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### Tic suppression  Since tic suppression is part of Comprehensive Behavioral Intervention for Tics (CBIT) and Exposure and Response Prevention (ERP), there has been increased interest in investigating the characteristics of tic suppression and the factors that affect it. A study of 26 TS adolescents compared free ticcing with a tic suppression condition \citep{25786675}. During the free ticcing condition tic distribution across body locations was consistent with the general view that most tics occur at the level of the shoulders and above. Eye tics were the most frequent followed by facial/cervical tics. Limb tics and tics involving the trunk were the least common. During the tic suppression condition, an increase in eye tics were seen in 10 subjects along with an increase in hand tics in 3 subjects. Tic suppression was most successful when it involved suppression of tics in the body locations that are generally involved in fewer tics (such as the legs and the trunk). The authors suggest that tic suppression involves specific, rather than global, inhibition since some types of tics are easier to suppress than others. Historically different categories have been used to classify tics such as simple vs. complex tics and motor vs. phonic tics. The results of this study suggest that future researchmay be productive by  clarifying the nature of the tics associated with particular body locations in even more detail (i.e., (e.g.,  whether premonitory urges are more likely to be associated with tics in particular body locations). locations) may be productive.  By definition, children with Tourette syndrome (TS) have had tics for over a year. They can often suppress their tics briefly and they do so more effectively when rewarded for successful suppression. It has not been known whether the ability to suppress tics develops only with practice over the years of having tics or whether the ability to suppress tics is present when tics initially occur. citet{Greene_2015_NTsuppress} addressed this question in children whose tics had developed within the past few months. When children received tokens with monetary value for tic-free intervals, they had significantly more of these intervals compared to a baseline, unrewarded condition. This result suggests the possibility that behavior therapy for tics may work, at least for some children, even before TS can be diagnosed.   ### Sensory phenomena   Total tic severity and vocal tic scores were significantly correlated with scores on In  the Premonitory Urge for Tics Scale (PUTS) and last few years research has focused on  the University role  of São Paulo Sensory Phenomena Scale for premonitory urges in  TS adults \citep{Kano_2015}. The PUTS scores since these urges triggers for tics in many people  and are as bothersome as  the USP-SPS scores were correlated with the scores on the Dimensional Yale-Brown Obsessive-Compulsive Scale. tics themselves to some people.  In addition, PUTS scores and USP-SPS total scores were both significantly correlated many people  with tic complexity TS report sensory sensitivities  and YGTSS vocal tic scores. researchers have been trying to examine the underlying causes of these sensitivities and whether they are related specifically to TS or to the associated comorbidities.  Total tic severity and vocal tic scores were significantly correlated with scores on the Premonitory Urge for Tics Scale (PUTS) and the University of São Paulo Sensory Phenomena Scale for TS adults \citep{Kano_2015}. The PUTS scores and the USP-SPS scores were correlated with the scores on the Dimensional Yale-Brown Obsessive-Compulsive Scale. In addition, PUTS scores and USP-SPS total scores were both significantly correlated with tic complexity and YGTSS vocal tic scores. This study provides additional evidence that the association between premonitory urges, as measured by PUTS scores, and tics is complex and, although the results have been mixed, are often seem to be associated with measures of obsessive-compulsive disorder.  Another study examined the association between premonitory urges and interoceptive awareness \citep{25879819}. Interoceptive awareness was measured by how well subjects could count their heartbeats during a specific period of time. Interoceptive awareness, tic severity, and severity of obsessive-compulsive symptoms were used in a multiple regression to predict PUTS scores. Interoceptive awareness was a highly significant predictor of premonitory urges with greater interoceptive awareness being associated with higher PUTS scores. Higher PUTS scores were also associated with greater tic severity but to a lesser extent than interoceptive awareness. The authors suggest that high interoceptive awareness might result in people setting a low threshold for perception of their own internal physiological sensations and therefore interpreting these sensations as an urge to tic. This study, however, also showed found  that TS subjects generally had lower interoceptive awareness than controls and this result was interpreted as possibly related to downregulation of interoception, perhaps reflecting a compensatory process that developed over time. However, the authors also point out that the reduced interoceptive awareness could reflect the effect of the comorbidities associated with TS. ### Symptoms and comorbidity