Introduction. Tourette Syndrome (TS) is defined by chronic motor and phonic tics with onset during childhood. Although the definition and diagnostic criteria do not include coprophenomena (obscene utterances or gestures), public perception of TS often includes them. The precise prevalence of coprophenomena in TS is not known, nor is it known whether coprophenomena are associated with a more severe phenotype.

Methods. We analyzed cross-sectional data obtained from a large prospective 2-site sample of 177 children ages 5-17 years with TS. Key clinical features assessed included tics (Yale Global Tic Severity Scale), ADHD (Swanson, Nolan and Pelham-IV), OCD (Child Yale-Brown Obsessive-Compulsive Scale) and overall function (Children’s Global Assessment Scale).

Results. 17 TS subjects (9.6%) had at least one coprophenomenon at enrollment.  Subjects with coprophenomena (TS+copro) had higher YGTSS total tic score (36.9 +/- 7.5) and impairment score compared with those without coprophenomena (TS–copro) (20.3 +/- 8.6) (p < 0.01). YGTSS item analysis showed that TS+copro subjects had  worse scores in every domain (number, frequency, intensity, complexity, interference) except phonic tic frequency. TS+copro subjects had greater hyperactive-impulsive symptoms, but no difference in inattentive-distractible or OC symptoms compared to the TS-copro group.  The TS+copro group has worse overall function (median CGAS = 51) than did the TS-copro group (median CGAS = 60) (p < 0.01).

Conclusion. Coprophenomena are infrequent in TS, but are associated with worse overall tics, tic-related impairment, hyperactivity-impulsivity, and overall function. The presence of coprophenomena may represent a more severe phenotype in Tourette Syndrome.