Objective To establish if the severity of the Tourette's Syndrome, the existence of co-morbidities or other factors impact on the likelihood of having a problematic employment history.

Method Clinical records of 152 patients with TS over the age of 18 were reviewed. Occupation at time of first assessment was categorised according to the UK National Statistic Socio-economic Classification Score (NSSEC) which ranges from 1.1 (higher managers and professions) to 8 (out of employment). Problematic employment histories over more than one time point were assessed including prolonged periods of past unemployment, multiple short employment, disciplinary issues etc. Severity of TS was recorded by YGTSS, MOVES and clinician impression and comorbidities were noted.

Results Little relationship between tic severity and NSSEC score was seen. However, problematic employment history was assigned in 52% and associated with comorbidities (13% for pure TS v. 57%), clinician-rated severity- (48% for mild/moderate v. 69% for severe, NS), MOVES score (47% score <30, 69% score >30). Coprophenomena were also associated with employment difficulties.

Conclusion Adults who attend a tertiary specialist centre are employed across the whole spectrum from higher management to unemployment. The presence of more severe tics, comorbidities and coprolalia make a problematic employment history more likely. These comparisons were made within TS patients on the background of rising general unemployment due to economic factors and it should be noted that in this classification students (n=18) are in the same group as jobless people although are likely to have a different future socioeconomic level.