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Recent research has again demonstrated the wide prevalence of TS-associated comorbities. In addition, studies are clarifying to what extent comorbities may contribute to the types of tics that TS patients exhibit.  A retrospective review of 1,000,000 people in the Taiwan National Health Insurance Research Database examined the association between epilepsy with TS \citep{26597416}. 1062 children and adolescents with TS were matched on age and sex with a control group of 3186.The TS group had an 18-fold increased risk of epilepsy compared to the control group and even after adjusting for comorbidities (i.e., bipolar disorder, depression, learning difficulties, autism, anxiety disorder, sleep disorder), the risk of epilepsy was still 16-fold. Although the authors raise the issue that some tics may have been mistaken for seizures, they also suggest that TS children be followed closely for the development of epilepsy. In a large study of psychiatric comorbidity in TS, approximately 800 families were recruited primarily from TS specialty clinics in four different countries over a 16-year period \citep{25671412}. A total of 1374 participants with TS and 1142 family members unaffected by TS were included. 86% of the TS participants had at least one psychiatric comorbidity and 72% had either OCD or ADHD. Other disorders, involving mood, anxiety or disruptive behavior, each occurred in approximately 30% of the TS participants. The genetic correlations between TS and mood were accounted for by ADHD and OCD, while ADHD alone accounted for the genetic correlations of TS with anxiety and disruptive behavior disorders. See also \citep*{Prime:Hirschtritt:2015}.  A study of 400 patients seen at a TS specialty clinic found that 39% had coprolalia and 20% had copropraxia \citep{26089672}. When the 222 patients with full comorbidity data were examined, only 13.5% had "pure" TS (i.e., without comorbidities). None of the "pure" TS group had coprolalia and none had a family history of obsessive-compulsive disorder. In contrast, 39% of the group with comorbidities exhibited coprolalia. These researchers also found that individuals with complex tics were significantly more likely to report premonitory urges than individuals with simple tics.   Emotional regulation difficulties were described in three studies reminding us that TS patients often report that tics are the least of their problems. An experienced clinician who has done research on "rage attacks" in TS has provided a clinically useful summary of current knowledge \citep{Budman_2015}. In another study \citep{25716486} study,  greater irritability was seen in TS adults with more severe tics and those with comorbid ADHD. ADHD \citep{25716486}.  \citep{26144583} found that both male and female TS subjects had significantly higher scores for personal distress and rated their abilities to take other people's perspectives lower than the control subjects did.In a large study of psychiatric comorbidity in TS, approximately 800 families were recruited primarily from TS specialty clinics in four different countries over a 16-year period \citep{25671412}. A total of 1374 participants with TS and 1142 family members unaffected by TS were included. 86% of the TS participants had at least one psychiatric comorbidity and 72% had either OCD or ADHD. Other disorders, involving mood, anxiety or disruptive behavior, each occurred in approximately 30% of the TS participants. The genetic correlations between TS and mood were accounted for by ADHD and OCD, while ADHD alone accounted for the genetic correlations of TS with anxiety and disruptive behavior disorders. See also \citep*{Prime:Hirschtritt:2015}.  More research is also being conducted on personality differences associated with TS. A small study of 17 male adolescents \citep{26078419} found that the only difference between the TS subjects and 51 age- and gender-matched controls on the Minnesota Multiphasic Personality Inventory-Adolescent was that the TS subjects scored significantly higher on the Obsessiveness Content Scale. In contrast a study of 50 TS adults in Germany used a variety of instruments to measure psychological symptoms and personality traits \citep{26112450}. Comorbidities were common with 41% having OCD, 28% being depressed and 26% having ADHD. Patients with OCD had more severe tics and there was a trend for those with ADHD to have more severe tics. Only 29% of the patients had no pathological personality traits. The demand-anxious trait was the most common personality trait (measured with the Inventory of Clinical Personality Accentuations) seen in patients and was present in 39% while histrionic personality traits were not found in any of these patients. Personality traits in patients with "pure" TS were comparable to those of the control group. Interestingly, ADHD did not contribute to increased probability of pathological personality traits. Although quality of life was affected by both personality traits and comorbidities, personality traits had a larger impact on quality of life. 
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More research is being conducted that follows the developmental progression of TS and its comorbidities. This work may provide clues that help clarify what factors contribute the appearance and disappearance of transient tics and what factors contribute to the developmental decline in tic severity with the result that most TS adults have only mild, if any, tics.  Baby videos were used in a study in Italy of 34 children who were identified as having autistic behaviors in their second year of life \citep{26246137}. Families reported that development during the first year of life had been normal and they donated videos that had been recorded before these children were 6 months old. Videos of 18 boys were examined in detail. Abnormal general movements, which are spontaneously generated by central pattern generators and modulated by more rostral brain regions, were seen in 10 of the 11 boys who were eventually diagnosed with autism spectrum disorder. In contrast, normal general movements were seen in the 8 boys who had autistic features and 7 of these boys were later diagnosed with Tourette syndrome. 4 of the boys who were eventually diagnosed with autism spectrum disorder had TS as a comorbidity. These results, combined with the recent nearly ubiquitous availability of home baby videos in some cultures, suggest that  a pseudo-prospective study design could be used to identify features predicting later development of TS.Clinical features associated with an early onset in chronic tic disorders \citep{26596364}. The clinical characteristics of children who developed TS before the age of 4 were compared with those who were older than 6. The younger group had a higher rate of stuttering, other speech disfluencies (e.g., speech initiation difficulties, speech prolongation), and oppositional defiant disorder. There was no difference between the two groups in rate of ADHD or obsessive-compulsive symptoms. Interestingly, the early-onset group was more likely to have a mother with tics. The authors suggested that this difference in onset age might be related to mother sensitivity to the child's symptoms resulting in tics being diagnosed at a younger age, possible prenatal or perinatal environmental factors or "maternally transmitted epigenetic modification or genomic imprinting which may be related to tic onset." An alternative explanation may come from the fact that TS is much less common in girls than in boys, so tics in a woman may represent a higher genetic load. Just as a tall woman may have taller children than an equally tall man (all other things being equal), so children of a woman with tics may be more likely to have earlier onset than children of a man with tics.  A follow-up study averaging 9 years The clinical characteristics  of 75 children who developed  TS patients previously seen before the age of 4 were compared with those who were older than 6  at tic onset \citep{26596364}. The younger group had  a University-based clinic found that reported TS impairment higher rate of stuttering, other speech dysfluencies (e.g., speech initiation difficulties, speech prolongation), and oppositional defiant disorder. There was no difference between the two groups in rate of ADHD or obsessive-compulsive symptoms. Interestingly, the early-onset group  was more likely to decrease over time have a mother with tics. The authors suggested that this difference  in males and increase onset age might be related to mother sensitivity to the child's symptoms resulting  in females \citep{25193042}. In addition, women were more likely than men tics being diagnosed at a younger age, possible prenatal or perinatal environmental factors or "maternally transmitted epigenetic modification or genomic imprinting which may be related  to have more body regions, primarily tic onset." An alternative explanation may come from  the upper extremities, affected by fact that TS is much less common in girls than in boys, so  tics in adulthood. This result suggests that sex continues a woman may represent a higher genetic load. Just as a tall woman may have taller children than an equally tall man (all other things being equal), so children of a woman with tics may be more likely  to influence TS symptoms beyond adolescence. have earlier onset than children of a man with tics.  Since anecdotal evidence has suggested that tics decrease when people are involved in musical activity, the effects A follow-up study averaging 9 years  of music were systematically studied. Questionnaires completed by 29 75 TS  patients supported the idea previously seen at a University-based clinic found  that listening reported TS impairment was more likely  to music decrease over time in males  and performing music increase in females \citep{25193042}. In addition, women  were thought more likely than men  to decrease tic frequency \citep{Bodeck_2015}. In have more body regions, primarily  the second study upper extremities, affected by  ticsalmost completely stopped when subjects were performing music. Listening to music and mental imagery of musical performance also resulted in a decrease  in tic frequency. It was suggested adulthood. This result suggests  that focused attention, along with fine motor control and goal-directed behavior, produced the decrease in tics. sex continues to influence TS symptoms beyond adolescence.