Talk:Tourette syndrome/Archive 12

TFA 3 March

Wikipedia:Today's featured article/requests/Tourette syndrome

TS is a 14-year-old FA, recently overhauled and updated, with editors Adrian J. Hunter, Casliber, Ceoil, Markworthen, and Yomangani helping to fine tune.

Colin and Outriggr poured exhaustive efforts into copyediting and clarifying my dreadful prose after the recent update; their considerable work is at Talk:Tourette syndrome/Archive 11.

A sincere thanks to all who have helped over the years in this collaborative effort. SandyGeorgia (Talk) 02:08, 2 March 2020 (UTC)

Sandy, it's been a pleasure, and kudos to you for the excellent result. I wish I hadn't been so busy in real life and could have contributed more. Adrian J. Hunter^{(talk•contribs)} 05:40, 2 March 2020 (UTC)

Well, I selected the TFA date around National Advocacy Day in Washington, D.C., which was apparently a dud, and has been replaced by a letter writing rally. So, we won't get the pageviews I had hoped for. SandyGeorgia (Talk) 17:19, 2 March 2020 (UTC)

Better or worse? [1] SandyGeorgia (Talk) 10:36, 3 March 2020 (UTC)

Thanks, Yomangani; the blurb also used "for". Best, SandyGeorgia (Talk) 10:45, 3 March 2020 (UTC)

Guess who? [2] SandyGeorgia (Talk) 11:05, 3 March 2020 (UTC)

Congrats on the Main Page appearance! ---Another Believer _(Talk) 20:50, 3 March 2020 (UTC)

Prognosis

This edit introduced some very old primary sources and a press release; some of these older findings are not reflected in newer reviews (eg, Packer 2013). I have trimmed the text to a potion that is reflected in Denckla, trimmed additional text that was already in the article (defining TS-only), and adjusted the flow to accommodate the text. The findings about IQ reported in the 2006 Denckla review are not reflected in any newer secondary review; see WP:MEDRS. Part of this added text (the part sourced to secondary reviews-- not the primary sources and press release) was actually taken from an older version of this article; when I updated it to newer sources, I found that current secondary reviews disagree with the IQ findings. To re-add, we would need a newer secondary review that includes these notions. 23:10, 6 May 2020 (UTC)

I have now revised the sources and removed all of this text. Most of it was taken from a much older version of this article, and newer secondary reviews no longer support this text. To reintroduce these concepts, recent WP:MEDRS-compliant reviews should be used. SandyGeorgia (Talk) 12:50, 7 May 2020 (UTC)

Apostrophe

Why is "Tourette's syndrome" not mentioned in the lead? It's a common variant, as evidenced at NHS, Patient, WebMD, Priory, Guardian, Medical News Today, BMJ and many more. Jenny Jankel (talk) 08:26, 16 April 2020 (UTC)

Hi, Jenny. In this case (unlike Down syndrome), the reason that particular common variant is not listed in the lead sentence (but is listed in the infobox) is that there are many common variant names (indeed, different official names) for this condition, and listing all of them would not be practical. There is Tourette syndrome, Tourette's syndrome, Tourette's disorder, Gilles de la Tourette syndrome, GTS, and even the outlandish official ICD term, combined vocal and multiple motor tic disorder [de la Tourette]. If we start listing them in the lead, where do we stop? We end up with a breach of MOS:FIRST.

In this case-- which is different than Down syndrome-- it is more important in the lead to highlight the abbreviation most commonly used (Tourette's), because that is what is used throughout the article as well as what is most commonly known to people. Both WP:COMMONSENSE and MOS:FIRST come in to play here, as they should in every discussion-- each article is different.

Another factor to consider is that this is a Featured article and has been through community review processes, so there is broader consensus surrounding the lead than in a non-FA (see WP:OWN#Featured articles), and edit warring is less likely to occur as people understand that.

Hope this helps. SandyGeorgia (Talk) 12:09, 16 April 2020 (UTC)

All due respect being given, I do not entirely agree with those arguments..firstly, those other variants you mentioned are *far* less common, and it is also a slippery slope argument, the hypothetial outcome of which is not reasonably likely to follow as a result of the thing that it is being used to argue against.. Furthermore, it is common Wikipedia practice to name the two most common names that exist for an article's subject (when two commonly used variants exist), along with a common abbreviation.

I would agree that two names and two abbreviations might be excessive, and that in such cases when there exist two very common abbreviations and one full name that is significantly more common than all the others, it would be best to list the single name and the two abbreviations in the lead sentence. In this case, however, I think Tourette's syndrome is a more significant variant than TS is an abbreviation. Unlike commonly known abbreviations such as ADHD or OCD, most people would have no idea what TS if they saw an undefined reference to it. Therefore, I would suggest something like, "Tourette syndrome or Tourette's syndrome, commonly referred to as simply Tourette's..."

LASTLY -- and, most importantly -- it is important for all editors to remember that there is no such thing as a perfect article, and no article will ever be perfect. An article having been chosen as a featured article would certainly be a good reason for not making radical alterations to it, but it shouldn't be used as a blanket reason for opposing any and all edits, no matter how small they be. Cheers Firejuggler86 (talk) 09:34, 30 May 2020 (UTC)

Agreed. With Tourette syndrome and Tourette's syndrome being the most common names, both should be prioritised over a lesser-used abbreviation. Jenny Jankel (talk) 14:52, 30 May 2020 (UTC)

TS is the most common abbreviation; if readers aren't aware of that, we make them aware of it by listing it in the lead. Here are some samples:

1. From the Tourette Association of America, first page, overview, key facts:[3]

   Tourette Syndrome (TS) is a neurodevelopmental disorder that becomes evident in early childhood or adolescence.

2. From the Tourette Syndrome Foundation of Canada, from the first About section, on What is Tourette syndrome:[4]

   Tourette Syndrome or TS is a Neurodevelopmental or brain-based condition that causes people who have it to make involuntary sounds and movements called tics.

3. From the NIH Fact Sheet on TS:[5]

   Tourette syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics.

4. From the CDC:[6]

   Tourette Syndrome (TS) causes people to have “tics”.

5. From the Cleveland Clinic[7]

   What is Tourette syndrome (TS)? Tourette syndrome (TS) is named for Dr. Georges Gilles de la Tourette, ...

6. From Tourettes Action (UK):What is TS is the name of the page!

   Tourette Syndrome (TS) is an inherited neurological condition.

7. In the journal literature (over 20,000 hits using the abbreviation TS):[8]

I could go on; those are just a few samples.

More significantly, the abbreviation is used in journal articles, and is even necessary for the distinction between Tourette's when it occurs with comorbid conditions, and the "pure" condition which is routinely referred to as "pure TS"[9] or "TS-only".[10] These abbreviations-- as reflected in the journal literature-- are used 61 times in the article. Please read beyond the lead and consider how cumbersome the article would become if all 61 instances of TS had to be fully spelled out.

Second, again, the naming here is distinct from Down v. Down's in that there are at least six commonly used names for the conditions, and listing two in the lead with the arbirtrary reasoning given here would require listing all six-- they are already indicated in the infobox, and the apostrophe form is listed in the lead already.

Third, WP:OWN#Featured articles is not used as a blanket reason for opposing edits; it encourages discussion before making changes. As yet, I haven't seen an explanation for why adding multiple names for the condition to the lead, and removing abbreviations throughout the article, serves Wikipedia's readers. What benefit is there to our readers to have to read through multiple names for a condition with a common name? And what is the benefit of having to spell out the condition in the article hundreds of times because common abbreviations are deleted from the lead? Imagine how cumbersome it will become to have to define "pure TS" halfway through the article, as that is what all the literature calls it. SandyGeorgia (Talk) 16:49, 30 May 2020 (UTC)

It would not require listing all 3. Tourette syndrome and Tourette's syndrome are in much more common usage than Tourette's disorder, so if we say adding Tourette's disorder as a third AKA is too cluttered, then so be it. Jenny Jankel (talk) 17:33, 30 May 2020 (UTC)

Yes, this is a no-brainer, and there is only one dissenting voice. Making the change. 2A02:C7F:6E64:1C00:60B3:B264:60FA:8500 (talk) 13:28, 21 June 2020 (UTC)

Thank you, I've done it. Jenny Jankel (talk) 13:31, 21 June 2020 (UTC)

Ok but do we need to even mention the shorter "Tourette's"? There is no mention of "Down's" at Down syndrome... 2A02:C7F:6E64:1C00:60B3:B264:60FA:8500 (talk) 13:35, 21 June 2020 (UTC)

I'm happy either way, but think it could make more sense to add Down's rather than remove Tourette's. Jenny Jankel (talk) 13:43, 21 June 2020 (UTC)

Please consider reading the articles and being fully familiar with the literature before making unnecessary changes. At the Down syndrome article, the abbreviation Down’s is not used once in the article, While at this article, the term Tourette’s syndrome is never used in the article (but mentioned in the infobox), while the common abbreviation Tourette’s is frequently used. (I could understand adding an abbreviation at Down’s if the abbreviation is actually used or needed in the article— which it is not.) SandyGeorgia (Talk)

Term added to lead without consensus

Change made without consensus: [11] consensus is not a “vote”. See the statement above from FireJuggler86:[12]

I would agree that two names and two abbreviations might be excessive, and that in such cases when there exist two very common abbreviations and one full name that is significantly more common than all the others, it would be best to list the single name and the two abbreviations in the lead sentence.

This change clutters the lead unnecessarily with a term that is already listed in the infobox and never used in the article. SandyGeorgia (Talk) 14:36, 21 June 2020 (UTC)

Jenny Jankel, could you please explain the objective here, in terms of MOS:LEAD and WP:MEDLEAD, so we can develop a meaningful consensus? I am unclear what the concern is here, but the situations at Tourette syndrome and Down syndrome are different, and I hope to avoid a protracted dispute as the one that occurred at Down syndrome. SandyGeorgia (Talk) 15:09, 21 June 2020 (UTC)

The consensus is clearly there. Four opinions and arguments for including it, versus one against. Tourette's syndrome is a national variant (UK) and thus should be given equal weight to Tourette syndrome. There is a long debate about this very issue at Talk:Down syndrome, with the obvious conclusion being that the national variant stays. Jenny Jankel (talk) 15:11, 21 June 2020 (UTC)

Your count is off, consensus is a not a vote, and the apostrophe in this case is not a UK convention: see item 6 in the list above. [13] [14] In Europe, TS has very long and convoluted names which are rarely used and are in the infobox (Gilles de la Tourette syndrome, which does not use the apostrophe or Combined vocal and multiple motor tic disorder [de la Tourette], which also does not use an apostrophe) and you may note in this article Robertson herself (UK researcher) acknowledging that US conventions and classifications and research dominate the field, hence most research defers to US. The variant stayed at Down syndrome for very different reasons. SandyGeorgia (Talk) 15:25, 21 June 2020 (UTC)

Such that even the European Guidelines call it Tourette syndrome.

• Roessner V, Plessen KJ, Rothenberger A, Ludolph AG, Rizzo R, Skov L, Strand G, Stern JS, Termine C, Hoekstra PJ (April 2011). "European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment". Eur Child Adolesc Psychiatry. 20 (4): 173–96. doi:10.1007/s00787-011-0163-7. PMC 3065650. PMID 21445724.

Unlike the situation and history which I mentioned in the Down syndrome discussion, US conventions dominate with TS and its research.

Also of note, two of the most frequent contributors[15] to this article (Ceoil and Colin) are from that side of the pond. SandyGeorgia (Talk) 15:57, 21 June 2020 (UTC)

Many people don't know how to use apostrophes.

Let's make it two opinions against, then. I oppose listing minor variations in all articles as being redundant. I like to believe that Wikipedia's readers are not so stupid that they can't figure out that any "Name syndrome" and "Name's syndrome" are the same thing. If an apostrophe made a significant difference to most people's understanding, then c:Category:Misplaced apostrophes in English would be empty.

So what I'd like to learn from its supporters is how creating redundancy in the first sentence would help anyone. So far, all I've been able to guess is that someone personally prefers the version that isn't in the first sentence, and wants to change Wikipedia so that their personal preference looks like it's been endorsed by Wikipedia as The Right™ version. (Imagine, say, a kid who wants to write one version in homework, but the schoolteacher says that the name is misspelled because it's not the version that Wikipedia uses in the first sentence.)

Note, for clarity, that an explanation of how it helps anyone does not include "But my source uses the other spelling". An example of how an additional name would help someone probably sounds like more "People won't know if they're at the right page unless this completely different name, which is the common name in the country of Ruritania, is in the first sentence". WhatamIdoing (talk) 17:30, 21 June 2020 (UTC)

And juuuuust like in the Down's discussion, we have US editors who would rather bury the UK name. Not gonna happen. Jenny Jankel (talk) 17:52, 21 June 2020 (UTC)

Jenny Jankel, could you please respond to the specific arguments above that the apostrophe is NOT the common usage either in the UK, or in all of Europe? Either with researchers[16] or the main (only) UK advocacy org.[17] It would be helpful if you would address the points raised, which is preferable to ”Not gonna happen”. SandyGeorgia (Talk) 18:48, 21 June 2020 (UTC)

Published literatre, last 10 years: Tourette syndrome, 1,887; Tourette’s syndrome, 430 SandyGeorgia (Talk) 17:29, 21 June 2020 (UTC)

I'm aware that some US sources use Tourette's syndrome and occasional UK sources use Tourette syndrome, but it is absolutely a national variant, as you can see from the NHS, Patient.info, Counselling Directory, Clinical Partners, gov.uk, etc. And Tourettes Action actually uses both. The situation is identical to the Down's one, and the UK name is not a minor variation. And obviously the names used in non-English countries are irrelevant to this discussion. I'm happy to create an RFC if you're not satisfied with the above evidence. Jenny Jankel (talk) 17:45, 21 June 2020 (UTC)

Please do not rush yet to another malformed RFC; discussion is preferable first, and you have not yet addressed the points raised. Tourettes action does not use an apostrophe once on its website— I provided that info above. How does adding the apostrophe here benefit our readers? Even the European Guidelines do not use it. If you could answer these points, your concern would be more understandable—-it seems clear that people in Europe know what Tourette syndrome is. SandyGeorgia (Talk) 18:55, 21 June 2020 (UTC)

Sorry, my search at the UK advocacy group page was malformed; here is the correct search. They do use the apostrophe occasionally, but almost every instance is where they are referring to someone else's use of the apostrophe. Their own pages and descriptions do not use it. SandyGeorgia (Talk) 19:38, 21 June 2020 (UTC)

Yes, that one website of a UK charity uses both, but otherwise all official and reliable UK sources use Tourette's syndrome. It's as clear-cut as Down's syndrome, and there is no mileage in repeating ourselves. You're welcome to send a link to these "European Guidelines" you speak of, if they're British. Are they? Adding the apostrophe S benefits readers for all the reasons pointed out in lengthy detail at Talk:Down syndrome. Have a nice day now. Jenny Jankel (talk) 13:31, 22 June 2020 (UTC)

Are you aware that M Robertson is arguably the leading UK researcher on TS? Do you see (even in this article) that she most often calls it Gilles de la Tourette syndrome (no apostrophe), and she also uses Tourette syndrome and Tourette’s syndrome?[18] Mary Robertson even authored a book entitled Tourette syndrome, (published by Oxford Press). While Cavanna (also UK) tends to almost always use Tourette syndrome.[19]

I am curious to understand why you are usng the term “official” since neither Tourette syndrome nor Tourette’s syndrome are “official” names under any classification scheme (DSM or WHO), rather they are both common names.

Also, is there any similar situation in the Down/Down’s dilemma as we have in TS, where the leading UK researcher acknowledges the US dominance in research and classification ?? It has been suggested that this dispute should be viewed in terms of WP:ENGVAR, yet in this case we have UK acknowledgement of US dominance in the field.

My interest is in avoiding the objection raised above by FireJuggler86, which you installed in spite of their and my objection based on one IP’s post (no consensus). If this addition stays, the implication is that one of the two common abbreviations should be removed, which would result in very tedious and repetitive reading. Because TS is the most common abbreviation, and necessary for the definition of pure TS or TS only, the fix would involve switching every mention of Tourette’s to TS, which seems to actually move in the opposite direction you seek, and would also introduce repetition ... TS used about 200 times.

The link to the European Guidelines is already given, just a few posts up. SandyGeorgia (Talk) 16:43, 22 June 2020 (UTC)

Jenny, I took a look at the DS page, and I did not find many solid reasons. I have found (in the order that I noticed them on the page):

• An inaccurate claim that "Down's Syndrome" was the first name, which is not true (Down gave it a racist slur for its first name);
• My country does it this way and others don't, and I believe that representing my country's slight spelling difference is "significant"; and
• "It is a national variation exclusive to a country" (even though it isn't), so WP:LEADALT (which doesn't happen to contain any of these words: national, variation, exclusive, or country) applies.

I am still trying to find out what practical difference it makes to the reader, if we have both rather than one or the other. Perhaps to put it another way, if this article were written in British English and (therefore) used the possessive form, would you be here demanding that the shorter name be added to the first sentence? WhatamIdoing (talk) 15:15, 22 June 2020 (UTC)

Yes, I would absolutely include the US name if the article used the British name. Can you think of any instances where this wouldn't be appropriate? I can't.

Tourette's syndrome is by far the most common term used in the UK, both by reliable and unreliable sources. What individual researchers might call it doesn't enter the argument. The common name here is Tourette's syndrome.

There is no need to remove "Tourette's" or "TS" and I don't know why that's part of your argument. The lead is not overly cluttered.

Likewise the "US dominance" thing. So what? That doesn't change the fact that the official and common name over here is Tourette's syndrome.

I have answered all of your questions, and they all come back to the fact that the term is a national variant, exactly like we see with Down's syndrome. There's no need to over-complicate something so simple. Jenny Jankel (talk) 17:09, 22 June 2020 (UTC)

• We sometimes give spelling variants, and we sometimes don't. Coeliac artery uses only the British spelling in the first sentence; Celiac lymph nodes uses only the US spelling. There is no rule requiring the presence of all spelling varieties in the first sentence.
• The name that researchers use is very important, because Wikipedia:Manual of Style/Medicine-related articles says to give it precedence over common names. That's why we have an article at Myocardial infarction instead of at "heart attack".
• Please tell me the name of the UK agency that is officially responsible for defining British English names. I have never heard that such an agency exists, and if one does, then I'd like to put a link to it in WP:MEDMOS.

WhatamIdoing (talk) 18:43, 22 June 2020 (UTC)

Firstly, it's not a "spelling difference". This argument was covered at Down's syndrome. Secondly, the Celiac artery page is clearly problematic since the title of the page and the body of the article are at odds. Thirdly, Myocardial infarction doesn't fail to include the common name in the lead now, does it? Jenny Jankel (talk) 23:33, 22 June 2020 (UTC)

Jenny, the opposition to the cluttered lead was FireJuggler86; please read up so I can avoid repeating posts. I requoted their post already at the start of this section. SandyGeorgia (Talk) 18:48, 22 June 2020 (UTC)

Why bring it up at all then? Jenny Jankel (talk) 23:33, 22 June 2020 (UTC)

Because you asked why it was “part of my argument”; read your previous post pls. SandyGeorgia (Talk) 00:50, 23 June 2020 (UTC)

Of course we should add it to the lede. This is actually exactly the same case as Down/Down's syndrome. Tourette's sydrome is the common name in the UK. See the official NHS webpage on the subject, on which it is referred to as Tourette's syndrome or Tourette's throughout. You can't really get much more authoritative than that for medical matters in the UK. -- Necrothesp (talk) 00:04, 23 June 2020 (UTC)

Note, Necrothesp has never edited either this article or its talk page before, and was canvassed. @Girth Summit: SandyGeorgia (Talk) 00:50, 23 June 2020 (UTC)

However, Necrothesp is a highly experienced editor with a wide range of interests and might take exception to the implication that his opinion is not valid because he has "never edited either this article or its talk page before" which suggests some sort of wrongdoing and/or ignorance on his part! Kindly refrain from such suggestions just because his opinion differs from yours. This is a discussion and no !voting is involved and I'm frankly grateful that my attention was drawn to it. -- Necrothesp (talk) 12:54, 23 June 2020 (UTC)

I would also point out that the suggestion that Tourette syndrome or Tourette's syndrome (abbreviated as TS or Tourette's) is overcrowding the lede is a little bit laughable. We have ledes much longer than that. It's a perfectly acceptable length and includes the relevant information (i.e. the common names and abbreviations in the common varieties of English). It is longstanding procedure that significant information should be included in the lede and not just in the infobox, which is only intended as a summary, not as a primary presentation of information. -- Necrothesp (talk) 13:11, 23 June 2020 (UTC)

Note: [20] SandyGeorgia (Talk) 13:28, 23 June 2020 (UTC)

I am aware of the conventions on canvassing. However, coming here due to being alerted does not invalidate my opinion - intimating that it does is tantamount to undermining freedom of expression (as it suggests that only those who are intimately connected with this page are entitled to express an opinion about it), which is contrary to the values of Wikipedia. I have a perfect right to express my opinion on any talkpage I choose and I will exercise that right. Thank you. -- Necrothesp (talk) 14:43, 23 June 2020 (UTC)

I have to agree with WhatamIdoing here; spelling variants are optional and agree they clutter the lead, hindering readability. Frankly I find this all very trivial, and an odd and minor point to become preoccupied with. Saying this as a BritEn speaker myself. Ceoil (talk) 01:36, 23 June 2020 (UTC)

Respectfully, you're not British. Jenny Jankel (talk) 15:52, 23 June 2020 (UTC)

This American can't recall ever coming across a reference to this disorder without an apostrophe. --Khajidha (talk) 16:37, 23 June 2020 (UTC)

Because most people and many publications do casually refer to it by the abbreviation, Tourette's (which is why we still need the abbreviation in the lead, hence end up with now four terms in the lead if we include the full UK alternate, which I felt was encompassed by the abbreviation, Tourette's, and that using both Tourette's and Tourette's syndrome is repetitive). SandyGeorgia (Talk) 16:47, 23 June 2020 (UTC)

It is not emcompassed by the ebbreviation, because the "syndrome" is missing. Jenny Jankel (talk) 17:23, 23 June 2020 (UTC)

No, I'm not referring to "Tourette's" in isolation. I'm talking about the full term "Tourette's syndrome". I can't recall ever seeing "Tourette syndrome". --Khajidha (talk) 16:53, 23 June 2020 (UTC)

And while I HAVE seen "Down syndrome", the bulk of usage I come across is still "Down's". --Khajidha (talk) 16:55, 23 June 2020 (UTC)

First sentence proposal

@Jenny Jankel, Firejuggler86, WhatamIdoing, Necrothesp, Ceoil, Khajidha, and Girth Summit: (I believe that to be the complete list of everyone who has engaged the discussion-- if I missed anyone it was unintentional!)

Tourette syndrome (TS), also known as Tourette's syndrome, is a common ...

This is a proposed resolution from Iridescent, who is an experienced Featured article writer.

Iri's proposal accounts for my concern (echoed by Firejuggler86) that four similar terms in the lead are too many, while still allowing for the apostrophe in the lead.

Iri's reasoning is that we don't need to include the additional abbreviation (Tourette's) because it is an obvious contraction, and the reader will understand that when they encounter the term in the text. Adopting this proposal would (I hope) satisfy Janny Jankel's concern, while providing a way forward that does not require the article to be re-written to accommodate different abbreviations (which was my concern).

Let's discuss, hopefully without the dreaded !voting via Oppose/Support ... SandyGeorgia (Talk) 14:37, 27 June 2020 (UTC)

• I am happy with this proposal if others agree that the contraction, Tourette's, can stay in the article without defining it in the first sentence, on the assumption that the reader will understand that Tourette's is a contraction for Tourette's syndrome. SandyGeorgia (Talk) 14:40, 27 June 2020 (UTC)
• I don't think this proposal is an improvement at all. The lede is not cluttered, and removing key info makes no sense to me. The current lede also doesn't require anything else to be rewritten, so I'm unsure what that part of the proposal refers to. Jenny Jankel (talk) 15:02, 27 June 2020 (UTC)

• That concern, expressed by Firejuggler (which I share) is here. SandyGeorgia (Talk) 15:07, 27 June 2020 (UTC)

• That's fine, but as you can see in the above conversation, it's not a widely shared opinion, and there are many perfectly fine ledes with much more clutter. The key point though, is that Tourette's is a very common abbreviation, so must not be removed. Jenny Jankel (talk) 15:41, 27 June 2020 (UTC)

what are explanation and reassurance sufficient for?

The article currently says in the 3rd paragraph:

Education is an important part of any treatment plan, and explanation and reassurance alone are often sufficient.

What are explanation and reassurance sufficient for?

• For the treatment plan? Presumably it doesn't solve the problem (the prior sentence: "There is no cure for Tourette's and no single most effective medication"), but is the author suggesting treatment plans often don't need to consist of more than that?
• Are those things sufficient for education? Explanation seems reasonable but reassurance isn't education.
• What are the alternatives that aren't included? (what is "alone" referring to *not* having?)

I checked the citation and ctrl+f had 0 results for "explan", "reass" (many for "treatment"), however, this seems like it contradicts the quote in question:

Cognitive-behavioural techniques for tics have a long history with good evidence for two particular approaches. One is called comprehensive behavioural intervention for tics, which is built on an older concept of habit retraining therapy in which the patient counters the urge to tic with a muscular action that prevents the tic. Trials of 10 weekly sessions in chil-dren and adults showed the effect is as good as that for drugs, can be sustained and was not matched by psychoeducation and relaxation strategies alone.23 24The other method is exposure and response preven-tion in which patients learn to tolerate the urge to tic without performing the movement.25 Not all patients are suitable for these treatments since motivation, learning disability or other comorbidities can get in the way.

--XertroV (talk) 19:15, 3 August 2020 (UTC)

Education is often all that is needed; that is, most often, no treatment is needed, and educating the individual about the natural timecourse of tic disorders is enough to reassure the individual. We can adjust that wording as needed, open to suggestions. Let me search around for some options (after I finish painting the ceiling). SandyGeorgia (Talk) 19:27, 3 August 2020 (UTC)

Tics, Tic-Tok , Covid & Eco-anxiety

This last year or so referals to speciality tic clinics have approximatly doubled in at least UK, much of continental Europe & Noram- its all about Tic-Tok,Youtube, Eco-Anxiety & Covid, not the causes already mentioned (that said, vast majority seems to be not true Tourettes). I was just going to to add the below to the 'Causes' section, with a note that I wasn't sure whether this warranted inclusion:

Starting in 2019, clinics specialising in treating tics began experiencing an increased referral rate from young people, especially after 2020. Increased stress from eco-anxiety and the Covid pandemic is believed to play a role. However, an August 2021 study reported the primary cause for many of these new cases was contagion resulting from a breakthrough youtube channel. Many of these young people were diagnosed as not having actual Tourettes syndrome; in some cases receiving this diagnoses resulted in the immediate remission of symptoms.

References

Saw the edit notice before hitting save. Am I ok to add the above? If definetly not and any regular editor for this page thinks this is just annoying clutter, no worries if you just want to delete this whole section. FeydHuxtable (talk) 16:22, 27 August 2021 (UTC)

FeydHuxtable, it seems unlikely that this sourcing would meet WP:MEDRS. Nikkimaria (talk) 03:00, 28 August 2021 (UTC)

It meets MEDS in my view. Primary sources are not outright barred, and both papers have considerable review like qualities. Admittedly the key takeaway from the August paper seems based mostly on the authors personal clinical experience. While these findings are already widely known to those working professionally in this field, they are not to parents. As this sort of causality seems to be accounting for the majority of new Tourettes like symptoms in several countries, it would seem to be in readers interests to reflect this information.

That said, as per my original post, totally happy to defer to the established editors here. No need to ping me unless you'd like me to reply further. FeydHuxtable (talk) 06:36, 28 August 2021 (UTC)

FeydHuxtable it may be possible to work in the idea you want to cover in a better, NOT-NEWSY way, since the general concept is already well established in secondary sources. If you can give me a day or so to dig into it, I will try to come up with something that mentions the specific (2020) while addressing the general … and taking into account the differences in diagnostic trends in Europe and the rest of the world, due to differing health systems (tic conditions in the US are increasingly less likely to end up in tertiary specialty clinics). SandyGeorgia (Talk) 14:34, 28 August 2021 (UTC)

Thanks SG, if you're up for personally integrating the idea that's a major win all round. I was hoping the Müller-Vahl study could be included as there's info in there that seems especially useful & reassuring, plus the good professor is well regarded AFAIK. Of course no worries if you judged other sourcing is better. FeydHuxtable (talk) 16:02, 28 August 2021 (UTC)

I agree that Mull-Vahl is well recognized and generally respected (now that we are past the early days of the cannabis-related misinfo) … once we have a general approach about where and how to add this, we can work on the specifics better. Best, SandyGeorgia (Talk) 16:16, 28 August 2021 (UTC)

Gathering other sources

See compilation of sources here. SandyGeorgia (Talk) 15:23, 31 August 2021 (UTC)

While the 2020 instance is reported as the first due to social media, the concept has long been established.

• https://movementdisorders.onlinelibrary.wiley.com/doi/abs/10.1002/mdc3.13316 Goetz and Kompoliti are much better known TS researchers … not yet PudMed indexed ???
• https://go.gale.com/ps/i.do?id=GALE%7CA372691227&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=10639330&p=AONE&sw=w&userGroupName=anon%7E16f64f57 and https://www.academia.edu/11252948/Mass_Hysteria_at_Old_Salem_Village … not PubMed indexed
• PMID 30118381 case study
• PMID 16536352 2006 review, Jankovic, description of psychogenic tics
• PMID 23288084 2012 review and history. Not necessarily the first reported due to social networks.
• PMID 25667816 2015 review of psychogenic tics.
• PMID 29868890 2018 review. Current terminology avoids “mass psychogenic” illness
• PMID 31356296 2019 review (Jankovic)
• PMID 32160165 2019 review (I am not impressed)
• PMID 31551261 2019 review (Ganos, Martino)
• PMID 34293224 2019 primary re COVID (Pringsheim, Martino)
• https://cp.neurology.org/content/neurclinpract/early/2021/04/13/CPJ.0000000000001082.full.pdf Jankovic … has this been published? Cannot find on Pubmed …
  • same … https://movementdisorders.onlinelibrary.wiley.com/doi/abs/10.1002/mdc3.13267
• Some history of the terminology from Jankovic, 2005, and a table of prevalence ... https://books.google.com/books?hl=en&lr=&id=v9RksBJx-pkC&oi=fnd&pg=PA375&dq=psychogenic+tic&ots=QuD4w8btt1&sig=Opk8DxZnGHwHnO1VQpBkF88nBDE#v=onepage&q=psychogenic%20tic&f=false

SandyGeorgia (Talk) 15:24, 28 August 2021 (UTC)

@Colin and WhatamIdoing: my initial approach is that we add generalized differential diagnosis information related to functional neurological disorders to the screening section (Tourette syndrome#Assessment and screening for other conditions) and that we footnote the specific instances as examples, eg the high schools in the US and the Covid-related current examples. That allows us to source the section to secondary reviews, while mentioning the primary sources only in footnotes, avoiding NOTNEWSyness. WAID, are you able to find other sources in books? I am particularly wondering if anyone has made an association between functional neurological disorders and tourettism, as I could then add this more broadly to that article. SandyGeorgia (Talk) 16:15, 28 August 2021 (UTC)

So, we have at least threefour recent primary sources from well known, established and credible researchers (Goetz & Kompoliti in Chicago, Jankovic and Co at Baylor, and Muller-Vahl in Germany … adding … Pringsheim/Martino Canada) discussing functional neurological disorders (psychogentic tics) in relation to social media and current events (eg COVID). The concept is not new; it is well established in secondary sources pre-dating COVID. We also have the NHS group primary report— I have never encountered those researchers, so cannot speak to their credibility, but their viewpoint says nothing controversial. Nonetheless, all four are primary sources. Are other editors comfortable with discussing the generalities sourced to secondary reviews under screening (eg differential diagnoses), and only footnoting the primary studies mentioning social media and COVID? Alternately, we could take a social media approach under Society and culture, but that does not seem the right place for me … it is a differential issue IMO. SandyGeorgia (Talk) 19:32, 28 August 2021 (UTC)

Fred's second source has a linked Editorial which supplies some context and food-for-thought, and ultimately suggests this is at the "needs more formal research" rather than just more accumulation of anecdotes. I agree with Sandy that the screening section could note functional (psychogenic) tics. It seems this is a topic the article currently neglects and is worth a mention.

The article says "Tics may increase when someone is experiencing stress, fatigue, anxiety, or illness" but some of these sources suggest anxiety may bring about symptoms exposing a hitherto unnoticed tic disorder, such as Tourettes. What is the relationship between children/parents first noticing the tics and a situation that exacerbates them?

The Societal and cultural aspects of Tourette syndrome is perhaps lacking in "The Internet" and showing its age with a focus on film, television and books. The challenge, though, is to bring in these Tic-Tok uploads and influencers fakes with first class sources and to avoid them becoming a magnet for drive-by additions or defamatory posts.

I'm reminded of XKCD's comment about 2020/2021 being anomalies. Statistics and impressions wrt referrals to experts will be disrupted by the lockdown and easing. In the UK, the pre-existing austerity and long-term neglect of mental health issues has only been compounded by Covid. Even if case-rate remained static, the figures for referral and cases examined are disrupted. There's a waiting list so long that a significant portion of teen cases will be adults by the time they are seen. Extracting this social/political mess from the real data on prevalence won't be easy. -- Colin°^Talk 11:10, 29 August 2021 (UTC)

Because so many different research groups have reported on it, I am confident that the TikTok scenario will eventually appear in secondary reviews. But for now, I think we have only the 2012 review, PMID 23288084, to work a mention of internet factors in to the Societal and cultural section. I will keep digging, and WhatamIdoing is usually able to find sources I can’t come up with. (Feydhuxtable, I will wait to hear from WAID before trying to formulate text … slow and steady wins the race). SandyGeorgia (Talk) 14:43, 29 August 2021 (UTC)

Oopsie ... just noticed that Bartholomew, PMID 23288084, is not classified by PubMed as a review ... although in 2012 they didn't flag reviews the same way ? How do others feel about that source? It seems written as a historical review ... SandyGeorgia (Talk) 14:14, 31 August 2021 (UTC)

It isn't primary research either. I think it is fair as a source to document the event that occurred, though if we included any opinions then they may need attributed. -- Colin°^Talk 14:22, 31 August 2021 (UTC)

Chapter 6 in this book:

McGuire, Joseph F.; Murphy, Tanya K.; Piacentini, John; Storch, Eric A. (2018-06-13). "Improving self-esteem for Youth With Tourette Syndrome and Tic Disorders". The Clinician’s Guide to Treatment and Management of Youth with Tourette Syndrome and Tic Disorders. Academic Press. pp. 128–129. ISBN 978-0-12-811981-5.

talks about social media campaigns to improve understanding and acceptance, but since it is a pre-pandemic source, it can't speak to anything that happened since 2018. I don't think we will find anything in books that talks about what's happened this year. WhatamIdoing (talk) 01:40, 30 August 2021 (UTC)

Thanks, WAID. So, it looks like these are all the sources we have on the psychogenic issue, although WAID may have found some useful content for Sociological aspects.

FeydHuxtable I will work up something for the Screening/Differential diagnosis section after I finish digging into other sources to see if I can address Colin’s other question. Your original suggestion was to add mention in the Causes section, but sources are unanimously referencing psychogenic tics rather than Tourette’s, so the content fits better under differential diagnosis/screening; no source is calling these presentations Tourette’s or a cause of Tourette’s— all are calling it mass psychogenic illness or using newer terminology of Functional Neurological Symptom Disorder/Conversion Disorder.

I will also keep looking for sources to, hopefully, separately address the lack of an Internet section at Societal and cultural aspects of Tourette syndrome as I work this up … please give me a day or two, as real life issues never cease. SandyGeorgia (Talk) 07:03, 30 August 2021 (UTC)

Thanks SG, even if it had to wait weeks or months, waiting for you to be ready is better than any immediate addition I might make. FeydHuxtable (talk) 07:23, 31 August 2021 (UTC)

Just found this … signed by the current who’s who in US TS research: https://tourette.org/distinguishing-and-managing-acute-onset-complex-tic-like-behaviors-in-adolescence/ SandyGeorgia (Talk) 14:02, 30 August 2021 (UTC)

Have we said enough in the article about the Differential diagnosis? WhatamIdoing (talk) 22:11, 30 August 2021 (UTC)

@WhatamIdoing: Here is what it looked like prior to the March 2020 TFA. I may not recall correctly, but I think some of those helping with copyedit in during the overhaul/rewrite felt that it was too repetitive and that a lot of that content was already covered at tourettism … secondary causes of tics, which covers most of the differential diagnosis. But I am wondering how I will work in psychogenic tics without giving due weight to more common differential diagnoses … perhaps Colin can remember why we deleted so much, and I wonder if we should bring some back. SandyGeorgia (Talk) 23:07, 30 August 2021 (UTC)

Do you happen to know the relevant prevalence of TS vs non-TS things that look similar to TS? If it's both true and verifiable, then adding some content along the lines of "Most people who self-diagnose with TS actually have something else". A line about "tics that suddenly appear when you're stressed aren't TS" might address this point of apparent confusion, too. WhatamIdoing (talk) 02:41, 31 August 2021 (UTC)

WhatamIdoing, your line of questioning helps me approach how to incorporate this text. One problem is that our differential material is spread around (in descriptions of tics). The second issue is that Bartholomew PMID 23288084 is questioning if the situation has changed; therein lies the rub, considering the worldwide reports of the TikTok COVID-related movements. We now seem to have a widespread issue of "these look like tics but are not"-- somewhat unprecedented in terms of scale/prevalence. (See the older Jankovic prevalence of psychogenic tics in this source; Jankovic is the differential guru of TS ... Bartholomew and others are suggesting that social media may change these relative numbers.) And yet, not yet covered in a secondary review, although it surely will be soon.

Most things that look like TS are TS. TS is easily self-diagnosable. We already mention the defining characteristics relative to other differential diagnoses: "In contrast to the abnormal movements associated with other movement disorders such as choreas, dystonias, myoclonus, and dyskinesias, the tics of Tourette's are nonrhythmic, temporarily suppressible, and often preceded by an unwanted urge." Suppressibility and premonitory urge are key. The natural history and time course are fairly predictable, so that physicians should investigate only when there are deviations from these known characteristics and hallmarks. On that, we say: "Most of these conditions, including dystonias, choreas, and other genetic conditions, are rarer than tic disorders and a thorough history and examination may be enough to rule them out without medical or screening tests."

The most typical misdiagnoses are in the autism spectrum: "There are different movements in contrasting disorders (for example, the autism spectrum disorders), such as self-stimulation and stereotypies. These stereotyped movements typically have an earlier age of onset; are more symmetrical, rhythmical and bilateral; and involve the extremities (for example, flapping the hands)." When tics and movements are explained by autism, an additional diagnosis of TS is unwarranted; that is where the most prevalent misdiagnoses are found (or at least were when I checked many years ago).

We used to have more of this under Diagnosis, but dropped a lot as repetitive in the 2020 rewrite. I suggest the solution here is to move some text around and to re-add a rewritten version of differential diagnosis, where the key characteristics of Tourettic tics are contrasted to other movement disorders, which will now include psychogenic (in the past, it was too insignificant to mention and rarely found in literature-- that changed with TikTok). I can do this rewrite/rearrangement using the reviews we do have. I could footnote the primary studies re TikTok, unless others complain of that use of primary sources. We have had such a time with misuse of COVID primary sources that I don't want to be a hypocrite, but we have similar reports coming from multiple countries, well known researchers, and very credible organizations (the NHS as well as the scientific advisory board of the Tourette Association of America, which has always been a who's who in TS research).

Summary to your suggestion: Most tics are TS and it doesn't take a rocket scientist to diagnose them once the hallmark characteristics are understood; most other conditions that look like tics are rare. But the landscape may have changed with TikTok, and we should now better explain what tics characteristic of TS look like relative to psychogenic tics. I'm not sure, though, I will find a source to say anything like "tics that suddenly appear when you're stressed aren't TS", as they well could be ... the differences mentioned in all sources come down to what is known about Tourettic tics ... suppressibility, premonitory urge, time course, location, severity, frequency ... etc. I am getting a clearer idea of how to better rewrite this, but would like to hear from all of you what you consider to be the appropriate use of the primary sources ... I suspect I can work them in as footnotes without overrelying on them. Also, I suggest that this source:

McGuire JF, Bennett SM, Conelea CA, Himle MB, Anderson S, Ricketts EJ, Capriotti MR, Lewin AB, McNulty DC, Thompson LG, Espil FM, Nadeau SE, McConnell M, Woods DW, Walkup JT, Piacentini J (August 2021). "Distinguishing and managing acute-onset complex tic-like behaviors in adolescence". J Am Acad Child Adolesc Psychiatry. doi:10.1016/j.jaac.2021.07.823. PMID 34391859. Available from the Tourette Association of America here.

puts us over the line in terms of discussing the issue, although not yet covered in secondary reviews. That's a Who's Who in TS research, includes representatives from multiple tertiary centers and countries, references other international reports, and ties together all of the primary sources into a consensus. SandyGeorgia (Talk) 15:07, 31 August 2021 (UTC)

PMID 31551261 has an interesting set of Venn diagrams trying to make sense of the patterns seen in functional tic-like behaviour vs TS tics. I learned a new word today - rostrocaudal - which refers to how the TS tics typically appear on the face and later may spread down to hands and the body. If anyone can't access the paper, let me know. I found interesting the similarity with epileptic seizures and non-epileptic seizures, and the fact that patients can have both (not rare in epilepsy). The latter, though, are not necessarily functional (those that are, are called psychogenic non-epileptic seizures). There's quite a lot of odd behaviour, particularly in those with neurological disorders, that can look like some kind of seizure, but isn't, and doesn't respond to medication. It seems for tics and tick-like behaviours, most of the neurological alternatives are quite distinctively different, but the functional ones can have enough overlap to make things difficult. Perhaps it has a spectrum from the bleeding obvious (copying some influencer) to the impossibly similar. And that article notes that some of the interventions are the same anyway, making it more of a problem for epidemiologists than clinical practice. -- Colin°^Talk 15:15, 31 August 2021 (UTC)

Yes, that (treatment response) is certainly the good news ... also, both can occur (organic and functional) in an individual. Most of these articles seem geared towards raising awareness of the TikTok phenom among practitioners, and pointing them towards the correct treatment in any case. SandyGeorgia (Talk) 15:36, 31 August 2021 (UTC)

I'm satisfied with the source you are looking at.

The article says that TS is inherited. If this is a key point in identifying TS, then that might be another way to differentiate between TS tics and psychogenic tic-like behaviors. WhatamIdoing (talk) 16:00, 31 August 2021 (UTC)

Correct ... mentioned in pretty much all sources ... family history ... will include that when writing new differential section. SandyGeorgia (Talk) 16:08, 31 August 2021 (UTC)

I wonder whether our description of a tic is sufficient. My (possibly wrong) impression is that a tic is "I have to do this now" (or soon). If my tic is clearing my throat or blinking my eyes, then jumping up and down really won't be a substitute; I will still need to clear my throat. My tic is specific to me, and doing "your" tic won't address my involuntary urge to do "my" tic.

However, if I am just so upset that I have to do something, then I could jump, or I could scream, or I could run, and while some of them might be more appealing to me (e.g., more socially acceptable, draws more attention to my distress, etc.), any of them would more or less work.

Also, the Wired.com article mentions "smashing eggs" as a tic. That sounds more like a compulsion to me. (If a tic is similar to an itch, how would you have an itch to act on an external object? What happens if there are no eggs around?) Should we more clearly differentiate between tics and non-tic compulsions? WhatamIdoing (talk) 21:29, 1 September 2021 (UTC)

WhatamIdoing … taking this in pieces.

“I have to do this now” is not entirely correct; more apt is “I have an urge to do this now”, but tics are characteristically temporarily suppressible, and that is one of the things distinguishing them from pseudotics. You are correct that substituting a different tic will not satisfy the premonitory urge that leads to the semi-voluntary (unvoluntary) tic … another distinction from pseudotics. Doing someone else’s tic is something seen more commonly in pseudotics, although tic mimicry is also an issue in tic disorders. I thought/believed we had covered all of this in the article here, but perhaps the descriptions need more work.

Your whole second paragraph about “so upset that I have to do something” isn’t really descriptive of tics, but as you go on to discuss in your third paragraph, distinguishing tics from compulsions can be tricky. The “smashing eggs” thing (like the “beans” thing mentioned in the Ganos article) is something different, though. The description in the wired.com article of the Tik Tok tics is not like the issue of distinguishing tics from compulsions: it is much more of a clear indication that these just aren’t real tics or even classic compulsions as in tic-related OCD. As Muller-Vahl indicated in the wired.com article, this is a whole ‘nother thing. (Wow, the wired.com article is quite good, and really ties it all together … I had not seen it until this mention. I am going to add it over at the Sociological and cultural article. Except that this is baloney: "In FMD, the hardware is intact, but the software isn’t working properly, whereas with Tourette’s, the software is working just fine, but it’s the hardware that isn’t. People with FMD physically have the ability to control their bodies, but they’ve lost hold of the reins, resulting in involuntary, abnormal behaviors.") Tics like the smashing eggs and vocal tics like the "beans" examples are just … not typical … or typically mimiced … just not how most vocal tics work … although I don’t know where I would find a source to explain that. Jo Cohen (who wrote most of the earlier lay literature on coprolalia, has a vocal tic where she screams “purple nigger”; I am not aware of anyone imitating that tic even though it was so widely publicized in the early literature. It is unique to her. Most vocal tics are not words, and when they are, as we say at coprolalia, “It is usually expressed out of social or emotional context, and may be spoken in a louder tone or different cadence or pitch than normal conversation.” Smashing eggs sounds more like plain old bad behavior passed off as a tic. This is an example of why the TS experts, when viewing those videos, are able to label them as not classic tics.

Separately, we discuss the distinction between tics and compulsions in the co-occurring conditions section. It is regrettable that my prose is not of a standard to be able to turn out something like the wired.com article (not sure what smilie to add on there, but I often lament the quality of my writing … and am happy that this TikTok epidemic may lead to lots of improvement here!). I should have time now to re-focus here … if there are areas that need more work, it is possible that a) my prose is not up to the task, and b) we deleted a lot of text in the 2020 rewrite to reduce my typical verbosity. Suggestions welcome ! SandyGeorgia (Talk) 15:50, 2 September 2021 (UTC)

What's missing for me in the ===Tics=== section is the non-substitutionary nature of tics. TS people don't have "a" tic (or "some" tics); they have "this exact specific" tic(s). The closest we come to this is saying that each person has "a unique pattern". WhatamIdoing (talk) 15:47, 3 September 2021 (UTC)

WhatamIdoing, the way to address this may be via the premonitory urge. A Tourettic tic is an unvoluntary (somewhat suppressible) response to a specific urge that occurs before the tic, akin to an itch that needs to be scratched. See the third para in the Tics section. You can’t scratch your arm to relieve an itch on your face … I will look around to see if I can find a sourceable way to explain that. SandyGeorgia (Talk) 16:04, 3 September 2021 (UTC)

Premonitory urge

Adding some quotes to see if any of this will be useful in resolving WAID’s comment:

• At approximately 10 years of age premonitory urges are typically expressed, coincident with first observations of tic suppression (Cohen and Leckman 1992; Kwak et al. 2003; Leckman et al. 2010; McNaught and Mink 2011). These sensations—which are frequently more distressful than the tics themselves—are anatomically localized to the region associated with the impending tic and precede the need for action; thus, they appear to signal the oncoming tic, making its suppression possible (Cohen and Leckman 1992; Leckman et al. 1993). Tic expression in GTS has been compared to sneezing: one feels the sensation coming on, could suppress it if necessary, but feels relief once expressed. The caveat here is that suppression of the tic is (1) transitory and (2) often results in an increased rebound severity of expression post-suppression (Leckman 2003; Grados and Mathews 2009). As they are unique to tic disorders and Tourette syndrome, the presence of premonitory sensations can be used to distinguish GTS from other movement disorders (McNaught and Mink 2011). [21]
• Certain clinical features can help to distinguish tics from other involuntary movements. Tics are usually preceded by premonitory sensory experiences. These were first described by Joseph Bliss, a physician with TS,4 and originally conceptualised as an analogous tic of the sensory system. Urges are now regarded as an intimate component of the tic, which can be resisted for a while, with the tic itself almost a response— perhaps more semivoluntary than strictly involuntary—and bringing a sense of relief. We can reproduce this by thinking of trying not to blink, sneeze or yawn, although this obvious interpretation can still be debated. Perhaps premonitory sensations develop over time as a response to experiencing tics. There have been experimental explorations of the dissociation between urges and suppression of tics.5 Patients with other movement disorders do not generally describe this arc of urge–suppressibility–tic–relief. For some people, the urge is a focal feeling of the part of the body that has to move; for others it is more diffuse or not articulated in such somatic terms. Tic suppression is sometimes a physical tensing; for others it is a more psychic process that is hard to explain. For a few patients the urge and/or effort of suppression is so unpleasant that it symptomatically outweighs the tic itself. Box 2 summarises some features of tics that are useful to raise in history taking.[22]

Not home, will add more when home with sources; is this helpful at all? The key words relating to not substituting would be … “focal feeling of the part of the body that has to move” and “anatomically localized to the region associated with the impeding tic”. How to rephrase that to non-substitutability without doing OR. PS, an interesting observation … there was on old push to eliminate the term “premonitory urge” from the article when English was being dumbed down across the board … this is reminding me of how absurd it is to eliminate such essential language about such a key concept to TS … SandyGeorgia (Talk) 16:20, 3 September 2021 (UTC)

Isn't that more about the location of the premonitory urge, rather than the 'location' of the tic itself? What I'm thinking about is something that says that the tic itself is localized/specific. Instead of "[The urge is] anatomically localized to the...tic"; I want "The tic is anatomically localized in the body". WhatamIdoing (talk) 22:26, 3 September 2021 (UTC)

Haven’t gotten to this yet, but haven’t forgotten it … planning to rework that section. SandyGeorgia (Talk) 15:17, 5 September 2021 (UTC)

WhatamIdoing I hope this is better. Part of the solution was to get premonitory urge before suppressibility, as suppressibility results partly because one has the urge, but can delay expression of the urge. I am concerned that I stick closely to sources, so hope that I got at your concern. Bst, SandyGeorgia (Talk) 19:25, 5 September 2021 (UTC)

First pass

@Colin, FeydHuxtable, and WhatamIdoing: I have made a first stab over at Societal and cultural aspects of Tourette syndrome ... an easier place to start because it is not a Featured article (FAs require highest quality sources). I have used the primary sources there (I hope not egregiously), but I would handle the whole thing differently in this (FA) article. See here. If we can work first over there, we may find better agreement about how to add content here in the Screening section. SandyGeorgia (Talk) 19:30, 30 August 2021 (UTC)

@Colin, FeydHuxtable, and WhatamIdoing:, in this version, I have moved around the pieces to reinstate a Differential section, listing most common (autism spectrum) first, and bringing back the less common. My intent is to expand the middle (teenagers and adults) to work in more basics about what tics vs. psychogenic look like. Please let me know if you think the structure so far works; I will work in sandbox on the new text. SandyGeorgia (Talk) 16:50, 1 September 2021 (UTC)

The structure is fine. I have always found the cocaine sentence a little odd. It is very much written from a doctor's POV ("presenting with" and surreptitiously ordering a drug test....) In the (old) source it is just a "for example" and I wonder if other sources consider it significant. The later "Acquired causes of tics" sentence mentions "drug induced tics" which may be sufficient or perhaps that could be amended to mention "(e.g., cocaine)". Also that sentence is stuck in the middle of a bunch of conditions and a sentence mentioning the conditions are rarer, so needs pulled out from that mix.

Other than autism's stereotypical movements, there isn't much said about how the tics from these other conditions differ from TS. Repeatedly it is noted that other conditions are ruled out, presumably with tests and signs unique to those conditions. But we read in some of those papers about functional tics that there are features of that are more common with TS tics than others, which may make a diagnosis of TS more likely or less likely. For example, although onset before 18 is a requirement, TS typically presents much earlier; has a male vs female tendency; may gradually develop rather than suddenly require hospital treatment for self harm; waxes and wanes; can be suppressed for a time; develops with head and face tics first; etc; etc. And the functional tics may include other give-aways like 'catching' a vocal tic that is the same word as another person. Of course, some of this is mentioned earlier in Symptoms so the challenge may be to hint at some of them again while contrasting with the tics or tic like behaviour in other conditions.

Perhaps, if this section grows, some of the other conditions that are either very rare or quite readily diagnosed for other reasons could be dropped. For example, Down syndrome. It is included in the source in a long list of "Primary neurologic disorders manifesting tics" and some of them, e.g. tuberous sclerosis, aren't AFAIK an important cause of tics. (Googling Downs and TS turns up case reports which smell rather of either happenchance coupled with an old idea that TS is rare, or are simply co-morbidities and not causes).

One thought: how many of these other causes of tics will meet the basic requirement of onset in childhood and "exhibits both multiple motor tics and one or more vocal tics over a period of one year". If there are some that do, then perhaps they are a priority for discussing as a differential diagnosis. -- Colin°^Talk 20:17, 1 September 2021 (UTC)

Colin crazy day here, working in bits and pieces, I haven't yet read all of your comments, and I will be out most of the morning tomorrow. I will later read and incorporate your comments, but for now, here is my Sandbox start for review. SandyGeorgia (Talk) 22:19, 1 September 2021 (UTC)

Yes that's a fair start. There's no rush, Sandy, so take time away from this if you need and we can continue whenever. Actually, wrt my last comment, I wonder if we could reinforce the basic requirements of TS by contrasting with other conditions (provided they are not exceedingly rare). So for example, we could say the tics that occur due to X, Y and Z do not persist as long as a year. Or the tics from A and B do not include vocal tics and are repetitive. And so on. I think it would be more interesting than just a long list of conditions and acquired causes that need to be excluded. It would give the reader a better idea of what tic-inducing conditions are very clearly distinct and which are harder to distinguish, perhaps. But this idea needs sources to confirm it, rather than me speculating. -- Colin°^Talk 07:46, 2 September 2021 (UTC)

I will see if I can do that, similar to what is done at dementia with Lewy bodies, once I get through my current busy-IRL-ness. I am not sure we have the sources, though … will do some digging. SandyGeorgia (Talk) 13:02, 2 September 2021 (UTC)

Exacerbation and parental first awareness

Re What is the relationship between children/parents first noticing the tics and a situation that exacerbates them? … short answer, I am fairly certain there is one, but let me see if I can find a secondary review from which to add a sentence … SandyGeorgia (Talk) 14:47, 29 August 2021 (UTC)

Colin I initially suspected I had once come across something addressing your question, but I am unable to find anything. It is possible I had this idea from something I may have read in a very old source (pre-MEDRS), but after the disruptive socking on other featured articles, I despaired of editing Wikipedia ever again, and tossed all my older sources. I don't think they would be useful at any rate with today's MEDRS (recall that I wrote most of the article pre-MEDRS, and then rewrote it post-MEDRS).

I have reviewed everything else I have, and can offer the following:

First ... All sources emphasize and recognize the strong phenomenology and natural history of tic disorders. While there is no one "typical" case of TS, the natural time course is quite predictable (the original work was even able to mathematically model the time course of tic severity [23]). What comes through in all of the literature is much more of a natural and predictable time course than one of stress-induced exacerbations leading to first awareness and diagnosis. The natural time course and hallmark characteristics are well established.

Second ... The old Leckman/Cohen standard textbook (which has well stood the test of time)

• Leckman JF, Cohen DJ (1999). Tourette's Syndrome—Tics, Obsessions, Compulsions: Developmental Psychopathology and Clinical Care. New York: John Wiley & Sons, Inc. ISBN 978-0471160373.

has a few tidbits:

• p. 191, Life Events and Stress: "Although individuals with Tourette's syndrome often report that change and stress exacerbate tics, there is no firm evidence that environmental stress of any kind affects the onset of tics. Social gatherings, emotional trauma, and anxiety-causing events do tend to exacerbate tics in individuals with Tourette's syndrome ... There is evidence ... that negative life events increase the probability of maintaining OCD ... [and] ... extreme stressors, such as life-threatening accidents and sexual abuse, to the onset of ADHD."
• p. 221, Environmental Risk and Protective Factors: emphasizes that stress produces "short-term symptom exacerbation", adding that "although acute stress seems to produce an exacerbation of symptoms over the short term, it is unknown whether acute or chronic stress alters the natural history of tic symptoms or comorbid illnesses". Every place where one encounters discussions of stress, sources seem to refer to exacerbation of TS rather than initial onset or awareness.

Third, I know I have encountered the statement somewhere that tics are often at their highest severity when they first come to attention, and that education and reassurance are often sufficient to reduce severity, but this does not address the question you raise relating to exacerbating factors and parents first noticing tics.

This is the best I am able to come up with ... so sorry I cannot find more, or anything new to add. My impression based on all sources is that the hallmark characteristics of Tourettic tics, and the natural course of the condition, are so well established that expert researchers are confident in their psychogenic diagnoses, but see PMID 31551261. SandyGeorgia (Talk) 16:55, 30 August 2021 (UTC)

A primary study is at PMID 23219489, but as in others, they are looking not at first awareness, but at stress related to severity. SandyGeorgia (Talk) 15:17, 31 August 2021 (UTC)

New text on psychogenic inserted

In this version, I have inserted the new text. FeydHuxtable, my prose always needs help; please let me know if this addition covers your intent. I suspect we will be able to tighten it once we have secondary reviews mentioning the Tik Tok scenario.

Thanks SG. Id be hesitant to even offer an opinion if Id not been pinged – hadn't read any TS related papers before hearing about contagion tics, and my FA + MEDS expertise is paltry compared to yourself, Colin & WAID. But FWIW I think the way this has been handled is awesome. I might just offer a little copy edit for the benefit of readers who might struggle with long sentences. FeydHuxtable (talk) 13:15, 5 September 2021 (UTC)

Colin, I have now separated out and discussed every condition about which specific meaningful differences can be explained. The final paragraph, with its list of conditions that manifest tics, serves a different purpose than helping to distinguish movements; it lists conditions that include tics, but are mostly so self-evidently other conditions that further investigation is not warranted. Those conditions, which are mostly self-evident or easily diagnosed, include tics, and an additional diagnosis of TS is not warranted. So, for example, when one hears a parent say that their child has Down syndrome and TS, that is typically a misconception-- tics are part of Down syndrome. Similar for every condition listed there. I think it helps to educate readers that some easily diagnosed conditions do include tics, but aren't TS. If you have a stroke, you may end up with tics. And so on ... I think it is helpful to have this left, but if the rest of you disagree, it will have to go again ... I don't think an examination of the differences in the tics would be helpful.

WhatamIdoing, I'm not sure if I've addressed most of your comments. Bits and pieces are spread about the article, and if I re-explained it all in Differential diagnosis, it may get too repetitive. Open to suggestion on how to address that, or just go ahead and edit if you can fix anything. SandyGeorgia (Talk) 23:53, 2 September 2021 (UTC)

I think we've made good progress. Thanks. WhatamIdoing (talk) 16:28, 16 September 2021 (UTC)

Common 2

Covered in archives:

• Talk:Tourette syndrome/Archive 11#Common

Eplee appears unconvinced. SandyGeorgia (Talk) 00:17, 15 November 2021 (UTC)

That does not cover anything relevant. Like all relative terms, "common" is meaningless without quantification. It is just poor writing. This syndrome is more common than some things, and less common than other things. The useful information that anybody would want to see is actually how common it is, and that information is given. Eplee (talk) 00:22, 15 November 2021 (UTC)

We already covered this (see extensive archive) when Wikipedia:Sockpuppet investigations/Moaia/Archive this happened. SandyGeorgia (Talk) 00:23, 15 November 2021 (UTC)

You are posting links that have no relevance. The useful thing to state is how common it is. The mere word common does not do that. Eplee (talk) 00:26, 15 November 2021 (UTC)

This conversation has already been had. SandyGeorgia (Talk) 00:32, 15 November 2021 (UTC)

In the second paragraph of the lead: It is no longer considered rare; about 1% of school-age children and adolescents are estimated to have Tourette's. [24] SandyGeorgia (Talk) 01:43, 15 November 2021 (UTC)

Blocked: same disruptive edit introduced by three (1) sockpuppet (2) editors(3). SandyGeorgia (Talk) 03:38, 9 December 2021 (UTC)

"common" 3

well i'm late to the party but i also question how "common" this condition is in otherwise healthy populations? in what groups is it common? prevalence is stated to be 1%, which would make the world population approximately 70,000,000. is that an accurate figure? the section in archive 11 wasn't helpful nor was the above section. 173.87.170.14 (talk) 19:53, 5 December 2021 (UTC)

"common" 3a

Talk:Tourette syndrome/Archive 12#Common 2

Talk:Tourette syndrome/Archive 11#Common

well i'm late to the party but i also question how "common" this condition is in otherwise healthy populations? in what groups is it common? prevalence is stated to be 1%, which would make the world population approximately 70,000,000. is that an accurate figure? the section in archive 11 wasn't helpful nor was the above section. 173.87.170.14 (talk) 19:53, 5 December 2021 (UTC)

• note, the above section was removed "per several SPIs" by SandyGeorgia. a) that is very rude, i am not a sock and if you believe that i am then bring a case or whatever. b) i looked not only in archive 11, but also in archive 10, only to find that several people have raised this concern, each one ending with Sandy Georgia dismissing the concerns out of hand, much like the above paragraph. c) she offered no answer and made zero effort to help. it appears that this article is owned by Sandy Georgia so i reckon it doesn't make much sense to try and improve it. 173.87.170.14 (talk) 20:10, 6 December 2021 (UTC)

Article WP:LEADs are summaries of the most important points in the article.

Tourette syndrome ... is a common neurodevelopmental disorder that begins in childhood or adolescence. ... Tourette's was once regarded as a rare and bizarre syndrome and has popularly been associated with coprolalia (the utterance of obscene words or socially inappropriate and derogatory remarks). It is no longer considered rare; about 1% of school-age children and adolescents are estimated to have Tourette's,

• Reading Prevalence, and Prevalence#Difference between prevalence and incidence may help you understand more specifically how prevalance numbers are used: "Prevalence is the number of disease cases present in a particular population at a given time". It is a condition that is most noticed in childhood as it tends to remit after adolescence; thus, the relevant prevalence numbers usually speak to childhood. More specific detail is provided at Tourette syndrome#Epidemiology.
• "how 'common' this condition is in otherwise healthy populations"; I don't know what other numbers you want.
• "in what groups is it common?" I don't think anything known about "groups" is lacking in the article or the lead; that is all spelled out; see Tourette syndrome#Epidemiology ...

  reaches across all social, racial and ethnic groups. It is three to four times more frequent in males than in females.[52] Observed prevalence rates are higher among children than adults because tics tend to remit or subside with maturity and a diagnosis may no longer be warranted for many adults

• "prevalence is stated to be 1%, which would make the world population approximately 70,000,000. is that an accurate figure?" The article text says:

  about 1% of school-age children and adolescents

  Prevalence is for a particular population-- in this case, children and adolescents. Yes, 1% of the world's population of children and adolescents is expected to have TS. As the article also explains, 1% of all people are believed to have a tic disorder, which is a broader category than just TS. I am not aware of any good numbers on the percentage of all people having TS; those numbers would be hard to come by, since most adults may not know they have TS, or met the diagnostic criteria as a child.

If you want something changed, please provide a reliable source that can be used to add anything you think is missing in the article. As the lead already specifies the population to which the prevalence applies, I don't see what else can be added. SandyGeorgia (Talk) 16:12, 7 December 2021 (UTC)

• the irony of all this is your frustration at owning this article would be mitigated if you weren't so insistent about archiving this page so quickly. that is to say: if the previous discussions were still present on the talkpage, most people who know howto use Wikipedia would have seen the prior queries and would not have to ask again and again and whatever white whale you seek would not be able to haunt you forevermore. btw just so you know, there is a template for articles with "perennial" issues and even a FAQ template, neither of which i am inclined to dig up, that can assist you in your continued owning of this article. also, i should point out that mediawiki automatically adds a numeral to section headers whose titles occur more than once on the page. ✨behold! (click items in the TOC to see)✨  :^) 173.87.170.14 (talk) 03:16, 8 December 2021 (UTC)

  It is not recommended to set up an FAQ to memorialize one disruptive edit introduced by three (1) sockpuppet (2) editors(3). SandyGeorgia (Talk) 01:01, 9 December 2021 (UTC)

Recent edits

Version of the lead before recent edits and after recent edits.

Merry medievalist thank you for taking an interest in TS. You may have seen this large notice when you edited, which points out Wikipedia's policy page related to editing Featured articles.

An update of the entire article was undertaken in preparation for March 3, 2020 TFA, including attention to how to write the lead. Preparing this article for TFA involved a collaboration among many editors (Adrian J. Hunter, Ceoil, Colin, Graham Beards, Markworthen, Outriggr, me, WAID, and Yomangani). Not much known about TS has changed since that effort.

Some of your edits are improvements (thank you!), but others could benefit from further discussion.

• Thank you for this edit, which is an improvement. SandyGeorgia (Talk) 01:01, 9 December 2021 (UTC)
• This edit introduced two unnecessarily short sentences, and introduced a however at the start of a sentence, so I reverted it. As explanation, see these articles on the overuse of however and User:John/however. SandyGeorgia (Talk) 01:01, 9 December 2021 (UTC)
• Introducing information about cause into the first paragraph of the lead may bring unnecessary difficulty early on, as it forces the reader to grapple with more complex parts of the topic before digesting the more common and frequently sought information. That sort of change is a preference that would better gain consensus. We now have a very long and harder-to-digest first paragraph, and a single-sentence as the final paragraph in the lead; I suggest that Cause was better where it was, in the fourth paragraph. SandyGeorgia (Talk) 01:01, 9 December 2021 (UTC)
• In the middle part of that same edit:

  Education is an important part of any treatment plan, and explanation alone often provides sufficient reassurance that no other treatment is necessary.

  means what is says, that no other treatment is necessary; the so changes the meaning:

  Education is an important part of any treatment plan, and explanation alone often provides sufficient reassurance so that no other treatment is necessary.

  It's not a consequence; physicians reassure individuals that no treatment is necessary. It's not that the reassurance renders no treatment necessary. SandyGeorgia (Talk) 02:14, 9 December 2021 (UTC)

I agree with Sandy and reverted those aspects of the edits to the lead. -- Colin°^Talk 11:11, 9 December 2021 (UTC)

Catamenial tics

@Colin and Graham Beards: this source mentions catamenial tics: I don't have access, but would like to incorporate these sex differences. SandyGeorgia (Talk) 16:00, 19 December 2021 (UTC)

• Garris J, Quigg M (October 2021). "The female Tourette patient: sex differences in Tourette disorder". Neurosci Biobehav Rev (Review). 129: 261–68. doi:10.1016/j.neubiorev.2021.08.001. PMID 34364945.

  Got the full text and will be working this in. I don't plan to mention catamenial tics, as broader reviews emphasize that the reported pre-menstrual increase in tics does not bear out. Also, this study does mention that results are limited by very small sample sizes and other methodological issues, but a few sentences can be added. SandyGeorgia (Talk) 00:08, 20 December 2021 (UTC)

ICD-11

• Liu ZS, Cui YH, Sun D, et al. (2020). "Current Status, Diagnosis, and Treatment Recommendation for Tic Disorders in China". Front Psychiatry. 11: 774. doi:10.3389/fpsyt.2020.00774. PMC 7438753. PMID 32903695. The CCMD-3, DSM-5, and ICD-11 diagnostic criteria for tics are almost the same. Currently, the DSM-5 is mostly used in clinical practice around the world, including China.{{cite journal}}: CS1 maint: unflagged free DOI (link)
• Reed GM, First MB, Kogan CS, et al. (February 2019). "Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders". World Psychiatry. 18 (1): 3–19. doi:10.1002/wps.20611. PMC 6313247. PMID 30600616. Finally, chronic tic disorders, including Tourette syndrome, are classified in the ICD-11 chapter on diseases of the nervous system, but are cross-listed in the grouping of neurodevelopmental disorders because of their high co-occurrence (e.g., with ADHD) and typical onset during the developmental period.
• "8A05.00 Tourette syndrome". World Health Organization. Retrieved March 28, 2022. Diseases of the nervous system --> Tic disorders: "onset during the developmental period"

Done; I have removed the update tag placed by SadAttorney613 and also placed the text explaining that the ICD is basically never used in TS practice or research at the top of the section where it is more prominent. Frontiers is not a high quality source, but it was all I have access to for quickly updating the article; if/as a better source becomes available, I'll replace it. SandyGeorgia (Talk) 18:22, 28 March 2022 (UTC)

SadAttorney613 there is nothing even remotely controversial about the statement of DSM vis-a-vis ICD in TS practice and diagnosis, and the source is used in combination with two others. For a Chinese source to say that DSM is used in China seems even less controversial, considering other sources support that. While my personal standards mean I want to eventually replace that with a higher quality source, I can't see a justification for the tag; perhaps you'll explain? Nonetheless, I've removed the source and used another more general one. (Thanks for the typo correction). SandyGeorgia (Talk) 22:06, 28 March 2022 (UTC)

User:SandyGeorgia, Template:Better source needed doesn't state that it needs to be controversial. You said that a better source was needed for the Frontiers, so I just put the template. Apparently you were referring to your own personal standards. SadAttorney613 (talk) 09:01, 29 March 2022 (UTC)

Factual Error - Incorrect Cause vs InfoBox

The article notes there is no known cause for Tourette's, yet the InfoBox incorrectly cites an NIH source that only states: Although the cause of TS is unknown, current research points to abnormalities in certain brain regions (including the basal ganglia, frontal lobes, and cortex), the circuits that interconnect these regions, and the neurotransmitters (dopamine, serotonin, and norepinephrine) responsible for communication among nerve cells. Given the often complex presentation of TS, the cause of the disorder is likely to be equally complex.

Also, it is clear to the layman, since behavioral theapy is first-line treatment and is the most effective treatment, clearly the cause is purely psychological; If it were the result of physical disease, then medication would be preferred. — Preceding unsigned comment added by 174.211.35.245 (talk) 05:30, 1 March 2022 (UTC)

The article is correct, and I know of no sources supporting your opinions. SandyGeorgia (Talk) 04:28, 5 March 2022 (UTC)

Recent edits to the lead

SophieTheSquirrel re this edit, please discuss here on talk:

• Once regarded as bizarre implies no longer.
• "Tends to be" is vague.
• "Researchers estimate that" ... researchers is redundant to almost everything we write about TS, or any medical condition, and not needed.
• See overuse of however and User:John/however.
• Introducing that coprolalia is not a diagnostic requirement is more info than needed for the lead.

This doesn't mean we can't work towards improving content, but discussing on talk to gain consensus for edits to a WP:FA is the best route to that. The WP:LEAD was arrived at based on long discussions. SandyGeorgia (Talk) 22:40, 2 July 2022 (UTC)

Functional tic-like movements

Colin I've worked in a new source here, but you may be interested in doing more with it ... I have a very busy three days ahead. SandyGeorgia (Talk) 14:19, 25 August 2022 (UTC)

Interesting article. I don't know we can say too much as this is a differential diagnosis, and the researchers don't yet have an explanation beyond speculations. -- Colin°^Talk 12:19, 28 August 2022 (UTC)

Colin, my main concern is whether we need to better flesh out how we are labeling whatever they are ... are you comfortable with how the word psychogenic is used ? The new review seems to indicates overlapping comorbidities, such that I'm unsure if psychogenic is ... an outdated or misused? ... term. SandyGeorgia (Talk) 17:22, 28 August 2022 (UTC)

I don't have a strong opinion though a large problem with such conditions is getting the patient to accept it and take appropriate treatment therapies, and the chosen name can be a factor in this. The word "psychogenic" seems to be disfavoured for exactly that reason - it provokes an "Are you saying I'm mad?" or "So, you're saying I'm just making this up, faking it?" response. Googling "psychogenic vs functional" returns quite a few scientific papers discussing these matters. It doesn't seem settled, but I think "functional" is favoured. I find the term a little bit opaque, though. The lay-friendly website neurosymptoms.org certainly favours "functional" and comments on some terminology in their FAQ. We should probably be more consistent in using one term in the article. -- Colin°^Talk 08:54, 29 August 2022 (UTC)

That gives me some ideas for how to rework this; when we originally added the concept, we didn't have a secondary review on the COVID issues, but now we do. I suspect I can address the terminology by moving some of the psychogenic to the History sub-article, and focusing here on the present. But I have to first dig out Jankovic (2006) to see what he was saying in 2006 ... more later, SandyGeorgia (Talk) 14:52, 29 August 2022 (UTC)

Colin I moved a lot of the content to History of Tourette syndrome, and rejigged here to reflect modern terminology. Have a look now? SandyGeorgia (Talk) 17:27, 29 August 2022 (UTC)

TikTok is not causing tic-like symptoms

The rise in Tourette's or tic-like symptoms is far more likely to be caused by Covid-19 induced PANDAS/PANS, FND which occurs in 37.2 per 100,000 Or possibly people with factitious disorder getting the idea to fake Tourette's as more people are sharing their experiences with disabilities than ever due to rising tolerance by the general public.

I do acknowledge that there have been trends on TikTok that encourage faking, such as the trend where people would put a hoodie over their head and preform dramatic convulsions and claim to have tics ot Tourettes.

All in all, claiming that TikTok is the cause in rising tic-like symptoms adds to the already high stigma around Tourette's. I think that we could put the fact that people are faking Tourette's on TikTok, but without a longer explanation, I think that mentioning TikTok at all may possibly be damaging. Asexual amanita (talk) 19:38, 9 December 2022 (UTC)

Wikipedia reflects what reliable secondary sources state, and does so in this case. SandyGeorgia (Talk) 22:10, 9 December 2022 (UTC)