Several reports have identified signed tics in people with deafness. Lang et al. [30] reported on a patient who developed tics at 8 years of age, and by 17 years of age she began training to learn sign language, and then began to incorporate tics into her use of sign language. She later developed coprolalia and copropraxia in her signing. This would also occur when she was not talking or thinking about the word or phrase she was signing, and analogously to persons using speech, some of her coprolalic signs after much usage were at times truncated.

One report of a 31-year-old man with prelingual deafness who had motor and vocal tics also had coprolalia, expressed through his sign language. He felt embarrassed about the compulsion and often tried to disguise it as another sign. Rickards noted that the urge to swear and attempts to disguise it in the context of other behaviors are common in both signing and spoken language [32].

Another report was of a patient who was found to be profoundly deaf at the age of 10 months [33]. At 5 years of age he was first noted to make screeching noises, and repetitively making ‘ppp’ or ‘prrrr’ sounds. He had multiple facial twitches. At 7 years of age he was taught sign language and finger spelling, and psychometric testing found him to have an IQ of 120. At the 20 years of age his tic behavior markedly worsened and his parents felt that he had developed TS. He made frequent loud screeching noises and complex motor movements. It became clear that sign language was an integral part of the expression of his range of tics. He would randomly intersperse obscene signs and finger-spelled obscene words in normal conversation. He repeatedly produced sexual signs when conversing with women. The production of contextually sensitive tics and finger-spelled obscenities was felt to be equivalent to writing or spelling words out. In this context, the semantic features are divorced from phonologic content. This suggests that the conceptual ideas underlying coprolalia may be more important than the phonology of the utterance.

Another report was of a patient who at the age of 4 months was diagnosed as profoundly deaf [34]. He neverr developed any vocal language. At 7 years of age he was referred for simple motor tics (eye blinking) and simple vocal tics (sniffing and throat clearing). He developed copropraxia, consisting of obscene gestures which were not sign language. His parents noticed ‘coprolalia’ in his sign language, palilalia, repeating his own signs, and ‘echolalia’, repeating signs made by others. Since he has never had a vocal language due to congenital profound deafness, the fact that he developed obscene expressions in sign language might best be captured by the term, coprolaliopraxia.

A 23-year-old woman first developed motor tics when she was 8 years of age [30]. Vocal tics began at 12 years of age with low-volume sounds, and at 17 years of age she developed yelping vocalizations. She began formal training in sign language at 17 years of age, and by the age of 18 years she began signing obscenities. Usually the complete sign of ‘fuck’ or ‘shit’ was combined with a high-pitched vocalization of shortened forms of the obscenities (e.g. ‘fu’ and ‘sh’). Only later, after she had been signing obscenities for a time, did she develop more typical copropraxia; for example, lifting the middle finger. Given her use of motor actions (praxis) in the performance of the verbal symptoms of coprolalia, echolalia, and palilalia, Lang et al. suggested the terms ‘coprolaliopraxia’, ‘echolaliopraxia’, and ‘palilaliopraxia’ to denote these unusual, complex motor-vocal tics.

Dr. Roger Freeman, who has 40 years of experience with deaf persons, notes that fingerspelling, if it involves poorly controlled, unacceptable written words ‘in the air’, is a form of coprographia, not coprolalia; whereas signing (gestural verbal language) would be coprolalia. Signing is verbal, and deaf persons (native signers) also use gestures, like anyone else, that are not verbal-gestural ‘words’ or verbal; they could thus have copropraxia in their gestural communication. When signs for concepts or proper nouns are not in a deaf person’s vocabulary, they fingerspell it (or in a hearing person’s vocabulary when it is limited, when they are learning to sign) [Freeman R, personal communication, 2014].