Tourette Natural History — MRCPsych Paper B MCQ

Correct answer: D — They usually peak in late childhood and decline during adolescence, often becoming mild or non-impairing by early adulthood

The correct answer is D. Tics characteristically wax and wane, with greatest severity usually occurring in late childhood, commonly around ages 8–12. Average tic severity then declines through adolescence, and by early adulthood many people have only mild or non-impairing tics. This should not be presented as guaranteed remission: objective examination may still identify tics in adults who consider themselves tic-free, and a clinically important minority continue to have impairing symptoms. Progressive deterioration through adolescence or after age 30 is not the usual course, excluding secondary causes of new or worsening movements. Persistent lifelong stability is also atypical, while abrupt and permanent remission at puberty overstates the likelihood and timing of improvement.

Reference: National Institute for Health and Care Excellence. Digital therapy for chronic tic disorders and Tourette syndrome: final protocol/background, 2025. https://www.nice.org.uk/guidance/hte25/documents/final-protocol-2