Talk:Tourette syndrome/Archive 10

Edit request
may not always be correctly identified -> may not always be correctly diagnosed — Preceding unsigned comment added by 220.241.144.250 (talk • contribs) 13:37, December 23, 2011‎
 * ✅.- gadfium 20:12, 23 December 2011 (UTC)
 * I reverted this edit because it's completely wrong. When go into the field to make estimates in broad-based populations of the prevalence of medical conditions, they are not always "diagnosing"-- they are "identifying".  Sandy Georgia  (Talk) 16:31, 28 December 2011 (UTC)
 * Disagree. How does this concept of identification (as opposed to diagnosis) apply to this sentence about Tourette's? 220.241.144.250 (talk) 13:16, 14 January 2012 (UTC)
 * The sentence is: "Tourette's is no longer considered a rare condition, but it is not always correctly identified because most cases are mild and the severity of tics decreases for most children as they pass through adolescence." The sentence is about epidemiology, not diagnosis.  It is true that it is not always correctly diagnosed-- more broadly, in epidemiological studies, neither it is always correctly identified, for a number of reasons explained in the article and summarized in the lead.  Sandy Georgia  (Talk) 20:24, 14 January 2012 (UTC)
 * OK, thanks. 220.241.144.250 (talk) 13:36, 16 January 2012 (UTC)

Edit request on 26 February 2012
Pediatric acute-onset neuropsychiatric syndrome (PANS) is a syndrome in which children have abrupt, dramatic onset of Tourette's Syndrome, obsessive-compulsive disorder (OCD), or anorexia nervosa coincident with the presence of two or more neuropsychiatric symptoms. It is believed that these children experience a rise in dopamine levels as a result of a of cross-reactive anti-neuronal antibodies triggered by streptococcal or mycoplasma infection. The cross-reaction is believed to cause such side effects as tics.

Werelived (talk) 02:48, 26 February 2012 (UTC)
 * No. 1.  You are misreading the source.  Tics are hypothetically a feature of PANS, but you've extended that to TS, which misses the whole point of the PANS hypothesis.  PANS is hypothetically posed as a condition in which symptoms are not better explained by another condition such as Tourette's, so your text is wrong.  Second, there is exactly one paper written about PANS, it is a proposal, see WP:RECENTISM, and there is no reason to include speculative text in a Featured article.  If more papers are published, and if PANS gains some widespread medical consensus, and if secondary reviews discuss it, then you might propose accurate text here discussing the situation. I'm a bit concerned that you are editing both PANDAS and PANS, and yet your definition of the hypothetical PANS above does not seem to match the cited source, which discusses abrupt onset of OCD.  Furthermore, PANS is proposed for research purposes-- until there is more coverage, it doesn't belong in this (an unrelated) article.  Sandy Georgia  (Talk) 03:13, 26 February 2012 (UTC)
 * Red information icon with gradient background.svg Not done: please establish a consensus for this alteration before using the template. See above.  elektrik  SHOOS  (talk) 05:26, 26 February 2012 (UTC)

Nicotine
I have moved this statement, based on an old review, to the daughter article, Treatment of Tourette syndrome, where experimental treatments are covered in more detail than typical for a broad overview article. (Mentioning also that I was halfway through upgrading this article to newer sources when the issues at PANDAS and several family funerals took my attention; I plan to return to this upgrade effort in about two weeks. If I find newer, better or different info on nicotine in all of the recent reviews, I'll add that.) Also please note the citation style (manual) in this article (just copy citation directly out of PubMed rather than going through Diberri). Sandy Georgia (Talk) 16:06, 14 March 2012 (UTC)
 * I agree with your edit and move of text. I am not very familiar with the treatment of this condition; thanks for correcting my error.-- Literature geek |  T@1k?  18:02, 14 March 2012 (UTC)

Nonsense statements
> Genetic studies have shown that the overwhelming majority of cases of Tourette's are inherited, although the exact mode of inheritance is not yet known and no gene has been identified. If genetic studies have shown inheritance, it is impossible for no gene(s) or genetic regions to have been identified since, you know, ***that is necessary for a genetic study to show inheritance***. I'm just a lowly IP editor though and thus not worthy to dare even think of editing or tagging your oh so precious featured articles. I never realized that before. Oh well, so much for anon editors being equally welcome to contribute. On point: I cannot tag that self-apparently nonsensical statement for verification and clarification. Can one of you other editors do it please? Thanks. --146.115.89.11 (talk) 07:35, 24 May 2012 (UTC)
 * Your understanding of genetic studies is incomplete but since I'm traveling and have limited access perhaps someone else will fill in the blanks ... twin study is a good starting place for understanding how genetic inheritance can be shown even though the exact genes are unknown.  The statement can be verified to just about every paper written about TS-- it's not very precious at all. Sandy Georgia  (Talk) 14:34, 24 May 2012 (UTC)

Throughout the history of genetics - the entire 20th century - most identifications of traits as 'genetic' - that is, inherited - have been done based on breeding studies, not gene isolation. In fact, it was impossible to identify genes until DNA technology made it possible. For instance, we knew that red hair was inherited long before any 'red hair gene' was identified. This is Biology 101 genetics the most elementary of knowledge, and there is no doubt about it. MarkinBoston (talk) 19:08, 14 September 2012 (UTC)

Regressive autism
Michele Zappella has long described what he termed dysmaturational syndrome or early-onset GTS, where one has transient regressive autism with tics, followed by fully blown, mostly non-pure GTS. The syndrome is differentiated from Landau-Kleffner syndrome by normal EEG. Shouldn't this be noted somewhere in the GTS article? I wanted to add it but thought I better check first lest I've got it the wrong way, given that a featured article failed to include it while it's been around for so long. To be clear my suggestion doesn't necessarily entail hastily promoting Zappella's propositions concerning therapy or classification, in case that was the problem.--What's_the_big_deal?! 03:33, 27 February 2013 (UTC) — Preceding unsigned comment added by Arpose (talk • contribs)
 * I think the question would be whether there is recent reputable literature that considers this as a valid entity. Looie496 (talk) 03:39, 27 February 2013 (UTC)
 * Zappella's work is, at least in my estimation, quite recent and reputable. Concerning his proposed syndrome see e.g. . In any case what I think is worth noting is that there are people with GTS who have histories of reversible regressive autism.--What's_the_big_deal?! 03:53, 27 February 2013 (UTC) — Preceding unsigned comment added by Arpose (talk • contribs)
 * I don't see this as being appropriate for inclusion at this time: you've cited primary sources, and there are not really any pubmed hits for 'dysmaturational syndrome', 'dysmaturational disorder', or variations on 'early-onset GTS' that do not originate from Zappella. For medical articles, we rely primarily on secondary sources to get a balanced view of the prevailing medical consensus. In this way, we avoid giving undue weight to original research that has not yet been reviewed or accepted by the medical community. Maralia (talk) 02:50, 23 March 2013 (UTC)

The edit that's been reverted did not refer to a "dysmaturational syndrome" or an "early-onset GTS"; let's please forget about that (sorry I brought it up). As for articles mentioning a relation between (regressive) autism and TS, could one start from here ? Again the cases are there. It's not a taxonomy I want added here but possibly useful facts. --What's_the_big_deal?! 09:02, 23 March 2013 (UTC) — Preceding unsigned comment added by Arpose (talk • contribs)

Tourette's as a child's disorder
I don't know how to better word the subject, my apologies. However, as someone who suffers from Tourette's and being in their 30s, I found the general consensus of the article to be somewhat odd. It sounded as if TS is something that only really happens to children and fades away as you get older. My lifetime of experience with it has actually seen it become steadily worse as I've gotten older - perhaps because life is more stressful these days with increased worry about bills and other problems. The point I'm trying to make is that the article seems rather misleading. Maybe I'm reading it the wrong way, it's been known to happen, but I can assure anyone that it is not something that "goes away". Likewise, the whole bit about "premonitory urge" is a bit confusing. If I do get urges, not that I've ever really noticed something before an increase in activity, they've never been related to the tics that occur. --68.6.234.179 (talk) 05:13, 30 July 2013 (UTC)
 * If you have examples of particular passages that trouble you, and reliable sources that disagree, we can address the wording (I have the new DSM-5 and am planning a global update, but am busy through August). However, I am unaware of any reliable sources that support your statements above  (for example, on  premonitory urges) ... perhaps I'm not following your points?  Sandy Georgia  (Talk) 13:37, 30 July 2013 (UTC)

I also had an adult onset tic disorder. And there is evidence that this exists, but they do not want to call it tourettes, likely because there are only 13 reported cases in one study (and some of them were cocain users, of which I am not, I was actually a consultant to the FED, before being shot down with my tic disorder.). From the web site "Adult Onset Tic Disorders", "Adult onset tic disorders represent an underrecognised condition that is more common than generally appreciated or reported. The clinical characteristics of adults newly presenting to a movement disorder clinic with tic disorders are reviewed, analysed, and discussed in detail. Clinical evidence supports the concept that tic disorders in adults are part of a range that includes childhood onset tic disorders and Tourette's syndrome." (Journal of Neurology, Neurosurgery, and Psychiatry, June 2000, volume 68) 172.243.58.98 (talk) 05:42, 26 December 2013 (UTC)
 * The source you present is from the year 2000-- quite outdated. Sandy Georgia  (Talk) 15:31, 26 December 2013 (UTC)

Coprolalia
I don't understand how to use these talk pages so I'm probably doing it wrong, but the main problem is this: The Tourette's page makes it sound as if Coprolalia only exists as possible symptom of Tourette's, which of course is not only false, but is an enormous society-wide misconception that Wikipedia needs to do its best to dispel rather than reinforce. The Coprolalia page does a very good job of making the full extent of the distinction clear, but unfortunately the Tourette's page fails at this (although not nearly as badly as, for example, popular film). Unfortunately, I am now at a complete loss as to how to fix this in a way that SandyGeorgia won't revert. — Preceding unsigned comment added by Nitrode (talk • contribs) 05:48, 22 August 2013 (UTC)


 * Thank you for starting a talk page discussion. I have added a section head for this; also, you can sign your talk page entries by adding four tildes ( ~ ) after them.  I apologize for not starting a talk section to explain earlier; I have been extremely busy in real life.  I have twice removed your edits  because a) the lead is a summary and should not introduce text not covered in the article; b) the article is an overview and some material is better covered in sub-articles, but more importantly; c) your addition is anecdotal, uncited original research.  I removed an edit that added text to the lead that is better included at coprolalia and is UNDUE in the lead.  I removed a second edit that replaced accurate info with inaccurate info; coprolalia is related to Tourette's, although not exclusively.  For example,  does not say what you seem to think it says (I have the full article). Further, most symptoms of most conditions are ... well ... symptoms; many symptoms occur in many conditions. Fever does not occur exclusively with flu, but it is associated with flu, for example.  Where on this page does something "make it sound like coprolalia only exists as a symptom of Tourette's"?  A full discussion of any symptom of any condition is better included at that symptom's page (eg coprolalia).  Additionally, although coprolalia occurs in some other conditions, it is highly associated with Tourette's; your additions extend beyond fact into anecdote, and are not backed by sources.  Perhaps if you can explain where you think this page is misleading about the relationship between coprolalia and TS, we can come to an agreement about how to fix it (if in fact there is a problem), but we can't fix something by a) adding WP:UNDUE or inaccurate text to the lead, or b) adding uncited anecdote.  The article already explains that coprolalia is present in a very small minority of people with TS, and additional detail is given at coprolalia.  It is unclear to me what you find wrong with the text, but if you could provide a medrs-compliant source that backs your preferred wording, we could adjust.  BTW, I am still extremely busy IRL and might not get back to this immediately ... please allow a few days if I fail to respond.  Regards, Sandy Georgia  (Talk) 22:45, 22 August 2013 (UTC)

"Further, most symptoms of most conditions are ... well ... symptoms; many symptoms occur in many conditions. Fever does not occur exclusively with flu, but it is associated with flu, for example[...]Additionally, although coprolalia occurs in some other conditions, it is highly associated with Tourette's"

This is the key part of the problem. Unlike with fever/flu, common public perception is that Tourette's *is* uncontrollable swearing - that each one exclusively implies the other.

You and I may both know perfectly well that Coprolalia is a symptom not exclusively associated with Tourette's, just like fever is not exclusive to the flu. And most people are intelligent enough to know that fever does not imply flu. But, there is very *little* public understanding that Coprolalia does *not* imply Tourette's and vice versa. The Coprolalia page does make this clear, but the Tourette's page fails to even mention at all that Tourette's is not inherently implied by uncontrollable swearing.

Admittedly (and thankfully) the Tourette's page *does* inform readers that Tourette's does not imply uncontrollable swearing, but it fails to inform people of the reverse (that uncontrollable swearing does not imply Tourette's). Considering the widespead "Tourette's == uncontrollable swearing" misconception, it is irresponsible to rely exclusively on the Coprolalia article to clarify this fact. 76.189.120.12 (talk) 01:14, 24 November 2013 (UTC)


 * From the lead:"Tourette's was once considered a rare and bizarre syndrome, most often associated with the exclamation of obscene words or socially inappropriate and derogatory remarks (coprolalia), but this symptom is present in only a small minority of people with Tourette's."
 * From the body of the article:"Coprolalia (the spontaneous utterance of socially objectionable or taboo words or phrases) is the most publicized symptom of Tourette's, but it is not required for a diagnosis of Tourette's and only about 10% of Tourette's patients exhibit it."
 * Sandy Georgia (Talk) 01:22, 24 November 2013 (UTC)

P.A.N.D.A.S
What I have experienced from some movement disorder specialists, is that Step infections cause autoimmune nightmares? The argument concerning the retention of antigen from Strep is still very unknown. The research is evenly split as of my last check on the matter? Idiotsavantmoron (talk) 17:04, 16 January 2014 (UTC)
 * PANDAS is briefly mentioned in the Causes section of this article. It is a contentious diagnosis that has still not been accepted in DSM and ICD. You can read more about it at PANDAS. Maralia (talk) 17:32, 16 January 2014 (UTC)

I have not been concerned about PANDAS as a cause or diagnosis of tic increase! I am more worried about the unique manifestations of myself as a 35 year old. I am intrigued about something I have lived with and felt get worse. I can't prove but understand how it might in my specific daily life? It feels like a electric current that bounces all around me that never completely "grounds out"? That may not make sense, but I feel it like a lightning bolt that will not ground. I have been a part of and started an adult's with TS support group. All of our ages and intensities are similar but so completely unique! I have seen the most powerful and strangely gifted adults in my life. We all are awesome! I thank Bruse Hologram and the TSA of Ohio, for helping me reach out, so I could meet such beautiful people! My problem is I live in a place that local church's preach Tourette's is the Devil. I am among a few adults that exhibit such a profound case. I will start learning Wikipedia. Any suggestions or comments are greatly appreciated! Excuse the typos and my stupid smart phone. Idiotsavantmoron (talk) 19:02, 16 January 2014 (UTC)

Featured Article Review?
This article was nominated for FA status in 2006. That's a long time ago. The standards were much different then, and it's been many years and the article has likely changed drastically since then. Should it be sent to FAR? I would like to see this article one day run on the main page, but I am not sure if it --Harizotoh9 (talk) 20:34, 1 April 2014 (UTC)
 * Yes, it was nominated in 2006 and it has also been continuously maintained since then, by a former WP:FAC delegate. Perhaps you can identify any issues you see with the article?  It has not been run on the main page for reasons well known to the mainpage delegate.  Sandy Georgia  (Talk) 14:23, 2 July 2014 (UTC)

Incorrect info removed
I have removed this incorrect edit to restore correct and correctly cited information. Please review WP:OWN, WP:WIAFA and WP:MEDRS. The edit I removed a) introduced a citation style change, and b) replaced a 2011 source with an outdated 2000 source, introducing incorrect information. TS is no longer considered rare, period. Please discuss changes when editing an FA, as this has occurred more than once from the same editor. Sandy Georgia (Talk) 14:21, 2 July 2014 (UTC)


 * It is certainly not rare, in the past it just was not diagnosed often. There were several kids afflicted with this at my school. Original research I know, just a personal anecdote. Chillum 15:52, 20 August 2014 (UTC)
 * Might be interesting to know when it actually stopped being considered as "rare"? If both of those sources are considered WP:RS, then sometime between 2000 and 2011, apparently? Martinevans123 (talk) 16:08, 20 August 2014 (UTC)
 * 2009: "Tourette's syndrome afflicts three out of every 1,000 children between ages 6 and 17 in the United States, the CDC says in its first-ever estimate of the prevalence of the neurological disorder.": . There are Rare diseases (although there is no agreed percentage criterion), so are there also "Rare neurological disorders"? What is the medical criterion for that term? Martinevans123 (talk) 16:45, 20 August 2014 (UTC)

\
 * It was known before the year 2000 that TS was a common neuropsychiatric disorder, albeit rarely detected by physicians. In 2000, that distinction was codified in DSM-IV-TR, and since then, publications mention it as a common neuropsychiatric disorder.  I have clarified the date in the text.     Sandy Georgia  (Talk) 14:26, 27 August 2014 (UTC)

Gluten hypothesis
, please review WP:OWN, and gain consensus for edits here on user talk (not at, for example, talk page). This is not even remotely a mainstream idea in TS research; if you can locate any secondary review mention of it, that would be welcome, but one descriptive case does not warrant addition. Sandy Georgia (Talk) 19:17, 15 April 2015 (UTC)
 * agree; you just beat me, on that revert. Jytdog (talk) 19:19, 15 April 2015 (UTC)
 * Love that last comma. Sehr schön. — Preceding unsigned comment added by Arpose (talk • contribs) 13:48, 1 July 2016 (UTC)

Trivia additions
Regarding additions to Tourette_syndrome, please review the following and discuss before adding mention of occurrences of TS in the media, in culture, or society:
 * 1) Summary style; this article is a broad overview
 * 2) WP:MEDMOS
 * 3) Sociological and cultural aspects of Tourette syndrome
 * 4) Ownership_of_content

Sandy Georgia (Talk) 17:09, 1 August 2016 (UTC)

Sentence
With respect to this sentence "Extreme Tourette's in adulthood is a rarity, and Tourette's does not adversely affect intelligence or life expectancy."

Have was moved to the first paragraph "Tourette's does not adversely affect intelligence or life expectancy."

The other half was summed up by " but this symptom is present in only a small minority of people with Tourette's" IMO

Doc James (talk · contribs · email) 19:56, 15 October 2016 (UTC)


 * Doc, you've introduced too many (mostly subtle, but some substantial) errors for me to fix, and I've edit conflicted three times now with you while trying to get back some accuracy. The order you want to impose on the article does not work with Tourette's.  Please give me a chance to get back to an accurate article, and then discuss each proposed change from there.  Once I get back to a point of accuracy we can talk about your proposals.  Sandy Georgia  (Talk) 20:03, 15 October 2016 (UTC)


 * Terms such as "eponym" are horrible. After 11 years of post secondary education I am not 100% sure what it means. We are really doing a disservice to our readers by using it. Same thing with the term "premonitory".
 * And why us the term "prevalence" and "etiology" when their is a better simpler word "rate" and "cause". Must we use latin and ancient greek? Experts have access to top quality sources that us all the vocabulary that professionals are accustomed to. Both experts and the lay public however can understand easier vocabulary.
 * IMO it would be good to have the lead follow the same order as the body of the text. Doc James  (talk · contribs · email) 20:14, 15 October 2016 (UTC)


 * Wax and wane would be better as "decrease and increase", temporarily does mean briefly. Agree strong urge was not the best but do not think premonitory is needed at all as it adds little. Doc James  (talk · contribs · email) 20:20, 15 October 2016 (UTC)

After seven edit conflicts in less than half an hour, and losing multiple responses and explanations, I will quit trying until you are finished. I have already answered and lost my responses to four of your edits. In the future, please lay out your issues first on the talk page -- it will be faster and easier for both of us. Because I've lost multiple responses to you in edit conflict, and I will be busy for the rest of the day and tomorrow morning, I will check back in tomorrow afternoon and address your points one by one. Sandy Georgia (Talk) 20:26, 15 October 2016 (UTC)
 * I am mostly done for now and off to work on other stuff. Doc James  (talk · contribs · email) 20:30, 15 October 2016 (UTC)

Reboot
OK, I typed up my responses in my sandbox to avoid edit conflicts.
 * In this edit, the problem is equating coprolalia with "extreme Tourette's in adulthood". Coprolalia is rare at any age.  Tourette's in adulthood is rare.  Extreme Tourette's in adulthood-- which is what we most often see in the media-- is even more rare than coprolalia.  Two different points.  Sandy Georgia  (Talk) 20:55, 15 October 2016 (UTC)
 * Sentence should at least be at least divided into two. Neither extreme nor minor Tourette's does affects intelligence so the two should not be connected. Doc James (talk · contribs · email) 21:24, 15 October 2016 (UTC)
 * This edit is just wrong. Premonitory urges are not necessarily strong.  They are urges that are felt before the tic.  They are SUCH a hallmark and defining characteristic of Tourette's that this cannot be left out; this is one of the things that distinguishes Tourette's from other movement disorders.  If you feel the word "premonitory" is above our readership level, I have to say they will find that word in any writing about Tourette's, but we can better explain it if you can find a way.  We can't just leave it out-- it is part of what distinguishes TS from other conditions.  Sandy Georgia  (Talk) 20:55, 15 October 2016 (UTC)
 * One way we might address this is to change the word "premonitory" in the lead to "unwanted", since premonitory is discussed in the body. Sandy Georgia  (Talk) 21:13, 15 October 2016 (UTC)
 * Either that or leave it out all together? Doc James  (talk · contribs · email) 21:14, 15 October 2016 (UTC)
 * This edit also introduces a subtle error; suppression of tics can be for longer periods than "briefly", and the word "temporarily" is there because suppression isn't permanent-- most often suppressed tics come back stronger, depending on how long the suppression period was. Sandy Georgia  (Talk) 20:55, 15 October 2016 (UTC)


 * This edit is awful; labeling the natural progression of tics with "worse" or "better" is a judgement that is quite damaging to children who live with the condition. And wax and wane does not mean worse or better ... tics are measured in many different ways (frequency, force, duration, type).  Worse or better is not only judgemental and POV-- it's just not precise or accurate language.  Sandy Georgia  (Talk) 20:55, 15 October 2016 (UTC)
 * How about "decrease and increase" rather than "wax and wane" in the lead? Doc James  (talk · contribs · email) 21:18, 15 October 2016 (UTC)
 * Pass through adolescence versus approach adulthood is simply wrong; see the landmark Leckman study which defined the natural course of tic severity.  Sandy Georgia  (Talk) 20:55, 15 October 2016 (UTC)
 * This "There is no effective treatment for every case of tics" is a truism for nearly every condition and therefore not sufficiently notable for the lead. It is like the statement "more research is needed" that the Lancet has banned. Doc James  (talk · contribs · email) 21:22, 15 October 2016 (UTC)
 * This edit took away via oversimplification important points about treatment; explain why you object to what was there, and we can fix it. Sandy Georgia  (Talk) 20:55, 15 October 2016 (UTC)


 * Those are the only step-by-step edits; because you reordered the lead while making changes to text, it is hard to see what the exact changes were. Please work on resolving content issues first, and then we can discuss the order; it will be much easier that way to see in edit summary what has changed.  I strongly disagree that all medical leads have to follow the same order. Tourette's is not an article like other diseases or conditions or illnesses, and the way each article lead needs to flow may be different.  With Tourette's, sometimes the order has to be different than medical diseases or illnesses for the flow to work.


 * IMO the word eponym is quite common, but we can change it to "named for" or "named after" if desired-- no problem. I don't entirely disagree that during the Eubulides tenor, we used highly precise medical terms.  I've restored some of them for now, but again-- hard to identify exactly what changes you made when you reordered text at the same time.  Done for now, and back tomorrow.  Sorry if I missed anything significant, but edit conflicts cause so much lost time ... Sandy Georgia  (Talk) 20:55, 15 October 2016 (UTC)
 * Here is a summary of your changes that I restored.  Sandy Georgia  (Talk) 20:57, 15 October 2016 (UTC)


 * Doc, I will lrespond to all of your suggestions as soon as I am home tomorrow afternoon ... some of them are quite workable, others would be subtly inaccurate ... mañana, Sandy Georgia (Talk) 00:41, 16 October 2016 (UTC)
 * Sure sounds good. Thanks User:SandyGeorgia Doc James  (talk · contribs · email) 19:37, 16 October 2016 (UTC)

Premonitory urge
Ideas on how to say this in simpler language? Is the term premonitory needed in the lead? Could we simply say "preceded by an urge"? Doc James (talk · contribs · email) 21:14, 15 October 2016 (UTC)

Co mobid
Rather than "Comorbid conditions (co-occurring diagnoses other than Tourette's)"

can we say

"Other conditions that commonly occur in people with Tourette's... seen in tertiary specialty clinics"

Not sure if this is needed in the lead "seen in tertiary specialty clinics". Associated conditions is simplier than comorbid conditions.

Doc James (talk · contribs · email) 21:17, 15 October 2016 (UTC)

hallmark
This "These other conditions often cause more impairment to the individual than the tics that are the hallmark of Tourette's; hence, it is important to correctly identify associated conditions and treat them"

is simpler as

"These other conditions often cause more impairment than the tics; hence, it is important to correctly identify associated conditions and treat them."

We already say in the first paragraph that tics are the prime characteristic of the disorder, IMO we do not need to repeat this in paragraph 3. Doc James (talk · contribs · email) 21:20, 15 October 2016 (UTC)

Next
Doc, in this version, I have gotten most of the changes you suggest (exceptions below). I find this imposed order of the lead clumsy, choppy, and confusing, but I've done it. A lead this choppy would not/should not pass FAC, and I believe the story flowed better by not imposing upon it the same order as the article. With TS, there are just some things that need to be explained before others can be understood. Generally, two kinds of people seek info about TS: parents of newly diagnosed children who are frightened out of their minds because they believe it to be a rare and disabling condition, or people who have encountered extreme media portrayals. The lead no longer addresses what most people seeking info about TS want to know in the order they can most easily digest it. Nonetheless, it is done. I think we've dumbed some very common words, but ... whatever. What I have not done is take out "wax and wane", because
 * a) I don't understand what the objection is (it is a quite common phrase in English, not hard to understand;
 * b) it is another hallmark of the condition, along with premonitory urges, and something that is pretty much instantly recognizable to those frightened parents who are reeling in panic from a recent diagnosis; and
 * c) the alternate ways I can come up with of explaining "wax and wane" are quite wordy. Tics aren't described as just "worse or better" or "diminishing or increasing".  Tics come and go, fluctuate, and change in frequency, intensity, anatomical location, number and type.  That is, as anyone who has or has seen the condition knows, they "wax and wane", and we provide that detail in the body.

I have also left in the word "comorbid", because like "premonitory", anyone coming to any article or discussion about Tourette's is going to inevitably and inescapably encounter those two words, so we might as well get them out there and define them. Please let me know where we stand. Sandy Georgia (Talk) 01:14, 17 October 2016 (UTC)
 * This may work.  If we are close to agreement, my plan is to add a few sentences on diagnosis and history, because I hate the choppy paragraphs.  Sandy Georgia  (Talk) 01:21, 17 October 2016 (UTC)
 * Sure this looks good  Doc James  (talk · contribs · email) 02:34, 17 October 2016 (UTC)


 * What do you think of simplifying "most often associated with the exclamation of obscene words or socially inappropriate and derogatory remarks (coprolalia)" to "most often associated with the involuntary speaking of obscene words"? I think stating it is involuntary is important.
 * That would be wrong in two ways:
 * Coprolalia is not just obscene words, and
 * Involuntary is a problematic word wrt Tourette's. Tics are responses to unwanted premonitory urges.  They are, in a sense, semi-voluntary.  So, they are often referred to as unvolntary.  If we introduce the word involuntary there, we have to explain this, which is explained later on.  I don't like the pipelink and don't think we need to keep covering up the words most associated with the condition (e.g. coprolalia). Sandy Georgia  (Talk) 02:52, 17 October 2016 (UTC)
 * Okay can we use "speaking" instead of "exclamation" so we would have "most often associated with the speaking of obscene words or socially inappropriate remarks (coprolalia)" Doc James  (talk · contribs · email) 03:02, 17 October 2016 (UTC)
 * We could, but ... for the sake of simplifying text, we would be introducing inaccuracy. Have you ever encountered coprolalia or seen videos of it?  It is practically NEVER just normal speech or speaking ... it is almost always in a different voice, and "exclamation" is the most accurate description.  One of the defining characteristics of coprolalia is that it is rarely just normal spoken conversation.  It's an out of context, different voice, exclamation.   Could you please leave the blank lines between different points ... it is hard for me to see where to respond without them.  Sandy Georgia  (Talk) 03:06, 17 October 2016 (UTC)
 * Yes have seen a case or two. I would argue it is not inaccurate just a little bit less specific. All exclamations are within the broader category of speaking. The body of the text can get into the exact specifics IMO. Doc James  (talk · contribs · email) 03:10, 17 October 2016 (UTC)
 * I disagree with characterizing coprolalia as speaking, but I would be OK with changing it to "the utterance of obscene words or socially .... " Sandy Georgia  (Talk) 03:36, 17 October 2016 (UTC)


 * In this text "tics that are the hallmark of Tourette's", we already say the last bit in the first sentence. What do you think of leaving out "that are the hallmark of Tourette's"?
 * Good, done. Sandy Georgia  (Talk) 02:53, 17 October 2016 (UTC)


 * What about starting the paragraph with "Between 0.4% and 3.8% of children and adolescents ages 5 to 18 may have Tourette's"? The currently understand of the prevalence IMO is better before historical beliefs of it's prevalence. Doc James  (talk · contribs · email) 02:43, 17 October 2016 (UTC)
 * yes, better, done. Sandy Georgia  (Talk) 02:55, 17 October 2016 (UTC)


 * We state in paragraph two "No longer considered rare, Tourette's is not always correctly identified" and then we say it again in paragraph 4 "Tourette's was once considered a rare and bizarre syndrome". What do you think about simply leaving out "No longer considered rare," Doc James  (talk · contribs · email) 02:58, 17 October 2016 (UTC)
 * That was a consequence of changing the flow-- one I really disliked. We had two thoughts that flowed correctly and logically that got disconnected by the order you wanted. Both points are important -- I have some ideas for how to fix, give me a bit to check the literature.  Sandy Georgia  (Talk) 03:02, 17 October 2016 (UTC)
 * Yep, figured a way to fix this, but need to find the citation ... still working on it. Sandy Georgia  (Talk) 03:08, 17 October 2016 (UTC)
 * Does that do it? Sandy Georgia  (Talk) 03:34, 17 October 2016 (UTC)
 * Yes looks better Doc James  (talk · contribs · email) 03:37, 17 October 2016 (UTC)

I would rather leave the remaining terms because ... this is not Simple Wikipedia ... in any literature about TS, these are terms that will be encountered. I feel pretty strongly that we cannot characterize coprolalia as "speaking" because that's just not how it comes out. We have made some improvements, though :0 Bst, Sandy Georgia  (Talk) 03:40, 17 October 2016 (UTC)
 * Yes thanks. What do you think about shortening "in only a small minority of people with Tourette's" to "in a minority". minority is already small and we stipulate Tourette's in the beginning of the sentence. Doc James  (talk · contribs · email) 03:43, 17 October 2016 (UTC)
 * Don't find it helpful. Sandy Georgia  (Talk) 04:03, 17 October 2016 (UTC)
 * Minority is less than 50%. Tony   (talk)  05:16, 17 October 2016 (UTC)

Summary
Although a few changes are improvements, I do not find this version to be an overall improvement on the FA version copyedited by that passed FAC with an unprecedented (then, and still today) level of support. While some wording changes may be improvements, we have diluted accuracy, and only for the sake of simplicity at times verging on Simple Wikipedia. The biggest damage to the flow resulted from imposing an enforced order of items to conform with an arbitrary notion of how medical leads should be constructed -- the same for every article. By chopping up and removing the paragraph beginning with "Tourette's was once considered a rare and bizarre syndrome, ... " IMO we have changed a narrative that had a logical flow, to a choppy lead that is unpleasing to read and doesn't answer the queries most people first encountering Tourette's are likely to have. I raise this because I am a bit troubled that I watched the same thing happen to 's exemplary Ketogenic diet. Doc, please consider it is not always imperative that History come last, and removing the "once considered rare" to the end, only because it sounds like "History", has damaged the flow here. You've made some good suggestions, but this arbitrary order has damaged the overall flow. I'm also wondering why, if these words were so hard to understand, that this lead stood for 10 years without any reader expressing that problem, in an article with substantial page views. Sandy Georgia (Talk) 04:04, 17 October 2016 (UTC)
 * I am not set on the ordering of content of the lead if you prefer something different. With respect to simplification of text, we have received a great deal of criticism for being at too high a reading level in the academic press. Without simplification translators also express concerns. I do believe that at least the lead should be simple as we have a global audience and therefore feel the current version is an improvement in that aspect. That Tourettes was once considered rare fits well IMO with the current estimated rates of disease. Doc James  (talk · contribs · email) 04:25, 17 October 2016 (UTC)
 * In my opinion the text should be reverted back to that on 1st August. Sandy should examine the changes proposed by Doc James at her leisure and decide if any have any merit. I look at "These tics typically worsen and improve" and want to cry it's so awful. James, you aren't a writer and I would have thought your long time on WP you might have realised that by now. A lead is the careful summary of the body text made by someone completely immersed in the article, with full knowledge of the subject, full appreciation of what the sources are saying, and a careful mind for what to include and what to exclude. It has been copy-edited by better writers than you and me. It has featured status because the writing and content is so good. We have not received complaints that this article's lead is too hard to read.
 * One does not (re)write the lead by coming here with no more knowledge of the condition than some random reader, and with no more understanding of the content than achieved after a cursory scan. One does not mess about with Featured Articles (or indeed any Good Article) simply to make it easier to translate. Terms like eponymn are vital in an encyclopeadia like this. The word is hyperlinked. It is absolutely the correct word. When someone unfamiliar reads it, they can follow the link and learn something. Or else the word in its usage will help them figure out what it means. That's how we learn new things: by reading text that contains the odd word we've not seen before or are slightly unfamiliar with. By removing that word, because it isn't in your dictionary of Simple English easy-to-translate words, means the article is less educational. I wonder if you've forgotten the joy of reading a hyperlinked encyclopaedia and following the blue links to learn words and terms and facts. We're an "encyclopaedia", not a series of medical fact sheets, and it means our mission is to provide an all-round education. If I want to read medical facts without engaging my brain or stretching my vocabulary, I can pick up a patient information leaflet. There's no joy in doing that. This article is a joy to read but your clumsy edits take out all that joy.
 * James, your pattern of making huge changes at a rate at which established editors cannot track let alone fix, is simply disruptive and arrogant. Your purpose here is not to improve this article, but to dumb down it's educational content so it becomes "simple" enough to translate. en:wp is not here to be simple-to-translate base material. It's here to educate our readers who read English. Educate them in all sorts of things, one of which is on medical disorders and another of which is their vocabulary. A well written article, such as this, manages both well. You seem to think our Featured Article should not expand anyone's vocabulary. It's clear you have an agenda that is at odds with improving this article and I ask you to stop. If you have suggestions for improvement, propose them on the talk page. -- Colin°Talk 06:54, 17 October 2016 (UTC)
 * Colin you taught me a lot about editing health/medical content but I find your attitude here repulsively arrogant. Being widely and immediately useful to people who maybe don't have the leisure you do, or assume that others do, is a serious goal. Jytdog (talk) 09:45, 17 October 2016 (UTC)
 * I think you misunderstand. James is editing this so the translators have an easier job. Sorry, but that's not what en:wp is about. What I find "repulsively arrogant" is hacking to bits the lead of a featured article people laboured over and polished, in order to dumb it down. What has this got to do with "people who don't have the leisure you do"? You have no idea why people are reading this article and neither do I. An "encyclopaedia" is about all of human knowledge, including language. Let's not damage it to serve some translation project. If James wants to create a "Simple English" article for the translators to work with, we have a whole other encyclopaedia for that. Or do it in a sub-page of his own user space. -- Colin°Talk 10:32, 17 October 2016 (UTC)
 * I agree with Colin and perceive sense not arrogance. I get the impression that the quality of the writing is not on the agenda here. James, what's the rush? It would be best to discuss any changes here first. Your edits often result in errors and mediocre prose. Graham Beards (talk) 10:46, 17 October 2016 (UTC)
 * Serious when did I say their was a "rush" User:Graham Beards? I made some bold edits User:SandyGeorgia reverted them and here we are on the talk page discussing. With respect to what kind of "prose" we should be trying to achieve in the lead, I am of the position that we would do well to have at least the lead being simpler. And User:Colin I have never claimed I am a "writer". And these changes are hardly "huge"
 * With respect to expanding people's Latin and Greek vocabulary IMO this should be done in the body of the text rather than the lead. We of course work on consensus and if consensus is against me I will not push the matter. Doc James  (talk · contribs · email) 19:22, 17 October 2016 (UTC)
 * This same kind of garbage besets articles in other fields (the ridiculous infobox wars, where creators of featured content cannot bear to have an infobox mar their precious creations (please read that with the venom with which I wrote it)). It is arrogant to demand that your "polished prose" be untouched and it is disgustingly arrogant to demand that readers "expand their vocabularies". Really  - about that - this is unacceptable.   I aspire to high quality, well sourced content but I  hate - hate - this attitude of protecting highly polished prose in the face of all other values in this project.  It is disgusting. Medical articles have generally been free of this and I am very disappointed to encounter it.  An attitude of collaborating to make sure that the lead is accessible and well-written would be great.  Polished prose can be accessible.  It is always hard to optimize under multiple parameters.  Not recognizing that there are multiple parameters is a fundamental mistake of working in a community that has multiple values.  Jytdog (talk) 20:33, 17 October 2016 (UTC)
 * And to clarify I am not just "editing this so the translators have an easier job" I also do so as I wish to increase accessibility for those who speak En as a second language or do not have a professional vocabulary. Here by the way is a breakdown of were our readers are from. Doc James  (talk · contribs · email) 20:51, 17 October 2016 (UTC)

I looked here after seeing mention of it on some user talk pages. I'm far from having made a careful study, but my gut reaction is to think that Sandy and Colin are making good points. I guess I can see how simpler language is easier to translate (not that I regard that as a primary objective, because I don't), but I would think that any language can be translated into another language if the translators are good enough at it (and in hypertext, any isolated incidence of a word or phrase that does not translate precisely can be readily clarified in the target language). I also do not think we are writing for readers who are non-fluent in English. I do believe that we should write for a general audience, rather than for specialists, but again, hypertext makes it easy to define unfamiliar terms. --Tryptofish (talk) 22:08, 17 October 2016 (UTC)
 * We are all over on my talk now :) Sandy Georgia  (Talk) 22:25, 17 October 2016 (UTC)
 * Then feel free to quote me (wink). Otherwise, I've said what I wanted to say, so anybody please ping me if you need more. --Tryptofish (talk) 22:35, 17 October 2016 (UTC)

Minor reworking
OK, I can live with this version. I've merged some sentences to eliminate the choppiness, moved things around a wee bit without changing Doc's preferred order, adjusted a few words, and worked in a bit of new text to make the new organization flow better. Comments? Sandy Georgia (Talk) 00:28, 18 October 2016 (UTC)
 * Yes I think it looks much better.
 * With respect to "Between 0.4% and 3.8% of children and adolescents ages 5 to 18 may have Tourette's." the ref says "studies have suggested a prevalence of 1% of youngsters between the ages of 5 and 18 years"
 * And page 83 of the DSM 5 states "prevalence of Tourette's disorder ranges from 3 to 8 per 1,000 school age children" so not sure were 3.8 comes from.
 * Doc James (talk · contribs · email) 02:30, 18 October 2016 (UTC)


 * I will have a look, but you may recall that Eubulides specialty was epidemiology, and we had quite a long go-round to compromise on epidemiology because of all the differences in sources, so it will take me some time. (Prevalence of TS is very complex, so I would be more inclined to question what sources DSM used ... more once I have dug back in to sources, and prevalance is increasing all the time ... )  Sandy Georgia  (Talk) 02:53, 18 October 2016 (UTC)
 * The DSM5 does not quote any references anywhere. Doc James  (talk · contribs · email) 03:08, 18 October 2016 (UTC)


 * Found: Yes, the source is Robertson (2011), which states 1% but cites as the source for that Robertson 2008 from which also came the range (I believe a citation was dropped when Robertson updated --  The prevalence and epidemiology of Gilles de la Tourette syndrome.)   Then, Du et al. (2010) report 1 to 3% in school-age children .  Several other sources are in line with the single point estimate of 1%, and since the range came from an older (2008) article, it makes sense to lose the Robertson range and just keep the (Robertson) 1% -- which means we would be ignoring Du et. al and others on the range, but exploring it in the body of the article.  There are many reasons epidemiology is tricky with TS, including that most children "outgrow" it, there are very few good studies, and so it's a decision of whether to report prevalence among school-age children or overall population, but the school-age rate is more useful IMO.  I can switch to Robertson 1%, without the range, if you concur.  Sandy Georgia  (Talk) 03:42, 18 October 2016 (UTC)
 * Sounds perfectly reasonable and about 1% is about the same as the DSM5 range. Doc James  (talk · contribs · email) 03:46, 18 October 2016 (UTC)
 * OK, will do that change momentarily (I may need to fix the body for the missing citation), and then off for the night. Sandy Georgia  (Talk) 03:55, 18 October 2016 (UTC)

MOS:BOLDTITLE
By the way, Doc's move of the significant names for TS to the infobox, and out of the lead, is not in agreement with MOS:BOLDTITLE (and FAs must conform to MOS). Don't much care, but the text in the infobox is barely legible, and those are "real" names of the condition depending on the country one lives in. I understand they were taken out of the lead to make it simpler, but then the stupid infobox needs to have a better font. (Have never wanted this infobox here anyway because it forces the article to knowingly link to sources that contain faulty info ... but we've had that discussion before.) Sandy Georgia (Talk) 00:44, 18 October 2016 (UTC)
 * A couple of them are minor differences "Tourette's syndrome, Tourette's disorder". The other one "Gilles de la Tourette syndrome" is historical and no longer used. We could look at changing the infobox if that would suffice. Doc James  (talk · contribs · email) 02:17, 18 October 2016 (UTC)
 * Some (many?) would argue that there is quite a significant difference between syndrome and disorder :) GTS is used all the time in European literature.  But my bigger complaint is that the font of the synonyms on the infobox is barely legible (and I'm on the "real" computer, not laptop now).  Sandy Georgia  (Talk) 02:54, 18 October 2016 (UTC)
 * Yes am aware of the arguments. Many argue that mental disorders are not diseases because classically diseases require pathological findings. But most of the world use the terms interchangeable (disease, disorder, illness, condition, syndrome) Doc James  (talk · contribs · email) 03:20, 18 October 2016 (UTC)

Faulty links in infobox
Edit on Wikidata --> Disease? TS is not a disease. The official ICD name for the condition isn't even listed there (Combined vocal and multiple motor tic disorder [de la Tourette]). Medline entry: Why must we link to incorrect and useless information because an infobox has the field???? MESH entry: Gene reviews: OMIM Diseases database OK, featured articles are supposed to be comprehensive; this article is. And yet an infobox forces us to link to inaccurate and outdated information which adds NOTHING to the article. I have never wanted the infobox; I am removing the faulty sources. Sandy Georgia (Talk) 01:02, 18 October 2016 (UTC)
 * First sentence is wrong. "Tourette syndrome is a condition that causes a person to make repeated, quick movements or sounds that they cannot control."
 * Second sentence is wrong. " ... Tourette, who first described this disorder in 1885. "
 * Prognosis is wrong. For that matter, most is wrong or useless.
 * Has been completely wrong for several decades, and has not been updated. Since DSM-IV-TR, the requirement for marked distress or significant impairment has been removed, because it was recognized that most people with Tourette's do not have distress or impairment.  Why must we link our readers to inaccurate data simply because someone wants an infobox to feed wikidata.  The information is WRONG.
 * OUTDATED by at least a year, and SLKTR1 is not even a significant gene. Why must we link our readers to outdated info just because an infobx provides the field?
 * a bunch of disproven primary studies. Why?
 * DSM-IV, really?
 * don't really care about your moaning over the infobox. An FA is not a license for drama.  These are all standard and useful links in one way or another; maybe not to you but to others. Jytdog (talk) 01:12, 18 October 2016 (UTC)

Jyt, point by point, above, explain why. Standard practice? Have you seen the arbcase? Why are we pointing our readers-- prominently at the top of the infobox-- to known inaccuracies and outdated information? What purpose does this serve? Sandy Georgia (Talk) 01:12, 18 October 2016 (UTC)
 * see above. Jytdog (talk) 01:13, 18 October 2016 (UTC)
 * I did see above. All I see is a statement about "moaning" and "drama", but no response to the points.  Specifics, point by point, please.  "Standard and useful links" in what way specifically, with respect to the predominance of inaccuracies in all of those links.  It may be clear to you, but it's not clear to me.  Please clarify specifically what each link provides our readers-- convince me.  I wouldn't mind if you did it with the same politeness that I do. I wouldn't mind if you didn't.  But I've long thought you could do yourself and Wikipedia a service by writing an FA, since you are competent to do so.  I don't find the barbs about FAs helpful, and they could leave a misimpression about you to those who don't know you. Sandy Georgia  (Talk) 01:21, 18 October 2016 (UTC)
 * Your personal style is just that, and nothing more. FA is not a license for drama or soapboxing about infoboxes.  Jytdog (talk) 02:31, 18 October 2016 (UTC)
 * OK, you aren't going to answer. If you don't want to do the work, that's understandable, but then it's not quite fair to label it "soapboxing" when someone does do the work and explain why the links are wrong.  Sandy Georgia  (Talk) 02:58, 18 October 2016 (UTC)
 * MedLine is written in easy to understand language but yes they over simplify some of it.. I have no strong feeling about either keeping it or removing it.
 * MeSH ids are important for publishing. It is what pubmed uses.
 * Doc James (talk · contribs · email) 02:34, 18 October 2016 (UTC)
 * Doc, Jytdog's snarkiness aside, this is not an issue so much of whether to use infoboxes, as it is whether we are required to use every parameter in an infobox, when some of them link to quite demonstrably wrong information. Since he won't, would you be able to give me point by point reasons above on which of these must be kept and why?  If you don't object to removing MedLine, then I would like Jytdog to explain why he does.  What about the others?  Sandy Georgia  (Talk) 02:58, 18 October 2016 (UTC)

I do not think any of them must be kept. Medline plus is not the best source but easy to understand.
 * GeneReviews it says it is from 2009 so 7 years old. Not sure how often they update and if an update would automatically be linked to but I imagine.
 * OMIM agree looks like a review of primary sources. But secondary sources are build from primary sources.
 * DiseaseDatabase yes still links to the DSM4. Doc James  (talk · contribs · email) 03:16, 18 October 2016 (UTC)
 * By the way on gout we changed the infobox to a more human friendly one. The classification and external resources were than moved to a box in the external links section. Was thinking of having build a tool to have do the switch. Doc James  (talk · contribs · email) 03:18, 18 October 2016 (UTC)
 * Thanks, Doc. OK,, Doc has given his analysis of the usefulness of each link; you haven't.  DSM-IV was published in 1994 for gosh sakes, and in the interim we have DSM-IV-TR (which made a significant difference for TS), and then DSM5.  Could you please weigh in with reasons for retaining any of these links?  Sandy Georgia  (Talk) 03:46, 18 October 2016 (UTC)
 * What do you think of the idea of moving the external links in the infobox lower in the article? And replacing them with more human interesting content?  Doc James  (talk · contribs · email) 03:49, 18 October 2016 (UTC)
 * They wouldn't bother me quite as much if they weren't up front and so prominent, when they are so wrong. I'd still argue a few of them (in this article's case) should go entirely, so if an external links box is designed, I would hope we would retain that flexibility.  What are you thinking (in this case) ala "more human interesting content"?  The gout example would also lead to all kinds of problems here.  Medications, for example, is a real issue on the Wikidata for Tourette's ... whatever we do, every article is different, and we need flexibility to remove that which is not useful, or just plain wrong, as in the case of the Tourette's infobox.   I've run out of steam for the day ... could you look at the epidemiology post above so we can finalize that point, if you concur?  Sandy Georgia  (Talk) 03:54, 18 October 2016 (UTC)
 * Will create something for discussion. Doc James  (talk · contribs · email) 18:52, 18 October 2016 (UTC)


 * I repeatedly tried to get WPMED to ditch the external links in info boxes as they failed policy on external links and had become merely a set of slots for unthinking editors to add parameters. No other project put external links in quite such degree into their info boxes and no other project fills the most precious real-estate on their articles with unreadable crap like "ICD-10 F95.2 ICD-9-CM 307.23 OMIM 137580 DiseasesDB 5220 MedlinePlus 000733 eMedicine med/3107 neuro/664 MeSH D005879". I would very much support their removal from the lead, and indeed the removal of the so-called info box altogether. I am very wary about substituting a "medical condition" box that assumes all such conditions can be easily summarised by wikilinked one or two words, as it perpetuates the cookie-cutter idea that all our disease articles can be made to look the same, with the same order and name of sections, etc, etc. While some claim the ICD codes/links are of use, there is no merit in the numbers for OMIM, DiseaseDB, MedlinePlus, eMedicine, MeSH -- they are just random database IDs. Instead, carefully choose links and write them out in full and per policy on EL. Very sad to see such spiteful hostile comments from Jytdog, who has contributed nothing useful here. -- Colin°Talk 11:53, 18 October 2016 (UTC)
 * am very happy we have not been beset by FA-writers Dramah Syndrome over infoboxes. WP:MED is data driven and people are almost all happy to use Wikidata to link to standard sources of data.  if you bring this to WP:MED you will get negligible if any support - the "precious real estate" stance is a fringe within WP:MED. So please drop this line of discussion.   thanks. Jytdog (talk) 17:42, 18 October 2016 (UTC)
 * Having the data linked is sensible, but its dominance in the infobox diminishes the actual data that Wikipedia can and should present. What really should happen is that authority control, while only about humans presently, should be expanded to include any of a number of identifiers, its use broadened to many/all articles, and the links removed from any of a variety of infoboxes (this one and Template:infobox chemical are the ones of which I can think). --Izno (talk) 18:09, 18 October 2016 (UTC)
 * I have a comment regarding the Wikidata edit for "disease"--this is due to a deficient bot (d:User:ProteinBoxBot) which adds inappropriate superclass information to a Wikidata entity. I have requested for the operators to fix the bot such that it only includes the immediate superclass, and given them a poke today because I saw your comment. --Izno (talk) 18:07, 18 October 2016 (UTC)

Discussion continued at Talk:Tourette_syndrome. Sandy Georgia (Talk) 01:29, 19 October 2016 (UTC)

note on reading level
from discussion at WT:MED....


 * The accessible version is self-archived on the author's website.
 * The accessible version is self-archived on the author's website.


 * comments on reading level required for our articles are interesting. "The readability of Wikipedia articles has continued to be unsatisfactory according to the yardstick of consumer health best practices. ...The article on Parkinson’s Disease can be considered to be the epitome of what the project seeks to accomplish....However, according to a recent assessment of the reading level of this article, a high narrative complexity had the potential to alienate readers and make them refer to substandard, simplified sources. The reading level of this particular article was calculated to substantially exceed the NIH’s recommended 7th grade readability level with almost any assessment tool that was used. A number of other studies have the same findings both for particular disciplines and for the encyclopedia as a whole. Nora Hutchinson’s article is fairly representative of this research in its finding that Wikipedia’s reading level was significantly higher than that of WebMD,  the Mayo Clinic’s website, and a number of other diagnosis-specific sites."
 * which is something we should keep in mind per WP:NOTJOURNAL (which is policy): "A Wikipedia article should not be presented on the assumption that the reader is well-versed in the topic's field. Introductory language in the lead (and also maybe the initial sections) of the article should be written in plain terms and concepts that can be understood by any literate reader of Wikipedia without any knowledge in the given field before advancing to more detailed explanations of the topic. While wikilinks should be provided for advanced terms and concepts in that field, articles should be written on the assumption that the reader will not or cannot follow these links, instead attempting to infer their meaning from the text."Jytdog (talk) 14:21, 20 October 2016 (UTC)


 * Or, as this policy was often alternately stated in FAC reviews (or at least was in the past), do not require readers to click on a wikilink to understand the lead ... if a term is used in the lead that is not commonly understood, use the link, but define it in parens. But the idea that we should aim at 7th grade is new since my tenure at FAC:  we aimed for upper level high school If I Recall Correctly.  Too many years ago to find those old conversations about reading level, though ... More tomorrow, busy day. Sandy Georgia  (Talk) 15:42, 20 October 2016 (UTC)
 * Just checked WP:MEDMOS, and do not find that our recommendations have changed since I was last hyper-active here on Wiki, but that was a quick scan, and I may have missed something. The NIH has a very different audience than an online encyclopedia does.  If someone proposes or has proposed a 7th grade reading level at MEDMOS, I would oppose.  NIH has handouts that are given to a very different demographic than readers of an online encyclopedia.  Has there been a change that I missed?  Sandy Georgia  (Talk) 15:56, 20 October 2016 (UTC)
 * We have "The leads of articles, if not the entire article, should be written as simply as possible without introducing errors." Doc James  (talk · contribs · email) 22:29, 20 October 2016 (UTC)
 * I see the problem. To be continued. Sandy Georgia  (Talk) 13:29, 21 October 2016 (UTC)

Copyright and attribution on translations interwiki

 * , could you provide guidance? Sandy Georgia  (Talk) 13:47, 17 October 2016 (UTC)

Now that I know why Doc James did this ... If I regain interest after this experience, I will at my leisure, step back through and make the necessary fixes. I can retain some of the necessary wording changes, while restoring the essentials as mentioned by Colin. If I care anymore. At least now the article is not inaccurate as Doc's first version was -- it is only dumbed down and awkward. Since I spend limited time on Wikipedia these days, I am unsure when or if I will attempt this. Doc, I am glad to finally understand why you did this, because I found it to be a most bewildering encounter with you, not understanding why you barged in here after ten years and unilaterally rewrote the lead. So my suggestions to you are: For now I have other things to work on. I wrote about 70% of this article (some as IPs before I registered an account). I see it has been copied almost verbatim on multiple translations, including several featured. If the correct attribution was not done on those translations, I have a copyright/attribution concern. Personally. I hope it is not a legal threat to say that I intend to investigate how the matter of correct attribution works on interwiki translation. Sandy Georgia (Talk) 13:32, 17 October 2016 (UTC)
 * 1) If you would have announced in advance why you were fiddling with the lead, I could have helped you make those decisions about which words to dumb down and whether the order of the lead should be changed.  We could have made  measured decisions together about whether essential words in medical reading -- critical words to this particular topic like comorbid, prevalence, premonitory, wax and wane, etc -- should be changed.  For example, as I stated "wax and wane" is simply the best and most accurate way to describe how the tics of TS behave-- particularly compared to the stereotyped movements of other conditions-- so I'm glad I did not let you remove it.  That it might not translate well is not a good enough reason to remove it from the English version-- perhaps the medical project should be translating from Simple Wikipedia rather than from Featured Articles.  I have always been troubled by translation on Wikipedia, because anyone not immersed in this topic will not know how to translate critical concepts and probably shouldn't be doing it.  And no one should be translating without consulting the original sources.
 * 2) Do not do this again to a Featured (and perhaps even a Good article):  WP-OWN-FA is a policy page.  My suggestion is that you first make a proposal on talk and explain not only what you want to do, but why you doing it.  As Colin mentions, the lead has now lost the careful selection of information that most people seeking to learn about TS need-- and those people are most often terrified parents of a five-to-eight year old, or curiosity seekers who need to be better informed.  The lead was not a medical factsheet-- it was carefully constructed for the most likely readers.
 * User:SandyGeorgia feel free to revert back to the version you are happier with.
 * I have not been involved with any of the translations of this article into other languages. Doc James  (talk · contribs · email) 19:24, 17 October 2016 (UTC)

Moonriddengirl appears to be barely active; this is what I have found:
 * 1) Translation
 * 2) Copying within Wikipedia
 * 3) Template:Translated page
 * 4) Template:Copied

which is pretty useless, because I would need to find the templates on the other-language Wiki. Would it be more expedient to send a DMCA takedown notice to the Wiki Foundation for every other language TS article, and let them sort their mess? Does a takedown notice by a Wikipedian breach No Legal Threats? IF so, how am I to locate all of these templates in all of these languages? Sandy Georgia (Talk) 02:05, 18 October 2016 (UTC)


 * How about reaching out to the editors in question first? Tell them to create the template in their language and add it to the page. Doc James  (talk · contribs · email) 02:14, 18 October 2016 (UTC)


 * How do you do that when you don't speak the language? So that was a mess in a language I speak; Wikipedia needs to clean their own house in languages I don't speak. Not sure to whom to write in the absence of Moonriddengirl. But I did attempt to ping the no.wiki and the es.wiki editors, and I did add a template in Spanish.  Sandy Georgia  (Talk) 02:42, 18 October 2016 (UTC)


 * Okay we have templates in it, es and ru already. Will take care of those three. And will work on creating templates in no and pt. Doc James  (talk · contribs · email) 02:40, 18 October 2016 (UTC)


 * Spanish is done (see above). Here is what I added at Norway, since I can't read the tempalte.  Sandy Georgia  (Talk) 02:44, 18 October 2016 (UTC)
 * Have added templates to the talk pages of the rest of the languages listed below Doc James  (talk · contribs · email) 03:05, 18 October 2016 (UTC)
 * Thanks, DOc ... it seems necessary to continue to remind translators that translations need attribution (often at DYK there are copyvio issues on non-English sources, and editors aren't aware that you can't just translate verbatim ... ). I appreciate you doing those, and hope you will keep up the reminders.  Sandy Georgia  (Talk) 04:16, 18 October 2016 (UTC)
 * Yes I was letting someone today who is possibly from the WHO, again know that they simply cannot copy and past from their own website until they release it under an open license.. Doc James  (talk · contribs · email) 18:48, 18 October 2016 (UTC)

Norway

 * As but one of many (MANY) examples I intend to pursue, the Norway TS article appears to be a Featured copy of this article. I don't find attribution on the article page or on article talk, but I don't speak the language.  If anyone knows someone who does speak the language, can you locate attribution in edit summary? I will focus on the Italian and Spanish articles, since I do speak those languages and can determine if there is a problem with lack of attribution on content I wrote, and if that lack of attribution results in a take-down per DMCA. Please don't email me on this, because I long ago lost my passwords and need to work on restoring my email account.  Sandy Georgia  (Talk) 13:49, 17 October 2016 (UTC)

As for the translators' skills. My lack of knowledge on a subject is no indication of the translations quality. My role in the process was only nominating the article as an FA, which i do in 75 % of all FA processes on no:wp. Runareggen is/was part of a wikipedian team within Norwegian Electronic Health Library, together with no:Bruker:Arnejanh, a clinical psychologist, and no:Bruker:Øystein Eiring, a doctor and psychiatrist. That wikipedian team translated several articles to norwegian during 2010-2011 (including 5 faq/ga), and made a significant contribution to a field where we (no:wp) have few other skilled contributors. --Orland (talk) 11:10, 18 October 2016 (UTC)
 * Google translate coughs up this translation on the FA nomination for the Norway article: "This is the fourth article of the team from the Health Library. I have to use the familiar caveat that I can not vouch for the professional level in the text; but both the original English and translators' skills seem convincing to me. M Haugen Feb 15, 2011 at. 1:19 p.m. (CET)" An editor who admits knowing nothing of the topic brings the article to Featured level on another Wiki.  This is a problem with translations that has long concerned me, and should concern all of us-- no one who isn't immersed in the topic and the sources should be translating.   Still looking for attribution of content I wrote on no.wikipedia.  Sandy Georgia  (Talk) 13:58, 17 October 2016 (UTC)
 * , thank you for bringing this article to Featured status on another Wiki. Could you please provide a diff that shows when attribution occurred in edit summary?  I don't speak the language. Thanks, Sandy Georgia  (Talk) 14:01, 17 October 2016 (UTC)
 * Never mind, I found it, from . . My suggestion as a warning to readers about possible problems introduced by translators who do not know the topic is that there should be a template on the article, or at least on the talk page.  Is anyone familiar with the topic maintaining the five-year-old Norway version to Featured standards?  Sandy Georgia  (Talk) 14:12, 17 October 2016 (UTC)
 * I have now (also) inserted the requested tag on no:Diskusjon:Tourettes syndrom.

It gives the revision number which is nice "Revision as of 22:29, 5 December 2010 by Runareggen (talk | contribs) (Translated from http://en.wikipedia.org/wiki/Tourette_syndrome (revision: 392451580) using http://translate.google.com/toolkit with about 49% human translations.)" Doc James  (talk · contribs · email) 20:12, 17 October 2016 (UTC)


 * Request left on no.wiki, since I can't read the template. And I pinged the translator, here.  Sandy Georgia  (Talk) 02:47, 18 October 2016 (UTC)

✅ added tag  Doc James  (talk · contribs · email) 03:03, 18 October 2016 (UTC)

Italian
The Italian featured article has a talk page template on translation: "Questa voce contiene una traduzione, completa o parziale, della voce originale: Tourette syndrome» tratta da en.wikipedia.org. Consulta la cronologia della pagina originale per conoscere l'elenco degli autori." I suggest a link to the version copied so readers will know how out of date and corrupted the translation becomes. The template was added 28 Sept 2016. We are left to guess which edits were translated, but looking at contributions on 9 Sept from the same editor who added the template, we still can't tell.  Does this satisfy our attribution requirement? More significantly, the Italians also have a medical warning to readers at the top, as does the Norway version, at the bottom. In addition to the numerous problems with medical content on Wikipedia, we now have translation issues as well. Perhaps my efforts will be better spent on renewing the effort to get a reader warning on Wikipedia's English content. Sandy Georgia (Talk) 14:23, 17 October 2016 (UTC)
 * I think the talk page attribution would meet the minimum. Could be better in that it could say the version that was translated. Doc James  (talk · contribs · email) 20:10, 17 October 2016 (UTC)
 * It could be pulling from a number of versions. Doc James  (talk · contribs · email) 02:52, 18 October 2016 (UTC)

Spanish
, the Spanish article is crap, but here we have significant portions copied verbatim without attribution. That content was authored mostly by, Colin, Eubulides, Fvasconcellos and me. In previous edit,, a template was added that does not seem to satisfy our enduring requirement for attribution in either edit summary, or less desirably, on talk page. The template doesn't cover which text was added in multiple subsequent edits. Then Evasive removes the translation template, and I find none on talk, so there is no record of attribution of specific text. is awarded on talk by Doc James as top medical editor, so I suspect we are seeing a classic example on the Spanish Wikipedia of what is going on elsewhere. (Nice translation, Evasivo, and I notice you didn't seem to have any problem with the words Doc James found difficult.) I would like the attribution to this article to be corrected, or the text taken down. Sandy Georgia (Talk) 16:41, 17 October 2016 (UTC)
 * The "top medical editor" award is a simple technical thing. Andrew West determines the number of edits made to medical articles across all languages in a given year. And the top 250 editors get barnstars. Doc James  (talk · contribs · email) 19:31, 17 October 2016 (UTC)


 * Notice on es.wiki talk, and pinged Evasivo. Sandy Georgia  (Talk) 02:45, 18 October 2016 (UTC)

Portuguese
The lead of the Portuguese TS article is also a translation from en.wiki. No template on the article, no template on talk, so I must troll through edit summaries to discover if my work was attributed. Not an optimal situation. So, I speak fluent Spanish, can read most Italian, and can get by in Portuguese ... what about the editor who cannot? And what about all of the other articles where work I authored was copied without attribution? Sandy Georgia (Talk) 17:03, 17 October 2016 (UTC)
 * The Portuguese text was added in this edit, without attribution, by . Anywhere that I can find.  BINGO.  Moonriddengirl, is Wikipedia going to fix these things, or does Digital Millennium Copyright Act apply?  Sandy Georgia  (Talk) 17:09, 17 October 2016 (UTC)

And, Doc, I need to point out that none of the words that concerned you were a problem in any of the translations in languages I speak or read. Sandy Georgia (Talk) 17:13, 17 October 2016 (UTC)
 * As mentioned the primary effort is not on major European languages. Doc James  (talk · contribs · email) 19:27, 17 October 2016 (UTC)
 * Are we writing for English Wikipedia here, or for some new "world-accessible-via-Google-wiki"? Martinevans123 (talk) 20:15, 17 October 2016 (UTC)
 * The comment was with respect to translation generally. Are we as a Wikimedia movement working to create a multilingual encyclopedia? IMO yes. Doc James  (talk · contribs · email) 20:18, 17 October 2016 (UTC)
 * I see. I honestly think we have enough difficulty working just in a so-called single language separated by a murky pond. But then maybe I have unresolved personality issues. Martinevans123 (talk) 20:23, 17 October 2016 (UTC)
 * Oh, my, Martinevans123, what a dreadful study. Typical of the ascertainment bias crap that creeps in from studying subjects who come to tertiary specialty clinic attention (that is, not representative of the majority of people with TS, who never come to clinical attention, period).  Good example of why we require reviews.  I was most intrigued by the shitty first sentence:  "...  the personality style underlying tic disorders or Tourette's syndrome".  So, dude, you tic because of your underlying personality!  Sandy Georgia  (Talk) 21:54, 17 October 2016 (UTC)
 * Hey, lady. Makes sense for Big pharma, don'tcha know. Don't worry, only baiting our friend "Doc Bones". Martinevans123 (talk) 21:58, 17 October 2016 (UTC)

✅ added template for attribution here Doc James  (talk · contribs · email) 02:58, 18 October 2016 (UTC)

Russian
The Russian TS article is a translation, by Meddoc13, and the translated text was added on 28 August 2010. There is no attribution in any edit summary or on the Talk Page. Also of interest is that "eponym" was not difficult to translate as it it exactly the same in russian (apart from the Cyrillic script). Graham Beards (talk) 18:30, 17 October 2016 (UTC)
 * A note with respect to the translation project, we are not working really on translating into major European languages like Russian and Spanish, but more into small and mid sized language groups like Swahili and Oriya. Doc James  (talk · contribs · email) 19:26, 17 October 2016 (UTC)

✅ attribution added to the talk page in Russian  Doc James  (talk · contribs · email) 02:46, 18 October 2016 (UTC)

Splitting the infobox
At the top

At the bottom

Thoughts? We can of course hide the references in the top box if people wish. Doc James (talk · contribs · email) 19:47, 18 October 2016 (UTC)

Discussion
Doc, getting the cruft out of the infobox would be a wonderful improvement. They wouldn't bother me so much if moved to the bottom, as you've done, although they remain inaccurate, hence a problem relative to WP:EL. I wonder why we would link to inaccurate info, but hope we could come to consensus to remove the worst of them from the bottom template. If that would be possible ... love it. The proposed additions to the infobox, though, will lead to the classic problems with trying to convey complex information in one parameter:


 * As one example in this case, we characterize TS as "long-term" which links to "chronic", which is not untrue but is an oversimplification, since the vast majority (yes, overused words, but true) of children with TS outgrow their tics. So, we again bump into the infobox issue that it is difficult to convey nuance and complexities, etc.  For most children, tics are gone before adulthood.  We can't fit that into an infobox parameter.  And it is one of the single most important and reassuring pieces of information that "parents reeling from the panic of a diagnosis of TS" are looking for.  Instead, before they've explored the text, they will see it is a chronic condition.   Sandy Georgia  (Talk) 22:58, 18 October 2016 (UTC)
 * The DSM5 says they must last for more than 1 year. Chronic does not mean forever, for example we have chronic back pain which is simple more than 3 months and does sometimes also go away. But we can unlink. Doc James  (talk · contribs · email) 23:07, 18 October 2016 (UTC)
 * Fair enough. Sandy Georgia  (Talk) 23:17, 18 October 2016 (UTC)


 * On differential diagnosis, in this article, we would have a very long list, which could become unmanageable for an infobox.   Sandy Georgia  (Talk) 22:58, 18 October 2016 (UTC)
 * The DSM only mentions a few possibilities. I think it is possible to simply list the main ones. Have a max or three like we do for brand names in the infobox. Doc James  (talk · contribs · email) 23:07, 18 October 2016 (UTC)
 * So you might have a hidden comment on the infobox suggesting to list only the three top -- that works. Except what are the three top diff diagnoses?  I don't know how DSM came up with those particular ones ... look at the bottom of Tourette_syndrome.  Sandy Georgia  (Talk) 23:17, 18 October 2016 (UTC)
 * The DSM5 is expert opinion which is reasonable for this content IMO. Doc James  (talk · contribs · email) 23:34, 18 October 2016 (UTC)
 * The DSM5 is expert opinion on DSM5 diagnostic criteria. Which of this "motley crew" (j/k) do you consider to be an expert on TS?  (Hint: observe the effects of the PANDAS debate.)  (Second hint:  Castellanos is ADHD, with some overlap with TS, but not really a TS guy.)  We cannot favor the DSM5 (beyond the diagnostic criteria) above other sources, and certainly not above TS experts.  The DSM5 is a diagnostic tool:  its other information about conditions is not higher in importance than literature from the researchers who have dedicated their lives to understanding the condition(s).  (I might make an exception if a single outstanding TS person was on the committee-- there isn't one.  TS, to its detriment, has turned out to be just No Big Deal, so its researchers get sidelined in favor or other conditions.)  Sandy Georgia  (Talk) 01:12, 19 October 2016 (UTC)
 * The expert on differential diagnosis in TS is pretty much Jankovic. Notice how many times his name shows up in high-quality TS reviews, vs. Castellanos (although you can find him over at ADHD), versus Swedo, who you can certainly find at PANDAS. Sandy Georgia  (Talk) 01:34, 19 October 2016 (UTC)
 * I am not attached to the different that the DSM5 presents. Happy to see other conditions listed if their are better sources. Any suggestions? Doc James  (talk · contribs · email) 01:59, 19 October 2016 (UTC)
 * Can think on this another day ... for now, just an example of the issues caused by infobox parameters. I will review the literature ... Sandy Georgia (Talk) 02:54, 19 October 2016 (UTC)
 * I've looked at the literature. The DSM5 focus on those two is just ... off.  (Although I can see why they may have listed them, based on a couple of primary studies.)  What that diff diagnosis does not convey is much more useful information-- TS is most frequently missed or misdiagnosed as allergies, asthma, or confused with stereotypic movement disorder or secondary causes of tics like autism, etc.   My suggestion-- if you decide you want to go this way-- is to lose the Diff Diagnosis in the proposed infobox, and just replace it with Diagnostic Method.  In this case, then, we would say something about No medical tests, based on history and observation and ruling out other conditions.  That is more useful info to the likely readers of this article.  But I will raise other concerns below.  Sandy Georgia  (Talk) 14:57, 19 October 2016 (UTC)
 * Yes "diagnostic method" would be fine. One could "based on symptoms". Doc James  (talk · contribs · email) 22:41, 19 October 2016 (UTC)


 * On Causes, unknown, that is also a generalization that verges on inaccuracy, because TS is basically genetic-- the genetic mechanism has not been discovered. You won't find a credible researcher, TS expert, or journal article that denies that TS is inherited, with variable penetrance, impacted by environmental factors.  Sandy Georgia  (Talk) 22:58, 18 October 2016 (UTC)
 * "it is also possible that many genes with smaller effects and environmental factors may play a role in the development of TS." But yes likely genetic but still not confirmed. Doc James  (talk · contribs · email) 23:07, 18 October 2016 (UTC)
 * Unconfirmed for a huge number of reasons, including that it is likely many genes. But inherited. Sandy Georgia (Talk) 23:17, 18 October 2016 (UTC)
 * Yes inherited or partly inherited for sure. But which genes is not completely clear. We could also have "partly inherited" as the cause. Doc James  (talk · contribs · email) 23:35, 18 October 2016 (UTC)
 * So, the nuance is that TS is most clearly genetic, but we say unknown because we don't know the genetic mechanism. This creates an infobox dilemma.  Sandy Georgia  (Talk) 01:12, 19 October 2016 (UTC)
 * So would "Partly genetic" work? Doc James  (talk · contribs · email) 02:00, 19 October 2016 (UTC)
 * Genetic with environmental influence? It's genetic.  Variable penetrance.  Environmental factors affect the expression of the genetic predisposition.  Sandy Georgia  (Talk) 02:54, 19 October 2016 (UTC)
 * Yes would be happy with "Genetic with environmental influence" Doc James  (talk · contribs · email) 03:57, 19 October 2016 (UTC)


 * Frequency of TS cannot be conveyed in an infobox, because ... are we talking about the rate in adults or children, etc ? We are (temporarily) lucky that Robertson is of the opinion that the rate in adulthood is similar to in childhood, but ... that opinion is unlikely to hold, and not all agree (I should tease this out better in the article, but epidemiology was already a convoluted mess-- did some work on that this morning).  If the numbers diverge, can we handle that in an infobox?  Sandy Georgia  (Talk) 22:58, 18 October 2016 (UTC)
 * We have "It is estimated that 200,000 Americans have the most severe form of TS, and as many as one in 100 exhibit milder and less complex symptoms such as chronic motor or vocal tics." Doc James  (talk · contribs · email) 23:07, 18 October 2016 (UTC)
 * Yes, that shows the problem. The first number is talking about severe TS in adults, which is quite rare, while the second part is talking about tic disorders rather than TS.  That's the problem with TS epidemiology ... we talk about it in many different ways, basically, to end up saying that mild TS is very common, extreme TS is very rare.
 * SO do you see how these parameters could result in the problems we often see in infoboxes? We have a whole 'nother level of discussion to clarify infobox info that is summarized in ways that could be misleading, when those issues are covered in the text.  Sandy Georgia  (Talk) 23:17, 18 October 2016 (UTC)
 * Which is why the "~" symbol. This is an estimate. We could put in a range aswell. Doc James  (talk · contribs · email) 23:37, 18 October 2016 (UTC)
 * OK, that works. Sandy Georgia  (Talk) 01:12, 19 October 2016 (UTC)

So, we could be changing one set of infobox problems for another. Really like getting those links away from the top prominence, though. Sandy Georgia (Talk) 22:58, 18 October 2016 (UTC)
 * All describes are varying degrees of approximations of reality. Some are simpler and less precise. Others are more complicated and more precise. None are 100% correct. Different people are looking for different degrees of accuracy. The infobox can provide one, the lead a second, the body a third, and subpages a fourth. This is one way we can reach multiple audiences within a single article. Doc James  (talk · contribs · email) 23:42, 18 October 2016 (UTC)


 * changes as proposed are fine. thanks for the suggestion. Jytdog (talk) 23:13, 18 October 2016 (UTC)

Infobox citations and other issues
Doc, in this version, with the exception of the problems with Differential diagnosis (mentioned above), your proposal is getting closer to something useful to our readers. In particular, moving the inaccurate links to the bottom of the page is nice, and some of the infobox parameters you propose might actually encourage readers to further explore the content of the article.
 * Duration-- long term (much better than chronic) will lead readers to want to know more: how long, what is the prognosis, will these tics diminish?
 * Causes-- genetic with environmental influence could lead readers to want to better understand those environmental influences.
 * Frequency-- ~ 1%. As a math undergrad, the ~ works for me, but for most readers, I would suggest changing that to "about" or "approximately" or something in English rather than a symbol.  And that could encourage further reading among those who want to know what the "about" is about.

In other words, one thing I am liking is that instead of attempting to be a summary of the condition that can stand-alone, these parameters could lead to additional exploration of the content. Sandy Georgia (Talk) 15:28, 19 October 2016 (UTC)
 * Sure "about" is fine. Doc James  (talk · contribs · email) 22:40, 19 October 2016 (UTC)

Now, to the problems
Do you see how much discussion we have had to have to nail down the information in these parameters? Are you prepared to deal with this level of (typical) infobox issues on muliple other health and medicine articles? You would be replacing a series of links with information that needs and requires extended discussion and MEDRS citation, which leads to my next point. This is an FA; the infobox must be cited. Now, let's look at the problem with this piece of work. DSM 5 was published in 2013. This factsheet was published in 2012, and allegedly updated in 2014. Seriously? Typical of YEARS of problems with them wrt Tourette's information, knowledge, and accuracy. So, first link our readers would encounter (a source you seem to trust), and we're back to the same problem we started with - faulty links in the infobox. The first paragraph of that source is demonstrably wrong! Those readers who may only read the infobox need to be led to the highest quality, most recent, and most accurate sources ... so we've got additional work cut out for updating infoboxes, if this is the way you want to go. Everything in that box needs high quality, MEDRS-compliant sources. Sandy Georgia (Talk) 15:35, 19 October 2016 (UTC)
 * 1) The word Stereotyped was removed from DSM 5 partly because stereotypic movement disorder (and other secondary causes of tics on the autism spectrum) are so often confused with TS (apparently not even mentioned as diff diagnosis in DSM). So, the DSM was revised, but the NIH can't be bothered to update their factsheet to account for DSM 5?  Why do you think I don't rely on these kinds of sources?
 * 2)  "Dr. Georges Gilles de la Tourette, the pioneering French neurologist [DID NOT] first describe the condition in an 86-year-old French noblewoman ... "
 * Jean Marc Gaspard Itard described tics in Charcot's patient Marquise de Dampierre 60 years before GTS published his account of nine patients, including her.
 * NINDS is exceedingly well respected. But just goes to show even reliable sources can be inaccurate in some points. NINDS supports what it is being used for. None of the claims being made are extraordinary so IMO it is fine. Doc James  (talk · contribs · email) 22:43, 19 October 2016 (UTC)
 * Sources for each article must be evaluated based on a number of factors, but you know that. NIH and their various branches are not an "exceedingly well respected" source in this topic.  Should we go this direction with the infobox, I will continue in my search for a freely available, well-written journal article for sourcing the infobox.  I do not want the first link our readers encounter to contain faulty info.   Doc, your bottom template is now in sandbox.  What does it take to make this happen?  Back tomorrow, Sandy Georgia  (Talk) 15:47, 20 October 2016 (UTC)
 * Used the non sandbox version Doc James  (talk · contribs · email) 22:30, 20 October 2016 (UTC)

Reverts
I've reverted edits done by as they appear to violate WP:NPOV, are not attributed to the sources (as they claim they are), and have introduced weasel words and expressions of doubt which are not attributed. Garchy (talk) 19:41, 24 April 2017 (UTC)
 * Sounds good. Doc James  (talk · contribs · email) 20:58, 24 April 2017 (UTC)

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"25% of cases"
User:Jaygeeee33, in this edit you inserted the claim that: "There are also an estimated 25% of cases where there is no evidence of genetic factors." Your edit summary said: "this text is directly from the reference cited". I wonder could you point out in which of the existing three sources that claim can be found, and exactly on which page(s)? Many thanks. Martinevans123 (talk) 17:51, 17 October 2017 (UTC)

Sidebar link broken
When I clicked on the "CBS News video clip" link in the sidebar labeled "Video clips of tics", it sent me to a CBS video about Charlie Rose being suspended amidst allegations of sexual misconduct. 97.127.15.92 (talk) 22:47, 21 November 2017 (UTC)


 * Have updated it with this clip. Thanks for spotting that. Martinevans123 (talk) 23:26, 21 November 2017 (UTC)

Tourette's syndrome
This article begins by talking about "Tourette syndrome" but should it also say that the disorder can be called "Tourette's syndrome"?Vorbee (talk) 09:35, 8 December 2017 (UTC)

Refs
I did the search in pubmed for reviews and found the following nonfree sources from the last two years, which I have obtained and can provide to anyone who wants them; there are several PMC reviews not listed here:


 * shaw tics.pdf
 * ganos tics.pdf
 * J Brit Psych 2015 lived experience.pdf
 * psych res valproate.pdf
 * advances.pdf
 * JAMA 2015 cannabinoids.pdf
 * Movement_Disorders 2015 pathophysiology.pdf
 * neuropharmacology 2016 histamine.pdf
 * Movement_Disorders 2015 therapeutics tics.pdf
 * Eur Child Adolesc Psychiatry 2016 stigma.pdf
 * reflections prev.pdf
 * reflections assess.pdf
 * corrections.pdf
 * Movement Disorders 2015 imaging.pdf
 * bmj Fifteen minute consultation2016.pdf
 * Curr Opin Neurol 2016 fMRI.pdf
 * nat rev neurol 2016.pdf
 * Prog Neuropsychopharmacol Biol Psychiatry 2016.pdf
 * Curr Neurol Neurosci Rep 2016.pdf
 * J Child Psych Practitioner Review.pdf
 * Curr Neurol Neurosci Rep 2016.pdf
 * J Child Psych Practitioner Review.pdf

-- if you want any of them, you can email me. i need to read them and will begin updating based on them when i am ready. Jytdog (talk) 20:07, 21 October 2016 (UTC)

Removed for discussion - diet

 * Preliminary evidence suggest that refined sugar, caffeine, and gluten may exacerbate tics.
 * , studies on the impact of dietary interventions on the symptoms of Tourette's are scarce and methodologically poor, and a single dietary pattern has not been established. Anecdotal reports suggest that certain dietary interventions may relieve symptoms, such as gluten-free and low-sugar diets.

This article is not listed at PubMed as a review, and is a very weak source-- based on parent anecdote. Also, the only review wrt Tourette and diet that I can locate in PubMed is from 1992. Sandy Georgia (Talk)  06:34, 23 March 2018 (UTC)

I know food and drink can induce tics, for example if I drink strong liquor straight it will make me tic; if i eat lemon and limes it will make me tic but that's just the strong taste setting off my tics; as for a particular diet affecting tics positively or adversely, I wouldn't know about that. HardeeHar (talk) 23:17, 24 July 2018 (UTC)

Histamine
In this edit, I reduced excess verbiage, removed primary sources, and tightened the prose to agree with the encyclopedic tone of a broad, overview article. However, I am not convinced this text belongs in a broad overview article, which relies almost exclusively (as an FA) on the highest-quality broad reviews of the general topic, rather than the reviews used to cite this text, which are very narrowly focused on the topic of Histamine. To retain this text in the article, a broad review of TS in general that places the H-3 in context wrt pathophysiology should be provided. Sandy Georgia (Talk)  06:30, 23 March 2018 (UTC)
 * After 2010, the role of histamine and the H3-receptor came into focus in the pathophysiology of TS, as "key modulators of striatal circuitry". A reduced level of histamine in the H3-receptor may disrupt other neurotransmitters, causing tics.

Video
It fits well under classification. And the video is supported by high quality references. It is not an external link. Doc James (talk · contribs · email) 23:59, 23 March 2018 (UTC)
 * It is replete with errors, and does not rise to the level of sources required for an FA. As hard as I worked to keep the POV words "suffer from" out of this article ... sheesh ... but that is not the worst of their errors.  I have a list.  It is also in breach of all manner of MOS-y stuff, which FAs must comply with ... I can live with these videos if I must in B- or C-class articles, but they breach too many parts of WP:WIAFA.   Also, how is it not an External link?  If it claims to be a source, where is their high-quality, recent secondary review that calls tics "quick" movements?  Like to see it, 'cuz it's wrong :)  There's more. It could go on tic disorders because that is, after all, what it is about.  If they clean up all the errors, once I post the list.  Which is buried somewhere in my car at the moment ... Tic disorders is not an FA, so breaching sourcing and other requirements there won't bug me at all. Sandy Georgia  (Talk)  02:36, 24 March 2018 (UTC)
 * "Tics are sudden twitches, movements, or sounds that people do repeatedly." Doc James  (talk · contribs · email) 05:04, 24 March 2018 (UTC)
 * Sudden is not quick. Sandy Georgia  (Talk)  16:18, 2 April 2018 (UTC)

Bots
I asked you this, and you responded with this. Please review WP:BRD and WP:EDITWAR, and use the talk page for discussion rather than reverting. More importantly, could you please explain to me where, in what discussion, the original problems at this article with the bots have been solved? Sandy Georgia (Talk)  14:56, 3 April 2018 (UTC)
 * It is not a bold edit. It is correcting (by removal) the misuse of a template. Read the documentation, and stop using bots as a blunt instrument contrary to the documentation. Did you address the problem with the bot operators? No, then the template shouldn't be used. —&thinsp;JJMC89&thinsp; (T·C) 04:10, 4 April 2018 (UTC)
 * , in order to help solve this problem, could you please answer the question? Yes, I attempted over a long period of time to get the problems resolved, and the conclusion was to add the templates.  Since you are removing them, could you please tell me if the problems have been solved?  Presumably, you have a reason for removing them because you know something about the resolution of the issues that I don't; please explain. Sandy Georgia  (Talk)  11:40, 4 April 2018 (UTC)
 * avoid change in citation style (02:10, 28 May 2017): InternetArchiveBot does not and did not change the citation style in the prior edit to the article. IABot edited after your edit since is malformed.
 * stop citation bot from editing here - shouldn't be adding quotes, not sure who's activating it (13:44, 26 December 2011): The bot is user activated, and using quotes for reference names is the safest form since HTML attributes cannot have spaces,,  ,  ,  ,  , or  . The bot won't be preforming the same edit since the duplicate 'Disentangling' reference is no longer in the article.
 * —&thinsp;JJMC89&thinsp; (T·C) 23:53, 7 April 2018 (UTC)

Barking like a dog
It was said on Sue MacGregor's BBC Radio Four programme "The Reunion" on Friday 13 April that some (but not all) people with Tourette's syndrome bark like dogs. Barking like dogs does not appear to be a characteristic listed in this article. Vorbee (talk) 08:32, 13 April 2018 (UTC)
 * Any movement or vocalization can be a tic, and it's not possible to list them all; the most common tics are noted. (Yes, barking like a dog can be a tic, and yes, the British media is fascinated with sensationalizing unusual tics.)  If you have a secondary, MEDRS source that mentions barking, it could be added to the tic article.  Sandy Georgia  (Talk)  11:57, 13 April 2018 (UTC)


 * For anyone who wants to listen, the programme is here. It was about the Enfield Poltergeist. The relevant part is from approx 22m 00s and involves the son of paranormal investigator Maurice Grosse. MacGregor seems to suggest that "some people" who suffer from Tourette's "get the ability to bark like a dog." But this seems quite a nonsensical explanation of the continuous gruff-sounding voice. The Tourette's explanation is not mentioned in the poltergeist article. Martinevans123 (talk) 09:48, 15 July 2018 (UTeC)


 * There are many tics, usually categorized as either motor tics or vocal tics. Vocal tics include puffing, grunting, squeaking, coughing, and yes making animal sounds such as bird chirping, pig grunting and dog barking.  Listing all possible tics would not, in my opinion, be a useful addition to the article.Work permit (talk) 19:04, 15 July 2018 (UTC)

Echolalia is listed, that can make one bark like a dog. HardeeHar (talk) 23:05, 24 July 2018 (UTC)

Other factors that induce on tics
Tiredness, pain and being startled can induce tics in Tourettes sufferers HardeeHar (talk) 22:59, 24 July 2018 (UTC)

Society and culture
I've noticed that it's socially acceptable to mock Tourettes, just search Twitter and you'll find endless tweets of people making comments mocking Tourettes, there's even accounts that tweet nothing but comments mocking Tourettes and nobody criticises it, even Twitter considers it acceptable even though their rules state that it's a rule break to do hateful tweets about disabilities. There was a smear campaign against Donald trump on Twitter, thousands of accounts tweeting that trump had Tourettes to stigmatise him but their was no public outcry criticisiding people for being hateful and Twitter banned nobody for it. People on Twitter created the slang term "Twitter tourettes" as a derogatory term, it's now a commonly used term on Twitter. Twitter is fine with such remarks about Tourettes and doesn't suspend violators even though hateful tweets are against twitters rules. HardeeHar (talk) 23:40, 24 July 2018 (UTC)

I just thought I'd point that out as it is quite significant as its different from the social norm, as normally it's socially unacceptable to mock people with disabilities or conditions. HardeeHar (talk) 23:52, 24 July 2018 (UTC)

Controversies
Japan had a forced sterilisation program until 1996 (https://en.m.wikipedia.org/wiki/Eugenics_in_Japan). Apparently their program affected persons with Tourettes. HardeeHar (talk) 00:03, 25 July 2018 (UTC)

Non-relevant picture
I suggest removing the picture with JFK, Malraux, their spouses and LBJ. To be honest I just wasted 2 minutes of my life reading the legend to understand which one(s) of these characters suffered from Tourette. Only Malraux apparently, - so either a picture of Malraux by himself would do - or else just drop the picture altogether.

The picture of the Soccer player is much more relevant, in that this famous person is also very involved in Tourette-related organizations etc.

MarmotteiNoZ 00:46, 28 August 2018 (UTC)
 * I'm sorry it took you so long! The first line of the image caption states: "André Malraux (1901–1976) was a French author, adventurer and Minister of Culture who had Tourette syndrome."  Sandy Georgia  (Talk)  01:49, 28 August 2018 (UTC)

Malreux
How about this from his main infobox? It highlights the subject and eliminates the long caption Work permit (talk) 03:31, 28 August 2018 (UTC)
 * I am disinclined to initiate the work to make sure a different image meets FA image policy when we already have one. Best regards, Sandy Georgia  (Talk)  15:04, 28 August 2018 (UTC)