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One study provided data on coprolalia from 11 different nationalities and found that the coprolalic words or phrases differed by country. Shapiro also noted that patients with TS tend to utilize the most socially unacceptable terms within their own cultural context [27]. Thus, coprolalia seems to be defined by the appreciation and utilization of a sophisticated region- and culture-specific lexicology of meaning and inferred intentionality of speech, phrases and, in some cases, gestures. Jankovic and Fahn reported on a patient who had coprolalia in Spanish at home around her family and coprolalia in English when she was in the hospital [28]. We have cared for a patient with severe mental retardation who was nearly non-verbal but had coprolalia in German (his first language and the primary language of his family). Nearly half of the 15–20 words he was capable of saying were mostly coprolalic in German. Case reports of tics and coprolalia emerging after treatment with neuroleptics has been reported [29]. The same has also been noted for copropraxia.

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.

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