (UTC)

The dark one is quite heavily cropped, missing out some important characters. The other is clearly scanned from a print so isn't ideal vs a photograph of the actual artwork. It is often hard to tell which is more accurate, and we don't have a reference link to a website of the art gallery itself which one might assume to display the most faithful version. Since this article isn't about the painting, then that's less important than a clear thumbnail. -- Colin°^Talk 11:41, 2 February 2020 (UTC)

The first one, File:Une leçon clinique à la Salpêtrière 02.jpg, is probably one of the copies, as it is supposedly taken in front of the Charcot lecture hall, at the Salpêtrière hospital. The other one, File:Une leçon clinique à la Salpêtrière.jpg, was supposedly taken in a corridor of the University Paris V which is where the original is supposed to hang; the original upload was quite different but has watermarks for (c) Art Resource all over it, so the claimed provenance is doubtful. The print scan has been uploaded over the top rather than being uploaded as a new version which is annoying. If you want to revert it on Commons then the second version of File:Une_leçon_clinique_à_la_Salpêtrière.jpg looks the best. Compare it to [7] (although the photo there looks a bit soft focus, it is probably trying to be true to the original colour). Yomangani^talk 13:34, 3 February 2020 (UTC)

They all have their flaws. The one Yomangani prefers is very low resolution 0.2MP vs the scanned print 5.3MP. There's a huge difference in how much detail one can see when examining the image (less so for tiny thumb). Although overwriting the image was against Commons policy, it was overwritten eight years ago and is heavily used, so Commons would not take kindly to Wikipedians reverting it to some tiny dark version that is 14 years old and sparking an edit war. The solution to these issues is to upload whatever version you want as a new filename, should that version not be on top. My 2p is that even though the scan may be less accurate in terms of brightness and saturation, it wins hugely for clarity and resolution. There is also File:Charcot experience histeric-hipnotic.JPG which lies between the two, though it has some border cropping issues. -- Colin°^Talk 14:03, 3 February 2020 (UTC)

I meant the reverted version for colour. It's obviously completely useless if you want to see anything. I like the last one that Colin found (colour is better and it shows more of the painting than any of the others, who cares if there is a bit of frame or wall in there too). Yomangani^talk 14:21, 3 February 2020 (UTC)

I can’t see the border cropping problem in the intermediate version? SandyGeorgia (Talk) 14:45, 3 February 2020 (UTC)

The top edge creeps outside the canvas a bit (that brown line). Yomangani^talk 15:02, 3 February 2020 (UTC)

Even if I can’t have my coffee yet (because the kids have the sofabed in the suite and they were out all night), no one will ever see that aun con dos dedos frente a la cara! SandyGeorgia (Talk) 15:05, 3 February 2020 (UTC)

March 3 TFA

• Wikipedia:Today's featured article/March 3, 2020 SandyGeorgia (Talk) 02:22, 19 February 2020 (UTC)

• Wikipedia:Today's featured article/requests/Tourette syndrome SandyGeorgia (Talk) 05:19, 16 February 2020 (UTC)

Talk page followers: please see this AN thread re protection on mainpage day. I tested Twinkle and, dude !! It takes two seconds to install Twinkle as a gadget just for mainpage day. Will need help watching the suite at {{Tourette syndrome}}. SandyGeorgia (Talk) 15:05, 19 February 2020 (UTC)

Colin review

Classification

Starting to read it. I got a bit stuck on "provisional tic disorder" which is mentioned in the lead and classification sections. I couldn't really get my head round what a provisional tic disorder might be -- it made me think of those elements at the bottom of the periodic table where nobody had yet decided what to call them. After a little googling I see that there are really just transient and chronic disorders, with the 12-month duration distinguishing them, but that while the child is inside this 12-month window, we have no idea if it is going to be transient or chronic. So someone had a bright idea to call that "provisional tic disorder", which you have until you don't. Only an epidemiologist could like that. I think, if that is now the initial language parents are going to hear from their neurologist, we're going to have to explain this term better.

I found the classification section confusing and couldn't really appreciate why I was being told in detail how it used to be defined. I also found it confusing that TS is very much a chronic tic disorder but isn't "Chronic tic disorder", which must not have both motor and chronic tics. I recommend we start with the current DSM 5 (I read this). The knowledge hierarchy from [other/unknown -> provisional -> chronic vocal or motor / Tourettes] is possibly useful. We can say that "provisional tic disorder" is diagnosed while the tics have lasted < 12 months. We can say that this was formerly called "transient tic disorder" but that name implied some retrospective knowledge. I think we should use the name "Persistent (Chronic) Motor or Vocal Tic Disorder" rather than "Chronic tic disorder" and make it clearer that TS requires Motor and Vocal tics.

Wrt the last paragraph in Classification, it is a tad dry and advanced and I kept waiting for something that happened after "Between 2008 and 2014". All classification systems have their controversies and evolve as we learn more about the cause or treatment. The initial sentence doesn't really explain to me why some studies think it isn't "a unitary condition" or how this is important. Perhaps in the [new] sentence where we explain the difference between the two chronic disorders, we could also note that some experts disagree that this distinction is relevant or useful. I think the comment about co-morbid disorders affecting management is probably better made elsewhere. The genetic comment could also be abbreviated to merely note that there is no genetic basis for the classification system [if we can state this as a fact is better than "genetic studies do not support" which sounds more like you are arguing a case].

While I agree we need to get classification out of the way early in the article, I think as the first body section, we need to work harder to make it easy to read and engaging for the reader. A long paragraph about an out-of-date manual-with-a-long-name, and classification research controversies are not helping me want to read the rest. -- Colin°^Talk 17:22, 9 February 2020 (UTC)

OK, got my work cut out for me :) This probably happened because I updated the article as soon as DSM-V was enacted, but at that time, there weren't good sources on TS in DSM-V, so the text was too driven by what it used to be versus what it is now, and all of that is complicated by different terminology in DSM v ICD. I'll tackle all of this. Ugh :( SandyGeorgia (Talk) 18:37, 9 February 2020 (UTC)

Colin have a look now. We need to keep the TS-only v. TS plus comorbids up front, because the article title is Tourette syndrome and the DSM5 defines it as Tourette syndrome, but most experts agree there are actually subtypes-- to the extent that we are describing multiple subtypes in one article, we have to get that clear up front. SandyGeorgia (Talk) 22:47, 9 February 2020 (UTC)

More Colin review

Sandy, I'm reading it again. I may make a few tweaks and feel free to revert at will if I make it worse. -- Colin°^Talk 11:25, 16 February 2020 (UTC)

Colin on this one, preferable would be to completely remove Jankovic and paraphrase the direct quote so I don't have to attribute it at all. Or reference him as we do other studies. The significant researchers in TS whose work warrants specific mention are already linked, and I've already written their articles. The only reason I named Jankovic there is I had to attribute the direct quote, as the text was too hard for me to paraphrase. SandyGeorgia (Talk) 11:44, 16 February 2020 (UTC)

Ok. I'll work through the article and we can rethink some things at the end. -- Colin°^Talk 11:49, 16 February 2020 (UTC)

Here are two really good sources for a lot of context.

• Robertson MM, Eapen V (October 2014). "Tourette's: syndrome, disorder or spectrum? Classificatory challenges and an appraisal of the DSM criteria" (PDF). Asian J Psychiatr (Review). 11: 106–13. doi:10.1016/j.ajp.2014.05.010. PMID 25453712.
• Mariam N, Cavanna AE (October 2012). "The most cited works in Tourette syndrome". J. Child Neurol. 27 (10): 1250–9. doi:10.1177/0883073811432887. PMID 23007298.

Mary Robertson is the top Brit researcher, so it is interesting that her review singles out the Yale Group as The Name of the Game in TS research. I always knew that, but I'm glad it's backed by a reliable source now. I also always knew that the money fell out of TS research and moved to autism, and the really high quality reviews stopped appearing after 2000. That was a factor that made it difficult to update the article for many years; so many of the newer reviews just aren't of the quality of those during the heyday. James F. Leckman & Donald J. Cohen are hands down the top TS researchers, which Robertson mentions and the Mariam/Cavanna source supports as well. Arthur K. Shapiro is the 1970s pioneer. Those are the bios I've written so far. The second source verifies that these are The Guys in TS. The second source also helps answer a question I think Yomangani, but maybe Outriggr asked a while back (why do we mention that ADHD is not required for diagnosis). It shows that the very old New England Journal of Medicine review by Jankovic, which erroneously stated that ADHD was required for a TS diagnosis, remains one of the top cited TS reviews. Letters to the editor took him to task, but NEJM did not retract or issue a correction. SandyGeorgia (Talk) 12:33, 16 February 2020 (UTC)

OK, starting back in here. I did not realize that the Joseph Jankovic article had been written (and darn, it's in terrible shape, I wish I hadn't seen it). He practices, and he is recognized in TS, although he is more of a broad movement disorder specialist (eg Parkinson's and all sort of other conditions). Given that his article is written, I decided to leave this text as is, but removed the word "research", because he does practice.

Alternately, if one reading here feels able to paraphrase that text, we could remove the attribution. SandyGeorgia (Talk) 18:49, 16 February 2020 (UTC)

Separately. Joseph Jankovic has SPA, COI and possibly paid editing in evidence. I'm not cleaning it up, but I'm embarrassed to have it linked here. All of the other doc bios are clean. SandyGeorgia (Talk) 22:53, 16 February 2020 (UTC)

• I'm not really understanding "Published descriptions of the tics of Tourette's identify sensory phenomena as the core symptom of the syndrome, even though these phenomena are not included in the diagnostic criteria". I think when you write "sensory phenomena" you mean the uncomfortable sensation and urge to resolve it. But is it always "sensory"? And sensory does not imply an urge (we sense many things and merely acknowledge or enjoy them) The preceding text says "relieving this tension or sensation", so perhaps it is sometimes sensory and sometimes emotional? I think you are trying to say that the diagnostic criteria only concentrate on the outward signs rather than the feelings of the person prior to the tic. They also seem to neglect the temporarily suppressible aspect. Has anyone said more on why the diagnostic criteria should ignore those aspects, as they seem very easy to ask the patient about. -- Colin°^Talk 12:03, 16 February 2020 (UTC) Ah the next sentence partly explains this: that self-knowledge about premonitory urges and ability to suppress tics increases with age, and may not be developed at the time of diagnosis. Perhaps we can make this clearer? Maybe drop the sentence I quote here, and add a rephrased sentence at the end of this section, once we've explained that young children might not be so aware/controllable. For example, "For these reasons, although a preceding urge to resolve a tension or sensation, and ability to temporarily suppress tics, are a core symptom of the syndrome, they are not included in the diagnostic criteria". -- Colin°^Talk 12:12, 16 February 2020 (UTC)

• I'll wait for you to finish on all of these, but yes. The seminal work in this area is a very old paper by a physician, Bliss, who had Tourette's, and elegantly described these phenomena, along with several Leckman/Cohen/Yale Group papers on the phenomenology. Kids don't get it until after 10. This is a Very Important Point, because CBIT is the mainstay in treatment these days, and the way CBIT works depends on awareness of the premonitory urges. So this must be clear; thanks for working on it! SandyGeorgia (Talk) 12:40, 16 February 2020 (UTC)

• OK, have a look now. (The citations are all out of order now, but I will wait til we are done to fix ref order.) I couldn't take your precise wording because it's not fully supported by the sources, and I had to divide suppressibility into one para, premonitory urge into another. Does it work? SandyGeorgia (Talk) 19:34, 16 February 2020 (UTC)

• Progression. The article doesn't explain that severity has an upward slope towards a peak, as well as downward (I read the paper). I think also the "as late as eighteen" onset point makes discussion of progression rather awkward, since this is past when the entire curve appears for most people. So I've made this edit to try to clarify. I dropped the "with an average age of ten" bit. I wondered if this over-complicated things for a study of 36 people. While I trust their maths, Figure 1 in the paper shows all the randomness of a small-population study. -- Colin°^Talk 12:43, 16 February 2020 (UTC)

• You have now read one of the most important studies ever published in TS :) And I can now say that based on a reliable source I give above! SandyGeorgia (Talk) 12:47, 16 February 2020 (UTC)

• "Fewer than 20% of individuals see continued (or more severe) symptoms in adulthood, while at least one child in three has a complete remission of tics." @WhatamIdoing: -- this is related to your″ Wikipedia talk:WikiProject Medicine#People can't math discussion. We've got two figures. One is a percentage and the other a ratio in prose. One is "fewer than" and the other is "at least". One is "got worse" and the other is "got better". I wonder if there is a better way to explain this. -- Colin°^Talk 12:54, 16 February 2020 (UTC)
  • That was a fascinating discussion; you will find more of this sort of thing in prognosis when you get to it, so perhaps WAID will look in there, too. SandyGeorgia (Talk) 19:39, 16 February 2020 (UTC)
    • I think we can say this much:
      • Whatever the form you choose, everything should be in the same form as much as possible. Use grammatical parallelism as the model. You might try "More than four out of five see improvements, and more than one out of three has a complete remission" (exactly what you can say depends on the details in the source – for example, if that "Fewer than 20%" happens to be 17%, then you should probably say "About five out of six" instead).
      • When convenient, especially for "big deal" prognosis numbers, giving 'both sides' can help. In this case, that probably looks something like this: "In a group of ten children, three or four will see complete remission by adulthood. Four or five out of those ten will see improvements, but not complete remission. The remaining two will have the same or worse tics as adults." WhatamIdoing (talk) 05:22, 17 February 2020 (UTC)
        • Wonderful, thanks WhatamIdoing; will work on this and similar. Thanks ! SandyGeorgia (Talk) 05:54, 17 February 2020 (UTC)

OK, I tracked down the actual percentages, put something else in the "Onset and progression" section, and added this instead to "Prognosis":

In a group of ten children, almost four will see complete remission by adulthood. Another four out of those ten will have minimal or mild tics in adulthood, but not complete remission. The remaining two will have moderate tics as adults, but only rarely will they have worse tics.

Ref
References

• How about "often" in place of "frequently" here? SandyGeorgia (Talk) 13:04, 16 February 2020 (UTC)

• Yes I just wanted an easy to understand word (usually) in the first sentence, and didn't want it repeated in the second. Have replaced. -- Colin°^Talk 13:08, 16 February 2020 (UTC)

• "Vocal tics often appear years after motor tics": I think "years after" is a bit vague when we are talking onset five to seven and peak at eight to ten. Since vocal tics are required for diagnosis, this does rather make me wonder when these kids get diagnosed compared to their progression with motor tics. Do we have any more precise figures on when vocal tics appear. -- Colin°^Talk 13:08, 16 February 2020 (UTC)

• I can find that, but it will likely be a dated source, as that work was covered in the late 90s early 2000s. On it. SandyGeorgia (Talk) 13:09, 16 February 2020 (UTC)

• By the way, Hollis explains that diagnosis in the UK takes three years !!! That is crazy. TS is a thing that is recognizable on the spot. But I'm not aware of any typical age of diagnosis data. This is related to a) most are undiagnosed and b) specialty clinics see atypical cases (more severe) and c) many physicians don't officially confer a diagnosis of TS even when they know the kiddo has it, per unnecessary stigmatization, blah, blah, blah ... covered in the article. No good data on age of diagnosis. SandyGeorgia (Talk) 13:15, 16 February 2020 (UTC)

I'm going to stop for lunch. Storm Dennis has caused a leak round the vent in my bathroom and I need to go up on the flat roof to investigate. -- Colin°^Talk 13:16, 16 February 2020 (UTC)

OK, I'm going back to sleep ... don't fall off! SandyGeorgia (Talk) 13:19, 16 February 2020 (UTC)

I'm safely back from investigations with no more harm than some wet moss splatters. I couldn't see any obvious cause, so will just have to call out the roofing experts to fix. Will return to the article later.. -- Colin°^Talk 13:47, 16 February 2020 (UTC)

Back to this. Kind of hitting a dead end, but for reasons I understand. Without getting into too much detail here, Robertson reviews sometimes report her opinions ("in this author's opinion"), or cite self, or do not cite at all. The (older) Yale people (were) are typically extremely careful in their wording, but the more recent Yale papers seem to always cite the 1999 Leckman/Cohen book, which has no mention of an average age of vocal tic onset that I can find. Everything I can find points back to some alleged average age of 11 for vocal tics, but I cannot locate an original source for the eleven, and most of the landmark Yale work does not mention that, and I suspect for good reason. Typical first vocal tics are things like coughing and sniffing and odd throat gulpy noises that are confused with asthma and allergies. So often, the diagnosis becomes more clear only in retrospect. I don't see good enough evidence to add the average age of 11 mentioned a few times, and believe this is why many reviews don't mention an average age for vocal tics. I did add the word "months or" to years, based on Robertson, as that could help answer your diagnostic query. SandyGeorgia (Talk) 19:50, 16 February 2020 (UTC)

Break Colin review

• "People with "full-blown Tourette's" have significant comorbid conditions in addition to tics." I'm uncomfortable with this description. "Full blown" is "possessing or exhibiting all the usual or necessary features or symptoms" and this seems to go above that, requiring behavioural disorders in addition to tics. Earlier in classification, "pure TS" was described as being without these comorbid conditions. I wonder what value there is in these ad hoc definitions, particularly if they do not have any consensus approval for their use. I did a google. I see Fact sheet uses "full-blown" in its dictionary interpretation of meeting all the diagnostic criteria. WebMD also uses this language, and I think also just to mean meeting the criteria, rather than exceeding them. The adjective also appears here. -- Colin°^Talk 18:22, 16 February 2020 (UTC)

• On the one hand, there may be no need to define "full-blown Tourette's" in this article, because I don't think it comes up again. Nonetheless. This is a problem of marginal sources versus expert sources (I believe you've heard me before on the NIH as a source for TS info, and the other sources are even lower quality, while the TS expert review uses the word as TS researchers use it. This is to distinguish fulminant TS from plain vanilla TS-plus. I don't care if we drop the sentence, since it's not adding anything, but take care with NIH as a source-- they have been wrong too often in my memory. Sorting out "full-blown" isn't critical to this article, while sorting out "pure TS" from TS when it occurs with run-of-the-mill cormorbids is. Let me know if I should drop this sentence, or if this explanation satisfies. SandyGeorgia (Talk) 20:28, 16 February 2020 (UTC)

• I'd rather drop it, as it confuses with TS-plus and isn't using the dictionary definition of that phrase. -- Colin°^Talk 17:51, 18 February 2020 (UTC)

This paper suggests "it has been suggested that it may be useful to clinically sub-divide Tourette’s syndrome into “pure Tourette’s syndrome,” consisting primarily and almost solely of motor and phonic tics; “full-blown Tourette’s syndrome,”which includes coprophenomena, echophenomena, and paliphenomena; and “Tourette’s syndrome-plus” (originally coined by Packer), in which an individual can also have ADHD, significant obsessive-compulsive symptoms or OCD, or self-injurious behaviors". I had to google coprophenomena: "Coprophenomena are traditionally considered to be tics that are socially inappropriate verbal expressions (coprolalia) or gestures (copropraxia)" -- only coprolalia is mentioned in this article. Echophenomenon similarly includes echolalia and echopraxia, only the former is mentioned in this article. And paliphenomena refer to the repetition of actions (palipraxia) or sounds (palilalia), with the latter mentioned. Are we missing out on including these action tics as well as verbal forms? Anyway, this definition does not suggest "full-blow Tourette syndrome" includes comorbid disorders, but that the type of tic is more severe. Is this "full blown" term controversial? There are many more google results so it certainly gets used though perhaps mainly I think for the more obvious end of pure TS rather than for the "plus". -- Colin°^Talk 18:22, 16 February 2020 (UTC)

I think I once had the praxias along with the lalias, but removed them because the list grows (I felt that klazomania was too far out there for a summary article) but I can add back the praxias. SandyGeorgia (Talk) 19:57, 16 February 2020 (UTC)

Yes, they got it right that Packer coined the TS-plus term (in the 90s), and the table there shows it goes along with a whole ton of other stuff-- most significantly mood and personality disorders. There isn't broad consensus to my knowledge around how this term is used because ... what to include. I will do more research to see how we can solve the "full-blown" issue. For now, I'm thinking that paper is messed up! I'll be back. SandyGeorgia (Talk) 23:08, 16 February 2020 (UTC)

Colin further research, here's what I come to when restricting scholar.google searches to 2016 forward (the source I had used was 2006). Google scholar coughs up a lot of Cavenna using the terms as you found above. This uses it to mean TS+ADHD+OCD, a whole new definition. (I've never heard of those people, in Italy, and they say TS is "rare"-- not something any credible source says.) This source indicates the defintion that Cavenna is using (apparently a Brit thing) originates with Baron-Cohen; don't go there ;) while at the same time it proposes a whole 'nother Cavenna classification. This one (more Robertson group) uses it as Cavenna does. Never heard of those people though. Stern, 2018, a very recent and good paper which we cite extensively, divides 1) pure TS (no comorbidity) full-blown to include echophenom and coprolalia, and TS-plus that includes a "range of comorbidities". That again is a British source. Curiously, Packer is USA, and the source I had used is USA. And Packer's terms has not caught on in the USA research literature. Probably because, what goes in to Packer's "plus"?

There could be a Brit/USA division here, because every 'full-blown' that I can find that is recent leads back to Brits, eg Cavenna. Most recent Yale Group (and remember, Robertson MM and Brit group acknowledge they are the leaders) don't go there at all. For example, Sukhodolsky (Yale) in addition to Fernandez (Yale) and Dale Australia (all recent sources the article uses) aren't using those defintions at all; they're talking generally that the current classification doesn't work. I'm not sure where that leaves us. We can take out the "full-blown" sentence without losing anything. But does that solve the big picture? I feel like it does; we have "pure TS" and some other as yet to be defined sub-types that are not "pure TS". SandyGeorgia (Talk) 23:42, 16 February 2020 (UTC)

Another tidbit from Robertson which makes me think we should, for now, be sticking with "pure TS" v TS when it is accompanied by other comorbid conditions, generally. It is suggested that what constitutes the GTS phenotype(s) would be come clearer only when the GTS gene(s) are identified and other aetiological mechanisms are fully understood. It will also be clearer as to what psychopathologies as well as tic phenomena are important in the various phenotypes, and whether or not these are related to the various aetiologies. That is, for now, regardless of how we label the subtypes beyond plain vanilla (pure) TS, we don't really know what goes in to these labels (full-blown or TS plus), and different research groups seem to be using the terms differently. On summary points like this, the British, Australian and US researchers are all saying the same thing. SandyGeorgia (Talk) 02:14, 17 February 2020 (UTC)

So, removed full-blown. SandyGeorgia (Talk) 02:54, 17 February 2020 (UTC)

Yes. -- Colin°^Talk 17:54, 18 February 2020 (UTC)

• "Referring to children with TS-only, Denckla said, "there is reason to give some credence to common clinical lore, namely, that these children are unusually gifted youngsters who showed no cognitive deficits"; for example, they are faster than average for their age on timed tests of motor coordination.". I can't read the 2nd ref. I'm cautious about such claims, given our experience with folk making such claims for autism when one naturally sees above-average IQ when one excludes those with below-average IQ, and "pure TS" necessarily excludes patients with other significant cognitive or behavioural deficits. The abstract of the second ref makes no mention of advantages, and further cautions their statements apply only to boys. Your first ref refers to this paper which "suggest[s] that the chronic requirement to suppress tics in TS individuals may result in more efficient inhibitory control, a skill that is advantageous when switching between tasks". It seemed a fairly obscure "gift", that doesn't to me imply a "gifted child". Indeed the authors suggest the improved skill is a result of years of tic suppression activity rather than an inherent neural ability in those born with TS. -- Colin°^Talk 18:51, 16 February 2020 (UTC)

• How's this? [8] SandyGeorgia (Talk) 23:51, 16 February 2020 (UTC)

• Better. Good. -- Colin°^Talk 17:55, 18 February 2020 (UTC)

• "In other cases, tics are associated with disorders other than Tourette's, known as tourettism." I'm not really following the grammar of this sentence. I think the "in other cases" clause is throwing me. The Tourettism article also isn't helping me (sorry Sandy) because if TS is diagnosed by symptoms and isn't itself a unitary disorder, then saying Tourettism has the symptoms of TS without the TS syndrome it is a bit circular. Presumably tourettism lacks the full criteria of multiple motor and one vocal and childhood onset? Or that the tics can be explained from the related neurological disorder. So is TS sometimes a diagnosis made by excluding other neurological sources of tics. Haven't read diagnosis yet. Sorry I can't help write what this should say, just to say that I find it a bit confusing. -- Colin°^Talk 20:42, 16 February 2020 (UTC)

• Colin several things in this section are going to require a lot of typing (and fixing, I see). Should I stop for now and let you finish reviewing? That is, are my responses getting in the way? (Yes, one can have symptoms that look just like TS and may seem to meet the criteria, but may really be, for example, autism or stereotypic movement disorder. Those blooming premonitory urge are one factor that helps in the differential diagnosis.) And I'm going to need to spend a lot of time on the TS-only post just above this. Should I hold off until you finish? What works best? SandyGeorgia (Talk) 20:49, 16 February 2020 (UTC)

• Although I've skimmed your responses, I'm not really considering them deeply at the moment. I'm trying to read the article from top to bottom and note when I get confused as I read it. If for example, I was to read the Diagnosis and then come back up to Causes, I might understanding it better, but that would ruin my ability to comment on my understanding as I go. So for same reason I don't want to get too bogged down in research and sources that would make me more knowledgable. So perhaps you should just take a break or concentrate on some earlier point. Remember too that some of our readers are really clever and might not be as easily confused as me! -- Colin°^Talk 20:55, 16 February 2020 (UTC)

• How's this? [9] SandyGeorgia (Talk) 00:02, 17 February 2020 (UTC)

• Better explained. -- Colin°^Talk 17:57, 18 February 2020 (UTC)

[Is this the review where we break Colin? If not, I'm calling trading standards] Yomangani^talk 00:44, 19 February 2020 (UTC)

If so, we're both broken, because that blooming RFC did me in. All three months' worth. Well, posted there, slept soundly for two hours, and will dig in to this tomorrow. Alert ... I'm also driving tomorrow to get a new book at the library for adding a whole new section on "Social support" under Management (per suggestion at WT:MEDMOS that we should do more of that, and similar to the Caregiving section I added at dementia with Lewy bodies). I would be so appreciative if all would stay tuned to repair my prose when I add it. SandyGeorgia (Talk) 02:27, 19 February 2020 (UTC)

Yomangani I just got it (section heading). Sheesh. Well, anyway, you met Colin at the same time I did; should we throw him off the bus for making the rest of us look like mere mortals? SandyGeorgia (Talk) 23:32, 20 February 2020 (UTC)

Colin review genetics

• "A person with Tourette's has about a 50% chance of passing the gene or genes to his or her child." I can't read the second ref. The first says "Heritability is approximately 50%". This is where it all gets more advanced and sciency than my little brain can manage. Heritability article and this web page defines heritability as a number from 0 to 1. So is this 50% actually 0.5 or are they using that word more loosely. I'm not sure what the article says (50% chance pass of passing on the gene(s)) follows from what the source says, unless the "50%" appears somewhere else in the paper I can't find. Surely, other than sex-linked genes, the percentage of any genes we pass onto children is 50%, or am I being dense on a Sunday evening?
• "Genetic epidemiology studies have shown that the overwhelming majority of cases of Tourette's are inherited" Coming back to this earlier sentence, it surprised me because it suggests a stronger link with genetics than the "genetics + environment" one. this paper confirms my earlier thought "first degree relatives share on average 50% of their genetic material". This and the other papers also note "highly familial" and that this aspect was even noted by Tourette himself. But familial does not prove genetics are 100%. I wonder if we should note the "highly familial" aspect (runs in families) while explaining that genetics aren't the only thing families share. The paper says "family studies consistently show a 10 to 100 fold increase in the rates of GTS in first-degree relatives when compared to those rates in the general population" which seems like a useful way of explaining the increased change in risk for children. Btw, this paper from 2014 says "The first phase of a large-scale genome wide association study is reaching completion, promising to begin to en toto illuminate these issues". Is it too early to expect that to have been published and reviewed? -- Colin°^Talk 21:23, 16 February 2020 (UTC)

• Will come back to all of this when you are done, but don't forget to factor "variable penetrance". One can inherit the genetic susceptibility yet show no, mild or severe symptoms, and then environmental factors can influence the severity. More when you're done. SandyGeorgia (Talk) 21:40, 16 February 2020 (UTC)

• OK, re-jigged most of this from two new papers. Re-reading, it is not at all clear to me how the first paper was using the 50%, and other papers have a higher than .50 heritability, so I left that off and used the 10 to 100 times more likely instead. [10] Have a look now ? SandyGeorgia (Talk) 17:41, 21 February 2020 (UTC)

• FINALLY! Colin, you mentioned above a 2014 paper saying a genome-wide association study was about to be published. I've been trying to sort these genetics for days, starting by searching high and low for a review that discussed a GWAS published after 2014. I just figured out you had a typo; it was a 2011 paper! So, no, the GWAS haven't panned out yet, that is in all recent reviews, and I will add something on that. SandyGeorgia (Talk) 01:15, 22 February 2020 (UTC)

• Just a note that I'm generally sceptical of neuroimaging wrt statistical competence. This paper had all sorts of pretty maps of the brain showing differences between the two small groups of patients, where one can't help but find "differences" and speculate on their purpose and effect. Red flags like "also" suggest they "found" differences they weren't looking for. This ref concludes "Research on this matter has produced numerous but sometimes conflicting findings". Hmm. Perhaps that is something we should note as a word of caution. -- Colin°^Talk 22:14, 16 February 2020 (UTC)

Colin, I hit the wall here, my eyes have blurred over, my fingers hurt, and I'm not sure what we need to do on genetics. Maybe I should just find a simpler source that summarizes easily? I'm unsure what you are asking here, but that's because I wore out. SandyGeorgia (Talk) 01:39, 17 February 2020 (UTC)

I'm not commenting on genetics, but the Mechanism that talks about finding thinner or smaller bits of brain in neuroimaging. I think if the review guards that the research is conflicting, then so should we. -- Colin°^Talk 17:59, 18 February 2020 (UTC)

Colin, I haven't done the genetics stuff just above this; hit the wall and wasn't sure what you were asking. Tomorrow is a new day, post-RFC input (although I'm not done there, yet), and maybe it will make more sense to me on re-read. Other than this section, could you scan everything above to make sure I've addressed the rest? More tomorrow. SandyGeorgia (Talk) 02:33, 19 February 2020 (UTC)

Colin, messed up pinging you to this question, re-ping. SandyGeorgia (Talk) 02:35, 19 February 2020 (UTC)

Back to the sensorimotor part: When the paper said there were conflicting findings, I believe they were referring specifically to one statement, not the sensorimotor bit.

The neurological anomalies mentioned above seem to cause impairments beyond the motor and phonic tics. Indeed, they have consequences on the neuropsychological functioning of TS patients. Research on this matter has produced numerous but sometimes conflicting findings.

Whether these cause additional impairments is the conflicting part (ala, pure TS, TS plus comorbids accounting for impairment). At any rate, I used PMID 29559228 and rephrased here. Have a look now? SandyGeorgia (Talk) 19:28, 20 February 2020 (UTC)

Colin remainder

• Diagnosis "and cannot be attributed to the effects of another condition or substance". Ah, so we've got an exclusion diagnosis wrt other conditions. I know classification and diagnosis are related, but perhaps this needs a brief mention at Classification. -- Colin°^Talk 22:19, 16 February 2020 (UTC)

• How's this? [11] SandyGeorgia (Talk) 23:55, 16 February 2020 (UTC)

• I tweaked it a bit. -- Colin°^Talk 18:04, 18 February 2020 (UTC)

• "The DSM has recognized since 2000 that individuals who meet all the criteria for Tourette's may not have distress or impairment". Perhaps this is one for the history section/article, not the diagnosis section, where readers will wonder why distress or impairment would even be considered necessary. Looking at this ref I see that "A "clinical significance criterion" (i.e., “the disturbance causes clinically significant distress or impairment”) 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". So this terminology is DSM nerd stuff and in practice was ignored by researchers and clinicians. Folk like you who have followed the research for years will know of that controversy, but new readers .. do they need to? Unless this now-dropped wrongheaded wording change in DSM-IV continues to cause misdiagnosis, I think this is too unnecessary a fact to burden our readers with in the main article. -- Colin°^Talk 22:29, 16 February 2020 (UTC)

• No, the impairment criteria was removed from DSM IV in the DSM-IV-TR (text revision) for important reasons. First, studies to identify genes etc were never going to progress unless they looked at ALL people with TS, not just clinically ascertained populations. Second, epidemiology is highly affected. For example, I was just debating whether to add this from the Robertson classification paper:

  The Chinese have their own Diagnostic Criteria for GTS which include both impairment and distress and this may be one of the reasons that GTS is found to be somewhat less common in China than the rest of the world.

  The Chinese don't look at all people with TS as defined in the Western world. Third, has to do with education and stigmatization. Epidemiology is affected because so many people (even physicians) believe one has to be a "sufferer" or have significant distress in order to have TS. Fourth, yes, the misconception leads to significant misdiagnosis. SandyGeorgia (Talk) 22:45, 16 February 2020 (UTC)

• I get you feel the removal was important (and I agree) but the addition seemed (from the quote I gave) to have nothing to do with TS and everything to do with psychologists getting concerned they were diagnosing "everyday life". Did that clause end up in the Chinese definition because they copied DSV-IV? Is that really the only /main reason the Chinese underdiagnose. I think the story then of how it got added and why is was removed and how it continues to cause problems should be given. We can't just say "distress or impairment" is no longer a diagnostic condition without explaining the wrong-headedness that led to it being added in the first place. -- Colin°^Talk 18:08, 18 February 2020 (UTC)

• Will do; I suspect I already have that in the History of sub-article. SandyGeorgia (Talk) 02:33, 19 February 2020 (UTC)

• Another slog. It may look like I'm having a manicure, but actually, getting what I want on this issue is giving me fits. Saving: Harris JC (March 2014). "New classification for neurodevelopmental disorders in DSM-5". Curr Opin Psychiatry. 27 (2): 95–7. doi:10.1097/YCO.0000000000000042. PMID 24441422. SandyGeorgia (Talk) 20:27, 20 February 2020 (UTC)

• I think I fixed this, but it involved lots of moving stuff around.[12]

• Is "Screening" really the best title for this section? It seems to be more about the additional comorbid conditions that one might check for when presented with a patient who might have TS. (Does it happen the other way round, that someone comes with OCD and they spot tics?). It doesn't seem to be about screening to find cases of TS in the population or at birth or at start of school, say. So I found the content surprising for the heading. -- Colin°^Talk 18:13, 18 February 2020 (UTC)

• When a child presents for evaluation of tics, physicians should screen for all the other stuff. How to fix? SandyGeorgia (Talk) 02:33, 19 February 2020 (UTC)

• See diff above; lots of stuff moved around to fix this. All related. Also setting up for expanding to Support text mentioned at WT:MEDMOS. SandyGeorgia (Talk) 23:25, 20 February 2020 (UTC)

• "Intelligence is normal in those with Tourette's, although there may be learning disabilities." This seems contradictory, unless the learning disabilities are quite specific. Are we in fact just saying that people with TS may have the same range of intelligence and learning ability as the population as a whole? -- Colin°^Talk 18:25, 18 February 2020 (UTC)

• Unsure what you are asking, because learning disabilities are separate from intelligence ... ?? That's why the neuropsychs get the big bucks! Will consult sources to see how I can rephrase. SandyGeorgia (Talk) 02:33, 19 February 2020 (UTC)

• Many people use LD as a synonym for low intelligence, so the two clauses may appear to contradict. Are there specific learning disabilities more associated with TS? -- Colin°^Talk 18:14, 19 February 2020 (UTC)

• Well, people shouldn't use it that way, 'cuz that's wrong :) Anyway, redone in this reorg. SandyGeorgia (Talk) 23:26, 20 February 2020 (UTC)

• That's all for tonight. I hope to do the remaining sections tomorrow. -- Colin°^Talk 18:30, 18 February 2020 (UTC)

• I will resurrect from the post-RFC input dead tomorrow and keep going. SandyGeorgia (Talk) 02:33, 19 February 2020 (UTC)

• " In the United Kingdom, a prevalence estimate of 0.1% in 2001 means that about 553,000 people aged five or older would have Tourette's." The source here is from 2007 and suggest 1%, not 0.1%. The maths support that 1% was used to get the 553,000 people, though I wonder if "half a million people ..." would be more appropriate than the three sig figs. The paper does qualify this "albeit mild and almost unrecognizable by the time they were older" though the authors argue these almost-symptomless individuals still have GTS. Should we add a similar qualifier? -- Colin°^Talk 18:14, 19 February 2020 (UTC)

• Could you do as you wish there? I am stalling as I intend to make the several-hour trip to library in another town today, and don't want to focus here today. Do as you wish on all text so far; I can adjust tomorrow. SandyGeorgia (Talk) 18:46, 19 February 2020 (UTC)

• Colin do you remember going 'round and 'round and 'round with Eubulides on this text? I dare not touch it; it was approved by the master. He wouldn't accept half a million! I want you to do whatever you want on this text. SandyGeorgia (Talk) 23:28, 20 February 2020 (UTC)

• I can imagine Eubulides not wanting to deviate from the source, but then the source also explains the maths comes from 1% of 55,302,941 so "approximately 553,000" doesn't seem so much of a mathematical crime of precision, and they also note "the present author suggests that the overall prevalence rate in the whole population is more than 1%". So I think it extremely unlikely that their 1% estimate is accurate to three significant figures as justifies retaining the "_53". -- Colin°^Talk 16:30, 21 February 2020 (UTC)

• Ugh. Somewhere in the recent week I came across Robertson saying a couple hundred thousand in the UK; now I've got to go deep searching again for that (before I change this). SandyGeorgia (Talk) 23:37, 21 February 2020 (UTC)

• I was wrong (and she was referring to children, IIRC, so this works).[13] SandyGeorgia (Talk) 00:00, 22 February 2020 (UTC)

• What do you think about moving this list to a note? The listiness in such a short section troubles me: [14] If you agree, will do that once I resume ... I don't think the specific names are all that important here. SandyGeorgia (Talk) 18:50, 19 February 2020 (UTC)

• Looked at it again, decided it's OK. SandyGeorgia (Talk) 23:25, 20 February 2020 (UTC)

• Whole lotta stuff here.[15] I moved learning disabilities to neuropsych function and explained, I found a source that helped me paraphrase vocal tics so lost the quite/attribution for Jankovic, I changed the screening subhead and expanded somewhat, while also moving the DSM-IV-TR significant impairment history to History, but explaining why it matters in mis-diagnosis. All of that involved a bunch of reorganization, so you may need to revisit now Neuropsych function, Diagnosis, Prognosis, and History when you get there. SandyGeorgia (Talk) 23:23, 20 February 2020 (UTC)

• Genetic stuff done here: [16] With this, I believe I'm done with all of Colin's helpful review. Please check ! SandyGeorgia (Talk) 17:41, 21 February 2020 (UTC)

Genetic

Just a note re "Non-genetic, environmental, or psychosocial factors" – in this context, "non-genetic" and "environmental" mean the same thing. Suggest "Psychosocial or other non-genetic factors". Adrian J. Hunter^{(talk•contribs)} 23:25, 21 February 2020 (UTC)

Adrian J. Hunter, amazing synchronicity; I was just going to your talk page to enlist your help with one sentence. If you are around, I'll type it all out. SandyGeorgia (Talk) 23:28, 21 February 2020 (UTC)

Adrian, I was having quite a time trying to update this section, but I think I finally got it. I decided to delete this. First, it was never correctly phrased. Second, the source was very old and I can't find new sources saying similar. Third, I suspected (don't know?) that the reason I can't find recent mention of this is that we are no longer looking for autosomal dominant, classic Mendelian inheritance, as was the case when penetrance was emphasized. Fourth, it wasn't adding anything. Have I got any of that right? Thanks! SandyGeorgia (Talk) 01:50, 22 February 2020 (UTC)

Saying TS has "variable expression" and "incomplete penetrance" are both strictly correct. But the "variable expression" bit is redundant to any part of the article that says severity is variable. And rather than note the incomplete penetrance, I'd note the result of PMID 1549232, which found a concordance rate of about half in monozygotic twins. That implies incomplete penetrance but is more informative and interesting. If you prefer a secondary source, note OMIM incorrectly reports the concordance rate (it conflates the concordance rates for TS and for tic disorders in general), though I can't tell whether the error is OMIM's or comes from the review that OMIM cites (Jankovic 2001). Adrian J. Hunter^{(talk•contribs)} 03:43, 22 February 2020 (UTC)

@Adrian J. Hunter: I tried for years to have the OMIM stuff and the other garbage in the EL removed from this article because it is all so full of errors, but I have not prevailed. I did at least get that junk moved out of the infobox (which I also disagree with being here) to the External links, so hopefully few will go there, and glad you saw one of the errors. Back on the Causes section ...

If variable expression and incomplete penetrance are still true (as we have moved beyond the search for an autosomal dominant gene), why do no recent sources mention them? That concept was all over the TS literature in the 90s, and now, nowhere to be found. All I had was a 1997 source. It was such a clear statement.

I hate getting in to the language of concordance with monozygotic twins because that will confuse the layreader even more than the simpleness of incomplete penetrance. Could you look at Ceoil's question two sections down so we can work on this together? SandyGeorgia (Talk) 13:39, 22 February 2020 (UTC)

PS, I have gobs of secondary sources on concordance rate in monozygotic twins; how to phrase all of this escapes me. I can dig around some more I guess. Is it OK for me to link incomplete penetrance with a simple statement about identical twins only having it half the time, or is that SYNTH since I no longer have a source that uses that term in discussing monozygotic twin concordance rates? That would be the best plain English to me, but seems to be synthy. SandyGeorgia (Talk) 13:55, 22 February 2020 (UTC)

Sorry to keep you waiting. For variable expression, I'd imagine few sources use that term because it's not terribly informative. Presumably any introduction to the disease will mention early on that the severity and range of symptoms vary greatly between individuals. After that, there's no point saying that "expression is variable", which is a vague phrase that could apply to a disease where everyone affected shows the exact same symptom to a slightly varying degree. For incomplete penetrance, I think you had the right idea earlier. Incomplete penetrance is highly relevant to a disease with a simple Mendelian inheritance pattern, because it means a genetic test cannot say for certain that a person will develop the disease. Whereas now that we know TS is multifactorial, there's little reason to think about penetrance. Adrian J. Hunter^{(talk•contribs)} 11:22, 24 February 2020 (UTC)

Added twin studies, please have a look. SandyGeorgia (Talk) 20:03, 22 February 2020 (UTC)

The exact cause of Tourette's is unknown, but it is well established that both genetic and environmental factors are involved. Genetic epidemiology studies have shown that the overwhelming majority of cases of Tourette's are inherited, but the exact mode of inheritance is not known; no single gene has been identified, and hundreds of genes are likely involved. Genome-wide association studies were published in 2013 and 2015 in which no finding reached a threshold for significance. A few rare highly penetrant genetic mutations have been found that explain only a small number of cases in single families (the SLITRK1, HDC, and CNTNAP2 genes).

Tourette's is highly heritable, and 10 to 100 times more likely to be found among close family members than in the general population. Twin studies show that 50 to 77% of identical twins share a TS diagnosis, while 10 to 23% of fraternal twins do. But not everyone who inherits the genetic vulnerability will show symptoms; the genes involved may not be highly penetrant. Only a minority of the children who inherit the genetic vulnerability have symptoms severe enough to require medical attention. Gender appears to affect the expression of the genetic vulnerability: males are more likely than females to express tics.

Sources

I think these two paragraphs could be combined into one. "The overwhelming majority of cases ... are inherited" and "Tourette's is highly heritable" seem redundant. The sentence about the rare highly penetrant mutations is great, and is all I would say about penetrance. The twins sentence works (wording could use a tweak... will ponder), but I'd ditch the sentence after it. "Only a minority of the children who inherit the genetic vulnerability have symptoms severe enough to require medical attention." – But outside of monozygotic twins, we only know who's inherited the vulnerability based on them displaying symptoms, right? So this seems to be a roundabout way of saying that not everyone who shows TS symptoms requires medical attention. The bit about gender feels misplaced to me; I'd have thought that belongs under epidemiology. "Sex" is probably a better word to use per Sex and gender distinction. Adrian J. Hunter^{(talk•contribs)} 11:22, 24 February 2020 (UTC)

Very helpful, thanks! (Glad to know my instincts on Mendelian inheritance were right :) Re-worked here. SandyGeorgia (Talk) 14:40, 24 February 2020 (UTC)

Psychoeducation and social support section

I really like this new section (Psychoeducation and social support). It's such an important aspect for treatment/management of almost any disease/condition, including Tourette's. (I say that not as much as a psychologist, but as a parent and patient.) ¶ I made some copy edits (diff). I'll offer a couple of recommendations a bit later today (fine tuning).   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 17:01, 21 February 2020 (UTC)

Markworthen, I still have more to add today, and I have a new book coming in tomorrow's mail, so you might want to hold off on additional comments or copyedits to this section. I first wanted to make sure I was on track with what was being requested at WT:MEDMOS, because in the past, we woulda been clobbered for adding some of this material. I still need to give adults with tics some real estate here, and a wee bit about educational support, etc. Thanks for the ce; as everyone knows, my prose stinks. I'd love your feedback on the rest of the article as I wait to get the book to finish this new section. Not sure if you are aware, but this will run on the mainpage on 3 March, so adding a whole new section at this late stage is risky, but it seems there is now more acceptance on Wikipedia of this kind of information than there was when I wrote the article 14 years ago. Regards, SandyGeorgia (Talk) 17:46, 21 February 2020 (UTC)

I have the article on my Watchlist so I shall monitor and wait until you add to the section. (Btw, I love your pingie-thingie remarks on your Talk page. :0)   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 18:21, 21 February 2020 (UTC)

Got the new book; it's dreadful. Can't get a single thing out of it. So, I will go back to other sources and come up with a paragraph focused on adults, since everything there now is aimed at children. SandyGeorgia (Talk) 23:06, 22 February 2020 (UTC)

Q

"in which an inherited vulnerability was seen to interact with environmental factors" - Dont or carnt parse this; on its face seems bordering on unproven, sociology level, trite. Sandy, coming from a non medical as always know nothing, family POV; wot. pps I know is a hard balance for wiki writers try and balance reader sensitivity against a a necessary high bar wrt RS: ie converting primary technical studies and secondary summaries into usable English in a sensitive, but sometimes necessary direct way. This is a quibble in an overall, wonderful, articulate, not talking down page that the project should see as a benchmark. Ceoil (talk) 05:58, 22 February 2020 (UTC)

@Ceoil:, bummer, as we know, I rarely write an eloquent phrase :) OK, if that phrase is problematic at the bottom of the article, it means I've failed earlier on, in the Causes section. Ceoil, have a new look at causes. The genetic vulnerability is inherited, but not always expressed, or expressed with different levels of severity. In most cases, environmental factors add an additional impact on whether and how severely the condition (that is, the inherited genetic vulnerability) is expressed. (This is not true for all cases, as there are some rare mutations that affect a few families, and those are almost always expressed in those families; those rare mutations of genes have high penetrance , but they represent only a very small number of families.) If I can somehow make that more clear in Causes, does it then work for you down here in History? Colin had problems with causes, and I spent days for looking for a source that explains it well in plain English; it seems that geneticists don't write in plain English. I am unable to find a recent source that explains genetic penetrance with respect to Tourette syndrome at all. SandyGeorgia (Talk) 13:30, 22 February 2020 (UTC)

Ceoil see two sections up, where I asked geneticist Adrian J. Hunter to help me sort this. SandyGeorgia (Talk) 13:31, 22 February 2020 (UTC)

Sandy, re "if that phrase is problematic at the bottom of the article, it means I've failed earlier on". I'm not sure it works like that. Each wiki sentence needs to stand alone & beinternally consistent; readers don't read from 1 page to the next like a book; typically, I guess they skip and hop from section to sect, the especially interested probably search for the term they are looking for nd read only the surrounding sentences. Re "I rarely write an eloquent phrase!" - snap, why do you think I have been courting mr Outriggr for all these years - its interesting to watch and learn from, basically, best in class. It helps that he also rocks. Ceoil (talk) 13:42, 22 February 2020 (UTC)

Re the sentence above, without wanting to be too reductive, maybe just say "...inherited and environmental". That way we dont say "vulnerability", whuch might confusing for young sufferers, and avoid the vague "factors". Ceoil (talk) 13:48, 22 February 2020 (UTC)

Thanks, Ceoil ... I'll sort this after I get the Causes stuff sorted with Adrian (which also means, after I get caffeinated :) SandyGeorgia (Talk) 13:53, 22 February 2020 (UTC)

Sound. Ceoil (talk) 15:05, 22 February 2020 (UTC)

Suggested revision of the sentence

Great discussion! (Your collaboration is a prime example of what makes Wikipedia great.) ¶ Here is one possibility for the original sentence in question.

Current sentence: During the 1990s, a more neutral view of Tourette's emerged, in which an inherited vulnerability was seen to interact with environmental factors.

Suggested revision: During By the 1990s, a more detailed comprehensive etiological theory had developed, postulating indicating that Tourette's syndrome occurs as a result of a genetic predisposition interacting with epigenetic and environmental factors, such as stressful life events.

Note: I hesitated including "epigenetic" since it's a word I still have to look up. It is hyperlinked, but for this sentence it might be best to leave it out—I defer to y'all's judgement.

→ As I stumbled around looking for relevant references, I found some recent articles that might be helpful at some point. I put the citations with abstracts on a subpage: User:Markworthen/Tourette's syndrome citations.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 15:44, 22 February 2020 (UTC)

Great Mark, agree 99%. Minor point, but from the POV of a know nothing invested reader, can we not say "postulating", rather than 'put forward', 'advanced' or what have you. Again tks. Ceoil (talk) 16:10, 22 February 2020 (UTC)

Excellent point Ceoil. It's great that you help us academic types write in plain language, rather than our typical pedantic prose. :0) ¶ I substituted "indicated" for "postulated". What do you think? Thanks!   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 16:18, 22 February 2020 (UTC)

Maybe..."indicating that Tourette's syndrome results from a genetic...", but yes. I especially like the addition of "stressful life events". Thanks Mark. Ceoil (talk) 16:42, 22 February 2020 (UTC)

Oh, I like that much better. So, for Sandy's review: "By the 1990s, a more comprehensive etiological theory had developed, indicating that Tourette's results from a genetic predisposition interacting with epigenetic and environmental factors, such as stressful life events."   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 17:01, 22 February 2020 (UTC)

with epigenetic (heritable phenotypes)..bla. It doesnt so much matter than people will get "phenotypes" but we do say "heritable", so its all fine. Ceoil (talk) 17:04, 22 February 2020 (UTC)

Hang on, checking out a couple of nuanced factors ... I'll be back :) SandyGeorgia (Talk) 17:16, 22 February 2020 (UTC)

Baby monkey hanging onto its mother (Saadani National Park, Tanzania, 2008)

No worries. Just hanging here. ;^)   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 17:38, 22 February 2020 (UTC)

I have a problem with switching "during" to "by", but I can't access the original source anymore. Best I can tell, Mark is using the Lanska paper for that (?), but the psychoanalytic theories persisted well into the eighties, and the switch occurred during the 90s. The Lanska paper is dealing with the time period when the switch began, with the Shapiro-Haldol revelation during the 60s and 70s, but psychoanalysts resisted for a long time. If we say, "By the 90s", we imply psychoanalysts had switched over in the eighties, and that the new view prevailed before the 90s. The definitive history is the Kushner book A Cursing Brain? The Histories of Tourette Syndrome and it disagrees; it supports the word "during" which the original source had. Page 142: "Even into the 1980s, long after the effectiveness of dopamine suppressors in regulating tics had been established, psychoanalytic spokespersons continued to insist that it would be a mistake to confuse a symptom (motor and vocal tics) with the underlying psychological forces that enabled it". P. 143: (emphasis mine) "By the 1990s psychoanalysis still dominated the diagnosis and treatment of multiple motor tic and coprolalia." Chapter 10 in Kushner lays out when the narrative started to change, which agrees with the statement about the 60s and 70s in the article. Page 187: by 1982, the "battle was far from over". Chapter 11 is all about a big clash with the French/Europeans. The French were doubting the US (Shapiro) results. p. 204 "While Lebovici's view continued to inform the thinking of French psychiatry into the 1990s, the Shapiros' influence among North American researchers declined. ... By the time of his death in 1995, Arthur Shapiro had concluded bitterly that he had become isolated ... " Then Oliver Sacks got into the picture (blech). p. 208: "By the mid-1990s, criticism of what was characterized as the American construction of Tourette syndrome intensified and began to take on nationalistic and almost conspiratorial overtones. Attempts to explain the etiology of tics in organic and nonpsychoanalytic terms would be met with charges of antisemitism". (From the French). In 1995, there was one (European) exception to the French view. In other words, even though I can no longer locate the original source, during is the correct word, and the Lanska paper does not seem useful here.

Also, we can't synthesize from the two sources listed by Mark. That Cohen and Leckman were arguing an organic basis does not mean it was accepted. Those sources are not usable, per SYNTH. The original source (emed, that I can't access) is based on Kushner's histories, which is accurate. Could we keep "during"? I will put my proposal next. SandyGeorgia (Talk) 18:01, 22 February 2020 (UTC)

References

Next suggestion

Current text:

• During the 1990s, a more neutral view of Tourette's emerged, in which an inherited vulnerability was seen to interact with environmental factors.

Proposal above:

• By the 1990s, a more comprehensive etiological theory had developed, indicating that Tourette's results from a genetic predisposition interacting with epigenetic and environmental factors, such as stressful life events.

I disagree with "during", I don't have a source that supports the word "comprehensive", and "results from" gives the false impression we know more about causes than we do. I also don't think we need to use the word epigenetic, and I don't see the need to emphasize stressful factors. Parents feel guilty enough about pre- and peri-natal events, without unduly emphasizing stressors. My proposal next. SandyGeorgia (Talk) 18:09, 22 February 2020 (UTC) My proposal:

• During the 1990s, a more neutral view of Tourette's emerged, indicating that a genetic predisposition interacts with non-genetic and environmental factors.

That is, I am adding Kushner and Cohen/Leckman only because people can't access the original source, but the original source is correct. I like the original text much better :) SandyGeorgia (Talk) 18:29, 22 February 2020 (UTC)

Given the troubling sourcing issues raised above, the version is obviously preferable. Re the original wording; don't really like using "vulnerability". Ceoil (talk) 19:51, 22 February 2020 (UTC)

Installed; [17] better now? SandyGeorgia (Talk) 20:09, 22 February 2020 (UTC)

Yup. Moving to my next grip ;) Ceoil (talk) 23:16, 22 February 2020 (UTC)

References

♠ during vs. by - You make a strong case to keep "during".

♣ Keep link to epigenetics, but change word to "non-genetic". → Superb solution!

♥ "neutral view" - I am nonpartisan on this point. ;^]

♦ "stressful life events" - Good point. As I understand it, peers are the most common stressor for kids with Tourette's (not parents). If that's accurate, it should be explicated in the article and then it could be more precise in this (or similar) descriptions. But for now, I like what you have written (including the citations).   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 19:57, 24 February 2020 (UTC)

Request

"Adults with TS presenting in clinics are atypical,[1] and might be childhood tics re-surfacing.[40]" - Sort of but dont really understand this claim. Would be good to have this odd construction rephrased. Ceoil (talk) 02:19, 23 February 2020 (UTC)

I was hoping you would do it :). Mañana ... trying to chunk in new text when tired. SandyGeorgia (Talk) 02:23, 23 February 2020 (UTC)

I'd say leave it to the morning my friend. Its probably a bit late there to brew up yet more coffee. Ceoil (talk) 02:26, 23 February 2020 (UTC)

‘Tis possibly one of the worst sentences ever :) SandyGeorgia (Talk) 02:48, 23 February 2020 (UTC)

I have much, much worse in my edit history. They are kept secret though. Between myself and the divine oversighter. Ceoil (talk) 02:52, 23 February 2020 (UTC)

We shall call those who don’t want to grow up by their rightful name of childhood tics henceforth. Need sleep! Is everything else I added at the end of the day this bad? I’m blaming it on having spent my afternoon immersed in chapters of crazy French psychoanalysts. Poor Outriggr must be fretting at what I’ve done! SandyGeorgia (Talk) 03:33, 23 February 2020 (UTC)

I didn't get that ping but my extra-sensory perception kicked in. (Looks like you re-signed and it still didn't ping? Hm. Whatever.) Now I have to look at your contribs to see why you're in French psychoanalysts. Were you interested in the French psychoanalysts as a child? (/joke)

On the subject: I never entirely understood the emphasis on 'clinics' in the article, and I suppose that's my fault. Does 'presenting in clinics' mean 'referred to a specialist'? Or just the opposite? Adults with TS presenting in clinics are atypical -- is the intent simply to say that TS rarely develops in adulthood, as opposed to a childhood development that was not diagnosed? Outriggr (talk) 10:19, 23 February 2020 (UTC)

Outriggr to the rescue! The section just above this one made me re-read chapters of Kushner and the battle over the etiology of Tourette's that went on for a century.

My back and fingers (arthritis) hurt so bad after three months of solid typing (independent RFC issues) that I am starting to despair. My edits yesterday were dreadful. I am, at this point, quite concerned that the lead never mentions the most severe and debilitating cases,[18] and we don't give enough real estate to the adults who DO emerge from childhood with tics. In trying to beef up some adult content long after I should have stopped editing, look at the dreadful sentence I added :)

Clinically ascertained cases versus the majority who never even seek care or diagnosis is a significant factor in ALL TS research, per ascertainment bias. I hope that part is clear, even if that one sentence isn't? People with TS in general who show up in clinics at all are atypical (most don't seek care), and adults who DO seek care are even further atypical of what TS looks like for most people. So, that needs to be better fleshed out? I'll go back to the source and see how I can fix that.

Outriggr, it would be totally awesome if you would check everything new that I've added in the last week. It was discussed at WT:MEDMOS that we should add more on pregnancy and psychosocial aspects, where in the past, there was little tolerance for that kind of content, so here I am at the 11th hour, trying to add that content as an example of how other med articles can do same. SandyGeorgia (Talk) 15:18, 23 February 2020 (UTC)

Forgot to ping @Outriggr:. SandyGeorgia (Talk) 15:22, 23 February 2020 (UTC)

These edits represent the bulk of changes/additions, interspersed with Ceoil copyedits. SandyGeorgia (Talk) 15:26, 23 February 2020 (UTC)

Outriggr, here is the source text for "adults presenting in clinics are atypical":

The syndrome has a wide range of severity and a wide range of how well individuals cope with it. The vast majority of adults with mild TS are probably not medicalised although they may still have comorbidities that have impaired them in childhood or later life. Some people with mild tics are very self-conscious, for instance, those who, despite distress, have never discussed their twitches with their partner. Others tolerate noticeable or even quite severe tics.

(Which reminds me: in one place, to vary the wording, Ceoil switched tic to symptoms which sounded too medicalized for me; perhaps I have underutilized the word twitch overall as a way to vary the wording.) Can someone with better prose command than I use this to fix the entire construct?

A related problem is how often one encounters the term vast majority in the literature; I found it four times in two paragraphs in a source the other day, and I hate that term. Overall, I would inquire of all of you whether you think there is enough content in the article about those adults who, although in the minority, have the most severe and debilitating tics. That is, that significant minority of adults who didn't outgrow their tics are the same group who represent the public perception of TS and have the most management needs. SandyGeorgia (Talk) 16:31, 23 February 2020 (UTC)

Adults

This section has a few topics; I will reply to your last one right now. In brief my feeling is that if I had severe TS as an adult, I might feel undersold by this article. The strongest themes I found are the sense of reassurance that the vast majority of cases will be ok and with any luck, one will not have to experience tics for the rest of their life. I would agree that a bit more text on quality-of-life/psychosocial/etc issues in adults with difficult cases would be appropriate (which goes back to the conversation on WP:MED that you mentioned).

Re I hope that part is clear, yes, that was one of the clearest takeaways of the article for me (ascertainment bias etc). Outriggr (talk) 07:14, 24 February 2020 (UTC)

Thanks, Outriggr. It is a difficult DUE WEIGHT issue. The "vast majority" blah blah blah consumes article focus, but we still have: some of the "most severe and debilitating forms of tic disorder are encountered" in adults. I feel we could do two things to address this better. Expand the sentence in the lead, "Tics often go unnoticed by casual observers" to included mention of the rare severe cases. And add more content in psychosocial about quality of life in adults (I can dig up sources for that). @Ceoil, Yomangani, and Colin: for input. "Reassurance" is not our job, and we should represent those who stand out most and need most treatment, even if they are a very small minority (less than 4%). I had so hoped to keep the article around 6,500 words at most, but expansion is needed on adults, unless others disagree. SandyGeorgia (Talk) 14:51, 24 February 2020 (UTC)

Having re-read two sources, my plan is to better separate the Psychoeducation section from a new Quality of life section, which I will add under Prognosis. Now, these two are somewhat intertwined in the article, and I need to do some moving around, so that the new Quality of life under Prognosis can deal more with the long-term aspects for adults. SandyGeorgia (Talk) 16:26, 24 February 2020 (UTC)

I'm not sure you'd be looking at the WP article as an adult Tourette sufferer(<--Hey kids, don't say "sufferer" or MEDMOS Compliance Special Measures will show you the true meaning of the word) looking for a prognosis. The reassurance boat has flown out of the station down the road by that time. I wouldn't think it would knock it too far out of kilter to have a bit of coverage on adult treatment though; maybe just rephrase some bits so they don't sound like all treatment is aimed at pre-adults (or children as they are sometime called by humans). I just took a bit out that gave "school" as an example of communities which - aside from the unnecessary spoon feeding - is the sort of thing that pitches it towards juvenile ********(<--Hey kids, don't say "********" ). Yomangani^talk 16:30, 24 February 2020 (UTC)

Yomangani what about adding mention of most severe and disabling in adults to the sentence at the end of the first para in the lead? DUE or UNDUE, helpful or not? Adults with persistent tics should feel mentioned in the lead. SandyGeorgia (Talk) 16:50, 24 February 2020 (UTC)

Also, the only treatment at this juncture that is very adult-specific is deep brain stimulation (because its use is controversial overall, and even more controversial in children), and I feel that is a case for summary style-- much better covered in its own article, particularly since it is so rarely used. SandyGeorgia (Talk) 16:58, 24 February 2020 (UTC)

I think you've answered your own question: Adults with persistent tics should feel mentioned in the lead. With regard to treatment, I wasn't necessarily suggesting an adult treatment section, just checking the article doesn't imply treatments are juvenile-only when they are equally applicable to adults, either by proximity to childhood diagnoses or by using terms that carry connotations of childhood (like the mention of schools and not workplaces in the examples of communities). Yomangani^talk 17:19, 24 February 2020 (UTC)

OK, I'll go back and look for that. Sidetracked: someone is persistently trying to hack my Wikipedia account. Probably related to arbcase. SandyGeorgia (Talk) 17:25, 24 February 2020 (UTC)

Excellent point Yomangani.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 20:06, 24 February 2020 (UTC)

Suggested edits re: adults

 Done - All of my questions and concerns, that I placed in this subsection (Talk:Tourette syndrome#Suggested edits re: adults), have been addressed. Other editors might have similar questions or concerns, which they might discuss in this subsection, but from my perspective, all is good here. (Thank you SandyGeorgia!)   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 14:38, 25 February 2020 (UTC)

Section of article: Onset and progression

Current: Adults with TS presenting in clinics are atypical, as most adults have mild TS and do not seek medical attention. While tics subside for the majority after adolescence, some of the "most severe and debilitating forms of tic disorder are encountered" in adults.

Suggestion: Most adults have mild TS and do not seek medical attention. While tics subside for the majority after adolescence, some of the "most severe and debilitating forms of tic disorder are encountered" in adults. → The last part needs explication.

Rationale: "Adults with TS presenting in clinics are atypical" is imprecise and unnecessary. (Re: imprecise - atypical can mean—or is synonymous with—abnormal, aberrant, deviant, etc.).

Current: "... some of the 'most severe and debilitating forms of tic disorder are encountered' in adults."

Explication needed: When I read this part, my mind immediately asks, "Why? Are they the folks who had the most severe TS during childhood and adolescence? Are they the adults with OCD and TS? Comorbid substance abuse? What causes this most severe form of the disorder?".

Putting your suggestion in for now; will expand later today after consulting sources. I read a good source on this last night, but have to go back and figure out which one it was. SandyGeorgia (Talk) 21:24, 24 February 2020 (UTC)

Markworthen Short answer: I've seen sources that discuss this, I didn't highlight that text when reading it because "malignant" or "florid" or "full-blown" TS in adulthood represents less than 4% of cases, so I had not thought to include it, and I would have to re-read hundreds of journal articles to discover where I saw a discussion of the possible causes. Long answer: just as in the overall causes of TS, likely to be combination of the many unknown genetic factors, possibly bilateral inheritance, I seem to recall an effect from maternal OCD (but don't quote me on that), certainly the more comorbids the more likely is fulminant, malignant, persistent TS (including bipolar, mood disorders, personality disorders), and also all of the environmental effects (family, social, substance abuse, stress, the works). That is my understanding from decades of reading hundreds of journal articles, but I can't put my fingers on a source to use right now. If someone asks, that's the best I can do for now :) When they don't outgrow their tics, it's likely because they got the whole shebang, multiple genes, multiple comorbids, multiple epigenetic factors, and quite often, bipolar along with ADHD. But don't quote me. Until I can find a source, I can't include anything. SandyGeorgia (Talk) 22:53, 24 February 2020 (UTC)

Added a bit here; gone all day tomorrow to a funeral. SandyGeorgia (Talk) 01:22, 25 February 2020 (UTC)

Looks good!   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 14:27, 25 February 2020 (UTC)

Section of article: Psychoeducation and social support

Kudos: "Adults with TS may withdraw socially to avoid stigmatization and discrimination because of their tics." → NICE.

Section of article: Prognosis

Current: Another four out of those ten will have minimal or mild tics in adulthood, but not complete remission. The remaining two will have moderate or severe tics as adults, but only rarely will they be more severe.

Suggestion: Another 40% will have minimal or mild tics in adulthood, but not complete remission. The remaining 20% will have moderate or severe tics as adults, but only rarely will they be more severe.

Rationale: I got lost in the sentence with "four out of" and "remaining two".

See big earlier discussion between Colin and WhatamIdoing, here and at WT:MED about "people can't do math" and most people don't understand percentages, keep it all to 4 plus 4 plus 2 = the ten children.. We have four plus four plus 2 = 10 ... unsure why that is not clear? SandyGeorgia (Talk) 21:24, 24 February 2020 (UTC)

I read the discussions. I don't think there's a clearcut answer. Like so many things, it depends on the context. For longer or more complicated explanations, I suspect that keeping track of the denominator across three sentences makes the reader work harder than needed, and that percentages would lead to greater reader comprehension (in this instance). But this is not a major issue—I'm fine keeping it as is.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 14:27, 25 February 2020 (UTC)

Current: "... but only rarely will they be more severe."

Question: More severe than what? More severe than their childhood Tourette's severity?

Yes, fixed that. SandyGeorgia (Talk) 21:24, 24 February 2020 (UTC)

Section of article: Quality of life

Kudos: Creating a Quality of life section was a great idea. :)

Current: In adults with persistent tics, depression may have a larger impact on their quality of life than the tics do, there is a greater effect on their overall functioning than in children, and there is often a financial burden.

Suggestion: In adults with persistent tics, depression may have a larger impact on their quality of life than the tics do. Adults with persistent tics experience more psychosocial dysfunction, including financial burdens, compared to children with persistent tics.

Having re-read the sources this morning, I'm not sure I would phrase it quite that way. I am going to dig back into this tonight or tomorrow, as soon as I have a moment. More content to be added, and needs beefing up, but the increased dysfunction for adults has to be better split out per several factors. I'll come back to this. SandyGeorgia (Talk) 21:24, 24 February 2020 (UTC)

Markworthen have a look at Quality of life now. [19] SandyGeorgia (Talk) 22:30, 24 February 2020 (UTC)

Excellent!   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 14:32, 25 February 2020 (UTC)

Rationale: Clarity.

  - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 20:53, 24 February 2020 (UTC)

Thanks, stay tuned, I'll get to the rest of this. I do have yet another wake and funeral to attend, but have highlighted already the text in the two sources that needs to be added/fixed. SandyGeorgia (Talk) 21:24, 24 February 2020 (UTC)

A comma

1. Version 1: Tourette syndrome (TS or simply Tourette's) is a neurodevelopmental disorder with onset in childhood characterized by multiple movement (motor) tics and at least one vocal (phonic) tic.
2. Version 2: Tourette syndrome (TS or simply Tourette's) is a neurodevelopmental disorder with onset in childhood, that is characterized by multiple movement (motor) tics and at least one vocal (phonic) tic.

I suspect this may be a Br/Am eng thing? Defer to the rest of you. SandyGeorgia (Talk) 18:22, 23 February 2020 (UTC)

The comma doesn't work in #2 grammatically (or so I'd say; IANALinguist). The comma would be an optional "breath" after "childhood" when without "that is". With "that is" in the sentence, the comma is wrong.

What about splitting the sentence: Tourette syndrome (TS or simply Tourette's) is a neurodevelopmental disorder that is characterized by multiple movement (motor) tics and at least one vocal (phonic) tic. In almost all cases, TS develops during childhood. (But this is why I never try/ed to rewrite any sentence from scratch: I am not necessarily comfortable, medical-writing-wise, inserting "develop" or "almost all" (your "vast majority").) Now someone will say "that is" is optional, but this is the first sentence (I think) and there's nothing wrong with the formality of "that is". It helps with the "compression" issue: not making readers insert grammatical constructs while reading that are not written. (As far as I got in Spanish, one of my favorite things is "lo que", which as far as I can tell is never an option in Spanish. It seems hard to get around, whereas in English people try to avoid it and clarity/syntax is lost.) Outriggr (talk) 06:50, 24 February 2020 (UTC)

Starting in now; I put the article inuse so Colin doesn't start his next review before I finish. This is why you get the big bucks, Outriggr. (Not sure we can say "in almost all cases", since TS by definition is before 18, and it is not clear if adult-onset have other causes or are childhood tics resurfacing-- best to stick with the definition at this stage). SandyGeorgia (Talk) 13:54, 24 February 2020 (UTC)

Simple solution? [20] Done for now, pending feedback. SandyGeorgia (Talk) 14:54, 24 February 2020 (UTC)

SandyGeorgia - Looks good to me.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 19:10, 24 February 2020 (UTC)

Outriggr - Excellent point, and I love your comparison to Spanish.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.)

Classification and tic definition

Tourette syndrome#Classification

The business of having to talk about tics before they are defined is partly a problem of the way MEDMOS suggests Classification before Characteristics. At one point, I reversed those, but Yomangani found that awkward. Then Colin wondered about the different kinds of tic disorders and how they all tied together. So, we are forced to talk about the distinction between phonic and motor tics, as they impact the Classification dilemma. Most TS researchers consider chronic tics no different than TS. That makes TS by FAR the most common childhood condition, period. Outriggr was trouble by tics being defined in two sections; I've tried to smooth that over, because we have to explain the classification dilemma. SandyGeorgia (Talk) 21:04, 24 February 2020 (UTC)

SandyGeorgia - I agree on all counts.   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 21:08, 24 February 2020 (UTC)

Drawing a line under it

I've done all the adding of content I can (to satisfy new, 11th-hour new WT:MEDMOS suggestions for article content in all medical articles) The 14-year-old FA has been completely overhauled, thanks to a wonderful collaboration. Prose size is 7,300 words, which is why past my comfort zone (where I trim to sub-articles). We're a week from mainpage day, when coprolalia-related vandalism is likely to hit the entire suite of {{Tourette syndrome}}. Tweaking of my miserable prose is always needed and welcome, but it's time to draw a line under adding any new content, and focus on being ready for mainpage day. SandyGeorgia (Talk) 23:25, 24 February 2020 (UTC)

Did you edit much past "Management" since I looked at it last? I am slow or thorough (take your pick); and would prefer not to review the last ~4 sections if they haven't been the target of your editing. (Those being, in reverse: Research directions, Society and culture, History, Epidemiology.) Outriggr (talk) 09:19, 25 February 2020 (UTC)

There is moderate evidence that the antihypertensive clonidine, along with aripiprazole, haloperidol, risperidone, and tiapride, reduce tics more than placebo One might read this as meaning the drugs are combined. I don't know why "along with", and is the "moderate evidence" regarding clonidine or all of them. Maybe give clonidine its own sentence if it's first or second-line? Outriggr (talk) 10:33, 25 February 2020 (UTC)

• How's this? [21] SandyGeorgia (Talk) 22:35, 25 February 2020 (UTC)

Outriggr I'll get to your inlines when I am home tonight from funeral. We now have "right not to be informed" twice. Clonidine is different type of drug-- the others are antipsychotics (typical and atypical). Yes to moderate on all; I can fix this when home unless you get to it first. No, I don't believe I changed the sections you mention; I worked yesterday on Classification, Causes, Onset and progression, Co-occurring conditions, and Quality of life, so that is where you will find most of my prose messes :) Gotta go, long drive, will follow somewhat from my iPhone. SandyGeorgia (Talk) 13:20, 25 February 2020 (UTC)

Re-worked Quality of life section to try to address inline queries; that's all I've got for now! Next to see what elegant wordsmithing I wake up to tomorrow morning; this is making waking up almost pleasant, even before caffeine :) Done for now. I am going to have to run through and check wikilinking when all the wordsmithing is done, but have been holding off on that. SandyGeorgia (Talk) 23:53, 25 February 2020 (UTC)

It appears that I had copied and pasted rather than cut and pasted "right not to...". I did think the new location was more relevant to the surrounding text, but haven't looked at the day's edits yet. Yes to the med sentence change. Outriggr (talk) 06:42, 26 February 2020 (UTC)

Mark deleted one of the extras ...hope it was the right one. SandyGeorgia (Talk) 07:05, 26 February 2020 (UTC)

Right. I'm  Done until the next major revision. Outriggr (talk) 07:10, 26 February 2020 (UTC)

Outriggr I sure hope I'm done now :) Here is the source text on the funding thing (Yomangani didn't like it either, but I seem unable to fix it):

Regardless of whether the focus is on discovering rare or common sequence or structural genetic variation, it is clear that large collections of biomaterials (likely in the tens of thousands) that are accessible by multiple research groups will be essential for success. Three consortia are now beginning to work toward this goal (TSAICG and TIC Genetics in the United States, and EMTics in the European Union); there is active collaboration among these groups, which will also be essential for success. However, the scale of the funded collection efforts, particularly in the United States, remains quite modest compared to other neuropsychiatric disorders in which there has been success in gene discovery.

The article is longer than I like now, but that seems to be the trend these days, so I ready to be done for now! SandyGeorgia (Talk) 07:13, 26 February 2020 (UTC)

Another review pass

I'm going through the changes since I last reviewed. I didn't like "a symptom evident " for coprolalia as this word implies the symptom exists but is hidden or unnoticed. I also felt that paragraph was best to set out the "old beliefs" case in the first sentence, and then the "current beliefs" in the second, rather than mix them up. I also decided to move "many go undiagnosed or never seek medical care" till after we explain diagnosis issues and that many cases are mild, since it then seems a logical conclusion rather than a standalone fact without explanation. I changed "medical care" to "medical attention" as it seemed more appropriate to my ear. The punctuation with commas and semicolons in this paragraph is beyond my abilities so may need fixing. I hope this is an improvement, but feel free... -- Colin°^Talk 12:40, 25 February 2020 (UTC)

• "are present at higher rates" -- compared to what? People with TS who don't attend speciality clinics, or the general population? -- Colin°^Talk 12:42, 25 February 2020 (UTC)

• than broader population of people with TS. SandyGeorgia (Talk) 13:26, 25 February 2020 (UTC)

• How's this? [22] Sample wording from Sukhodolsky, as one example found in many: "Studies of clinically referred samples reveal ... but ... the co-occurrence is lower in community ascertained samples" and similar everywhere. SandyGeorgia (Talk) 22:45, 25 February 2020 (UTC)

• "with onset in childhood" (lead sentence). Would it be equivalent (enough for the lead sentence) to say "that begins in childhood", to avoid "onset" which seems to me a somewhat difficult word. -- Colin°^Talk 12:47, 25 February 2020 (UTC)

• Yes, also see the TFA blurb linked in the article history. It had "neurodevelopmental disorder that develops" which was ick redundant, so I changed to emerges, which is not great. Maybe one of you can fix. SandyGeorgia (Talk) 13:26, 25 February 2020 (UTC)

• How's this? [23] Also at Wikipedia:Today's featured article/March 3, 2020. SandyGeorgia (Talk) 22:47, 25 February 2020 (UTC)

• I've move the "spectrum of tic disorders" up to the first paragraph where the syndrome is being defined, and included an adjective so we know where it is in that spectrum. The final paragraph seemed odd with the history stuck arbitrarily on the end just after the (current) research sentence. So moved the order around and it seems to flow/develop better. -- Colin°^Talk 13:06, 25 February 2020 (UTC)

• No prob, will look when home tonight. SandyGeorgia (Talk) 13:26, 25 February 2020 (UTC)

• "on behalf of his resident" my dictionary tells me "resident" is a North American term for "a medical graduate engaged in specialized practice under supervision in a hospital". Some readers will wonder if this is his lodger (person who lives with him). Is there another term or can we fix it to be clearer? -- Colin°^Talk 13:06, 25 February 2020 (UTC)

• Unless someone thinks of one, I will re-read sources for inspiration. Thanks Colin, more later. SandyGeorgia (Talk) 13:26, 25 February 2020 (UTC)

• PS, Residency (medicine). SandyGeorgia (Talk) 13:27, 25 February 2020 (UTC)

That article suggests "intern" is the term used in France (today anyway), and that's also the term (internship) used in the bio article, which also says "a student, amanuensis, and house physician of his mentor, [Charcot]". Perhaps "resident" is fine if the article is US English, but if we can avoid professional jargon for a simpler word -- I don't think precision is vital here. -- Colin°^Talk 13:40, 25 February 2020 (UTC)

I suggest a wikilink to Residency (medicine), or an endnote with a definition, e.g., American Heritage Dictionary: "A physician receiving specialized clinical training in a hospital, usually after completing an internship."   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 15:30, 25 February 2020 (UTC)

The Brits describe it as an internship and never use the word resident.(Rickards H, Cavanna AE (2009). "Gilles de la Tourette: the man behind the syndrome". J Psychosom Res. 67 (6): 469–74. doi:10.1016/j.jpsychores.2009.07.019. PMID 19913650.) French Wikipedia calls him an intern, but is unsourced. Kushner doesn't seem to use either word (at least I can't find either on a quick scan). Some sources just say "pupil".[24] Many reliable sources use "resident" and many reliable sources use "intern". Based on reading a ton of the sources, it is pretty clear there are problems with the specific meanings of intern and resident in US medicine [25] v European medicine and most certainly v French medicine at the time. I don't want to link to current dictionary definitions, as they may be unrelated to what was the practice at the time in France, and we need to go by sources, not dictionaries. I think it safest to use the word used in many sources (pupil - but we can say student), with a footnote saying that some call it intern, others resident, others pupil, with a sample citation to all three.

If others disagree with "student", then I think "intern" is safer than "resident", based on European writers. One problem is that, while he started as a student of Charcot, by 1884 he was a clinic director, so what was he at the time Charcot named the condition? Who knows; sources vary. We used to say he was a French physician who was a student of Charcot; that would do it without the need for a footnote. Someone along the way cut that. SandyGeorgia (Talk) 23:18, 25 February 2020 (UTC)

And we have: "After a year as Brouardel's intern, Gilles de la Tourette was appointed Chef de Clinique to Charcot" (clinic director). Resident should go. SandyGeorgia (Talk) 23:26, 25 February 2020 (UTC)

How's this? [26] Based on one source, no footnote needed, removes the (too American) word resident, more specific to what the relationship exactly was. SandyGeorgia (Talk) 23:29, 25 February 2020 (UTC)

Problem solved: we always prefer a translation from a reliable source to our own, and we now have a source that does the translation for us and explains that he was both intern and senior resident (Chef de Clinique). How's this? (Scroll all the way down for addition of new source.) [27] SandyGeorgia (Talk) 02:40, 26 February 2020 (UTC)

• "Genetic studies indicate that tic disorders occupy a spectrum that is not recognized by the categorical approach of the current diagnostic framework" I'm not sold on the edit by Outriggr here. The word "distinct" was lost, which I think was essential to avoid the categories overlapping or being vague. Would "cover a spectrum" be more idiomatic and "clear-cut" a suitable paraphrase of the quoted word? -- Colin°^Talk 21:02, 26 February 2020 (UTC)

• Good catch, yes the "distinct" was important (I may have missed that as I may not have read to the bottom of that edit summary). Fixed, SandyGeorgia (Talk) 21:28, 26 February 2020 (UTC)
• The word 'distinct' had, and has, no additional meaning to me in that sentence, so I removed it, and was in general trying to avoid more direct quoting, which is always a bit jarring. Outriggr (talk) 07:01, 27 February 2020 (UTC)

• Thanks Outriggr; yeoman's work here to clarify and correct my writing. I could promise you my first-born, but that nimwit is about to embark across the world on a dangerous venture, and you Don't Want To Go There. Thanks again, :( SandyGeorgia (Talk) 18:19, 27 February 2020 (UTC)

• "urge preceding the onset of a tic" (previously "that precedes tic onset"). What is the purpose of "onset" here? Isn't a tic a rapid and short-lived event, so wouldn't it be simpler to say the urge precedes the tic. -- Colin°^Talk 21:52, 26 February 2020 (UTC)

• Short answer, yes, removed those words. Long answer, look at the HBO documentary trailer in External links. Tics, oddly, can be sudden and repetive but still dystonic ... notice the girl who stretches out her legs in a certain way, etc. Anyway, those words were adding nothing here. SandyGeorgia (Talk) 21:56, 26 February 2020 (UTC)

• "People with TS-only do not show cognitive deficits. They ..." changed from "Children". Sources say Children (and boys). So strictly, we don't really know about adults. -- Colin°^Talk 22:05, 26 February 2020 (UTC)

• Yep, fixed. SandyGeorgia (Talk) 22:15, 26 February 2020 (UTC)

• "Most Tourette's is diagnosed merely by observing a history of tics" (changed from "Most cases are diagnosed merely by observing a history of tics"). "Most Tourette's is " doesn't seem very grammatical or professional-level phrasing. Do we want "Mostly, Tourette's is diagnosed" or is the original better. What do we mean by "observing a history of tics"? -- Colin°^Talk 22:21, 26 February 2020 (UTC)

• First sentence was vague and redundant anyway, [28] SandyGeorgia (Talk) 23:04, 26 February 2020 (UTC)

• "About 20% of people with Tourette syndrome do not recognize that they have tics." Would "do not realised that they have tics" be better? -- Colin°^Talk 22:24, 26 February 2020 (UTC)

• Done, SandyGeorgia (Talk) 23:00, 26 February 2020 (UTC)

• "It is critical to note that the comorbid conditions may determine functional status more strongly than the tic disorder" I'm not that fond of this quoted text, with "functional status" being a rather opaque medical term. We already say "Because comorbid conditions such as OCD and ADHD can be more impairing than tics, and cause greater impact on overall functioning, " so I think it can be dropped. Oh, I now see that other text was rephrased "Disruption from tics is commonly overshadowed by comorbid conditions that present greater interference to the child." I think the original text was better, with "overshadowed" and "interference" being confusing to me. -- Colin°^Talk 22:33, 26 February 2020 (UTC)

• Done, SandyGeorgia (Talk) 23:00, 26 February 2020 (UTC)

• "Limited surveys of small numbers of women show no consistent evidence of a change in frequency or severity of tics related to pregnancy (about a quarter of women do report that their tics increase before menstruation)" I wonder if we really need to say "Limited surveys of small numbers" for a comment that we've not yet found "consistent evidence of" something. Surely that caveat would be more needed if we had found consistent evidence of no change or some change. The comment about menstruation seems like an aside rather than something 50% of the population might be concerned about. How about "A quarter of women report that their tics increase before menstruation, however studies have not shown consistent evidence of a change in frequency or severity of tics related to pregnancy". -- Colin°^Talk 17:38, 27 February 2020 (UTC)
• "women's symptoms" Hmm. Women's symptoms reads to me like female-only symptoms. How about "Overall, symptoms in women respond better to haloperidol than they do for men". -- Colin°^Talk 17:38, 27 February 2020 (UTC)
• "one report found that haloperidol was the preferred medication during pregnancy". Preferred by whom? The women or their doctors. Why preferred? For risk of harm to baby, for minimal adverse trouble in pregnancy, for some other reason? -- Colin°^Talk 17:38, 27 February 2020 (UTC)
• "Most women report that withdrawing from medication during pregnancy is well tolerated." I don't think people themselves report "well tolerated". They report that they had no or few problems and the doctors conclude it is well tolerated. How about "Most women find they can withdraw from medication during pregnancy without much trouble". Something like that? -- Colin°^Talk 17:38, 27 February 2020 (UTC)

• Got all the pregnancy edits, here. SandyGeorgia (Talk) 17:57, 27 February 2020 (UTC)

• "Most children and adults report having at least one painful tic" This surprised me, given all the comments earlier about tics being mild, going unnoticed or not requiring suffering, etc. The source says "the majority of respondents reported at least one tic that caused pain or physical damage" but I haven't looked at the two cited research papers they are referring to. I wonder if this is more that at some point they've had a tic occur that caused pain or damage (i.e. they whacked something and it hurt or got a bruise) rather than that this tic is a painful tic. Is the "physical damage" to their body or to perhaps something else (i.e. they whacked a glass off the table). -- Colin°^Talk 17:47, 27 February 2020 (UTC)

• I will look at the original source, but this does not surprise me. A mild tic, even unnoticed, can still become painful. For example, CONSTANTLY clearing your throat can irritate your throat. CONSTANTLY scrunching your shoulder blades together can give you muscle soreness. CONSTANTLY brushing your finger on the side of your nose can irritate and break the skin. Etc ... I'll see if I can expand this from the original primary sources. SandyGeorgia (Talk) 17:59, 27 February 2020 (UTC)

• Colin I am going to remove this (I only added it when I was concerned that we weren't doing enough to reflect the rare, severe cases). Both sources cited by the review are self-reported, internet survey (Surveymonkey.com) responses solicited through the Tourette Syndrome Association webpage; that is, by definition they contain a *very* high degree of ascertainment bias, with no clinical rating instruments or independent observation used to assess actual severity. To use a phrase overused in the literature the VAST MAJORITY of people with TS are not even reading the TSA webpage, much less responding to surveys there. The results don't seem well quantified, but mention head neck and shoulder pain. For all the reasons well laid out in the literature, this is barely usable, and I shouldn't have added it. SandyGeorgia (Talk) 18:13, 27 February 2020 (UTC)

• I will find another way to work in mention of sometimes painful tics. SandyGeorgia (Talk) 18:14, 27 February 2020 (UTC)

Agree that survey doesn't meet our standards. -- Colin°^Talk 18:24, 27 February 2020 (UTC)

• "Decreased measures in quality of life are observed in children whose tics are accompanied by ADHD". Wordy, passive, jargon. Perhaps we can just drop this and retain the sentence that follows it, if tweaked: "Comorbid ADHD can severely affect the child's well-being in all realms, and extend into adulthood". -- Colin°^Talk 17:57, 27 February 2020 (UTC)

• Done, SandyGeorgia (Talk) 18:03, 27 February 2020 (UTC)

• I'm done reading through again. Well done Sandy and to all the others for their contributions. -- Colin°^Talk 18:24, 27 February 2020 (UTC)

But wait...more feedback!

Does anyone really call it TS? And mentioning "Tourette's" seems like overkill...but not my area and I may be wrong - do they need to be in the lead? Whereever they are it might be best to note they are abbreviations...? Cas Liber (talk · contribs) 13:28, 26 February 2020 (UTC)

• Yes, TS is very commonly used, but I have implemented your suggestion to note that they are abbreviations. SandyGeorgia (Talk) 15:24, 26 February 2020 (UTC)

• and no medication effectively treats all symptoms without significant adverse effects -not everyone gets adverse effects. You need to shoehorn "risk" in here e.g. "and no medication effectively treats all symptoms without significant risk of adverse effects" or "and no medication effectively treats all symptoms without risk of significant adverse effects"

• Working on this, sidetracked on updating some older citations while at it. SandyGeorgia (Talk) 15:24, 26 February 2020 (UTC)

• Done. SandyGeorgia (Talk) 17:56, 26 February 2020 (UTC)

• Tourette syndrome is a spectrum disorder—its severity ranges from mild to severe - not thrilled about a noun being used as an adjective here...and do we need it at all? Can we just say there is a wide variation in the severity of the condition (which is true of just about every psychiatric and neurological condition and hence renders the term "spectrum" ubiquitous and hence pointless)

• I think this is emerging as significant to the classification controversies, and is mentioned throughout the article, so would like to keep this. On noun adjective, we have spectrum disorder ? And it's often used that way ? SandyGeorgia (Talk) 15:24, 26 February 2020 (UTC)

• Using it as a noun is a bit better. I still think it is stupid but given we have to reflect the literature so be it. Cas Liber (talk · contribs) 22:30, 27 February 2020 (UTC)

More later. need to sleep Cas Liber (talk · contribs) 13:37, 26 February 2020 (UTC)

Opinions on length

@Outriggr, Colin, Ceoil, Yomangani, Markworthen, Casliber, WhatamIdoing, and Adrian J. Hunter: Recognizing that not everyone at WP:FAC agrees with my views on length, I'd appreciate feedback.

I was quite happy with the length of the article (6,400 words, which I consider optimal) before I expanded to cover the new territory wanted at WP:MEDMOS (more psychosocial, pregnancy, etc). With the new content, plus some additions for clarity as pointed out by all of you, the article has grown to 7,400 words, which IMO makes for an exhaustive read. If you disagree, now is the time to speak up.

The bulk of the extra length is in Management, where I added most of the new content. There is a sub-article: management of Tourette syndrome. For a condition that requires little to no treatment for most people, there is an awful lot of space given to Management-- more than any other section. My desire to have this FA be a good sample of summary style to keep the article to a readable size, versus having it demonstrate how we can incorporate the new content mentioned at MEDMOS, are competing. If I cut some Management content to the sub-article, we still have the content, and available on a page where those who seek information about Management will find it.

Shall I do some trimming to the Management sub-article, or are my views on size too extreme? SandyGeorgia (Talk) 21:38, 26 February 2020 (UTC)

Here is a sample of what a trimmed Management section would look like. It gets the article down to 6,700 words, which I am more comfortable with. Does anyone feel that is a great loss? Will people who want detail on Management go to the sub-articles? SandyGeorgia (Talk) 23:29, 26 February 2020 (UTC)

Yes, I think your proposed Management section is fine, although I think some of the text in 'Psychoeducation...' was useful, and helped with reassurance. On the other hand, much of that removed text could be said of any medical condition; concern, research on the internet, the way people feel. Would be put it in every main article, if sources allowed? Probably not. So that's a good case for reducing it. The 'quality of life' section or Prognosis covers some of the same ideas anyway. If I was going to cut anything else, I would reduce the detail on epidemiology, where various people are giving slightly different estimates. For example, the third paragraph ("Fernandez...") is mostly a mathematical exercise and I wouldn't miss it. And the first (short) paragraph of "History" is interesting but probably not very important outside the History article. Outriggr (talk) 07:29, 27 February 2020 (UTC)

Thanks, Outriggr; I will wait to hear from others before chopping. I woke up to no edits! I should go back to sleep ... SandyGeorgia (Talk) 14:23, 27 February 2020 (UTC)

Separately from trimming Management, I cut the 15th-century mention in History (because we have that in a sub-article), and moved some of the epidemiology to footnotes.[29] I don't want to cut the epidemiology information entirely, and there is no sub-article to trim it to; we had an IP trying to remove that TS is common, and so I want to keep the half a million children number for context, and there are serious problems in prevalence estimates throughout the literature because outside of the Yale Group, not all authors are careful to specify when numbers pertain to clinically-ascertained populations. So, kept the detail in footnotes. SandyGeorgia (Talk) 14:53, 27 February 2020 (UTC)

No objections voiced, so I have trimmed and given hatnotes to sub-article. Prose size is now 6,700 words, which I am comfortable with, and I think most important points in Management are still covered. SandyGeorgia (Talk) 21:22, 27 February 2020 (UTC)

Also, as far as I know, everything above has been done, and I'd like to archive some. If there is anything I missed, please let me know. SandyGeorgia (Talk) 23:06, 26 February 2020 (UTC)

Ok late to the party, happy with page length as of now Cas Liber (talk · contribs) 22:32, 27 February 2020 (UTC)

I am so impatient :) SandyGeorgia (Talk) 22:40, 27 February 2020 (UTC)

The current length means that it probably takes about half an hour to read the article (longer if you're paying close attention, shorter if you're just skimming). That means that it's a heavy lift for FAC reviewers, and that most readers won't read all of it. But it's not an inherently bad length. WhatamIdoing (talk) 05:34, 28 February 2020 (UTC)

Common

Multiple sources refer to TS as a common condition. What these sources mean is that pediatricians will encounter it in practice, teachers will encounter it in the classroom, etc. I could add thirty-five citations to the word, but that shouldn't be necessary. Does anyone understand the removal? SandyGeorgia (Talk) 18:48, 8 February 2020 (UTC)

Wikipedia:Sockpuppet investigations/Moaia SandyGeorgia (Talk) 01:41, 28 February 2020 (UTC)

Blocked: same disruptive edit introduced by three (1) sockpuppet (2) editors(3). SandyGeorgia (Talk) 03:37, 9 December 2021 (UTC)

TS is "common":

• Gulati 2016 doi:10.1007/s12098-016-2176-1 "Tic disorder is a common neurodevelopmental disorder of childhood. It is one of the commonest condition encountered by a pediatrician in office practice, especially in developed countries."
• Hollis 2016 PDF "Tourette syndrome (TS) is a common condition affecting up to 1% of children and young people and is characterised by motor and vocal tics."
• Medscape "Tourette syndrome (TS) is a common genetic neurological disorder characterized by chronic motor and vocal tics beginning before adulthood."
• Albin 2019 PMID 31649568 "Tourette syndrome is a common neurodevelopmental disorder defined by the presence of tics, … "
• Nosra et al 2019 PMID 31289052 "Tourette syndrome is a common childhood-onset neuropsychiatric disorder, with tics that wax and wane in frequency and severity over time."
• Jones 2019 PMID 29763133 "Tourette syndrome referred to as Tourette disorder in the recently updated Diagnostic and Statistical Manual of Mental Disorders (DSM–5), is a common neurodevelopmental disorder affecting up to 1% of the population."
• Reilly 2019 [30] " Tourette syndrome (TS) is a common neuropsychiatric disorder which, in addition to the core symptoms of motor and vocal tics, includes a high association with co-existing mental health disorders … "
• Robertson 2018 [31] "Gilles de la Tourette syndrome (GTS), a common disorder affecting about 1% of the population in most parts of the world … "
• Roth 2018 PMID 28807495 "Tourette syndrome (TS) is a common neuropsychiatric disorder, more common in males than females, with onset before age 18. TS is characterized by multiple motor tics and one or more vocal/phonic tics, persisting for more than a year. "
• Specht 2018 [32] "Tourette syndrome (TS) is a common neurodevelopmental condition affecting approximately 1% of the general population (American Psychiatric Association, 2013, Robertson, 2008, Scahill et al., 2013)."
• Ganos, Martino, Pringsheim 2017 PMID 28451624 "Primary tic disorders, notably Tourette syndrome, are very common movement disorders in childhood."
• Rath 2017 PMID 28740637 "For many years, Tourette syndrome (TS) was considered to be a rare disorder, but tics and TS are now recognized as fairly common childhood-onset conditions."
• Robertson 2017 PMID 28150698 "Several diagnostic criteria for GTS exist, the establishment of which (and resulting research worldwide) has led the scientific community to view GTS as a common disorder."
• Karagiannadis 2016 [33] "Gilles de la Tourette syndrome is a common neurodevelopmental disorder that presents early in childhood and has an estimated prevalence of 0.3–0.9 %."

For comparison: [34] "ADHD is the most common childhood psychiatric disorder with an estimated prevalence of 2% to 15%." (But don't expect Wikipedia's "Good article" on ADHD to tell you that.) SandyGeorgia (Talk) 21:05, 28 February 2020 (UTC)