deletions | additions       diff --git a/Phenomenology.md b/Phenomenology.md  index dc1e26b..1ff245b 100644  --- a/Phenomenology.md  +++ b/Phenomenology.md 
...
The clinical characteristics of children who developed TS before the age of 4 were compared with those who were older than 6 at tic onset \citep{26596364}. The younger group had a higher rate of speech dysfluencies (e.g., stuttering) and oppositional defiant disorder. There was no difference between the two groups in prevalence of ADHD or obsessive-compulsive symptoms. Interestingly, the children in the early-onset group were more likely to have mothers with tics. The authors suggested that mothers with tics will be more likely to recognize that the children have tics resulting in tics being diagnosed when children are younger. The authors also suggest that prenatal or perinatal environmental factors may contribute to the development of tics in their children. An alternative explanation may be related to the fact that TS is much less common in girls than in boys. Consequently, tics in a woman may represent a higher genetic load, resulting in a more severe form of tics and an earlier age of onset in her children.   Researchers re-evaluated 75TS  patients previously seen at a University-based TS  clinic, with a mean follow-up of 9 years \citep{25193042}. This study found that reported TS impairment was more likely to decrease over time in males and increase in females. In addition, women were more likely than men to have tics an expansion  in adulthood in various terms of the number of  body regions, regions exhibiting tics. This expansion was seen in women  primarily in  the upper extremities. This result suggests that gender continues to influence TS symptoms beyond adolescence.