Lewis Capaldi and Tourette syndrome: can people with tics ask for workplace adaptation?

By Ramon Martins Andrade, attorney (OAB/RJ 188.374)

English translation of an article first published in Portuguese: read the original.

In September 2022, in a live broadcast on Instagram, the Scottish singer Lewis Capaldi said that he had Tourette syndrome and that he had already noticed the tics in recorded interviews going back to 2018. He said he had received botulinum toxin in the shoulder, which worked for a while, and that the tics come and go. In the documentary How I’m Feeling Now, released in March 2023, he added that they get worse in traffic, when he is tired and after a big event (Rolling Stone). On 24 June 2023, at Glastonbury, the tics interrupted one of the songs and the audience finished singing it for him; at the same show, he said he was losing his voice. Three days later, he announced that he would step back from touring “for the foreseeable future”, with no return date, because he was still learning to adjust to the impact of the syndrome and needed to get his physical and mental health in order (ITV News).

The account is his own, and nothing is said here about the singer’s doctors, treatments or career decisions. His pause, however, raises the three questions that the article examines for anyone who has tics and works in Brazil: when the syndrome justifies paid leave through the INSS (the national social-security institute), what the employer must adapt and what treatment the SUS (Brazil’s public health system) and the health plan must offer. Since September 2026 there has been a specific federal law, Lei 15.492, which answers part of this with wording that admits two readings.

What science knows about tics in adults

The French guidelines for diagnosis and management, published by Andreas Hartmann and colleagues in 2024 in the Revue Neurologique, summarize the essentials. The syndrome is the combination of several motor tics and at least one phonic tic, with no identifiable cause, present for at least one year and beginning before the age of 18. The diagnosis is purely clinical: no additional test is needed to confirm it. It begins at around 6 or 7 years of age and evolves with periods of worsening and of relative improvement of the tics; most patients improve by the end of the second decade of life, but the symptoms persist into adulthood in around one third of them. Coprolalia, the tic of obscene words that common belief associates with the syndrome, appears in only 10% of cases. Psychiatric comorbidities, such as attention deficit, obsessive-compulsive disorder and anxiety, are very frequent (the subject of the guide to mental health law (in Portuguese)).

Three of these features have legal consequences. The diagnosis is clinical: the medical report is worth what it describes, not an attached test. The symptoms fluctuate: someone assessed during a calm phase may appear to have no limitation at all, at the INSS medical examination or at the company’s periodic examination. And the comorbidities weigh: often what limits work is the anxiety or the obsessive behaviour, and the report needs to say so.

On work, the evidence is scarce. A systematic review by researchers from the US CDC (H. J. Hutchins and colleagues, Clinical Child and Family Psychology Review, 2026) gathered 69 studies published between 2003 and March 2025 on the schooling and employment of people with Tourette or persistent tics, almost all with fewer than 100 participants with tics; only five dealt with the employment of adults, and the authors point to this subject as a necessary direction for research. Science does not authorize saying that the syndrome is incapacitating, nor that it causes no harm at all: each case is examined by reference to the specific task.

What the guidelines recommend

The American Academy of Neurology published in 2019 its guideline on the treatment of tics (Pringsheim and colleagues, Neurology), drawn up by a panel of physicians, psychologists and patient representatives, with 46 recommendations, among them counselling on the natural course of tics, offering psychoeducation to teachers and peers, investigating comorbidities and periodically reassessing the need for treatment. The options are watchful waiting, comprehensive behavioral intervention for tics (CBIT) and medication, in a shared choice between patient, family and physician; for adults with severe and refractory tics, the guideline addresses deep brain stimulation.

The European Society for the Study of Tourette Syndrome updated its guidelines in 2022. In the part on psychological interventions (Andrén and colleagues), psychoeducation is the initial intervention at any level of severity; when it is not enough, habit reversal, above all within the CBIT package, and exposure with response prevention are first line. The summary statement of the guidelines records that, over the last decade, the emphasis has shifted towards non-pharmacological treatments. The French guidelines complete the picture: antipsychotics are essential in moderate to severe forms, botulinum toxin may be useful in certain isolated tics and deep brain stimulation is a real hope for the very severe forms. The same document assigns the general practitioner a role in ensuring adaptations in the patient’s school or work environment. Adaptation of the workplace lies within the recommended care, not beside it.

In Brazil: treatment through the SUS and the health plan

Lei 15.492, of 2 September 2026, established the National Policy for the Protection of the Rights of Persons with Tourette Syndrome and came into force on the date of its publication. Among its guidelines is access to medical treatment “and to complementary therapies” (art. 2, III). Among the rights, access to health actions and services under Lei 8.080/1990 (the Organic Health Law), including early diagnosis “even if not definitive”, multiprofessional care, adequate nutrition, medicines and the information that assists in diagnosis and treatment (art. 3, III). The law does not say which medicines or which therapies, and the technical criteria for the syndrome were left to acts of the federal Executive (art. 1, § 1).

As to health plans, the law merely reaffirmed that a person with Tourette will not be prevented from joining private plans by reason of their status as a person with a disability, “as provided in art. 14 of Lei 9.656” (art. 5), without creating any new coverage, as the article on what the Tourette law changed, and did not change, in health plans (in Portuguese) shows. What already existed, however, reaches the treatment that the guidelines put first. Behavioural therapy is a psychological intervention, and RN 541/2022 of the ANS (the health-plan regulator) revoked, from 1 August 2022, the utilization guidelines for sessions with psychologists, speech therapists, occupational therapists and physiotherapists in the ANS list of mandatory coverage (the “rol”) (art. 3). Refusing those sessions on the basis of a guideline limit has lost its normative basis.

Workplace adaptation: two readings of the new law

On work, Lei 15.492 has three passages. Among the guidelines, the “encouragement of the entry of persons with Tourette syndrome into the labour market” (art. 2, IV). Among the rights, access to the labour market and to social security (art. 3, IV, b and c) and, in the item that matters, the “right to reasonable adaptation in the work environment, with support measures guaranteed according to the needs of the person with Tourette syndrome, in accordance with the principles laid down in Lei 13.146” (art. 3, V). In the same law, art. 1, § 2, says when a person with Tourette will be considered a person with a disability “for all legal purposes”: “when the symptoms significantly compromise their functioning and social participation, according to a biopsychosocial assessment”. The question is whether workplace adaptation depends on that classification or arises before it.

The first reading requires the classification. Item V refers to the principles of the Estatuto da Pessoa com Deficiência (Lei 13.146/2015, the Brazilian Inclusion of Persons with Disabilities Act), which defines reasonable adaptations as adjustments “that are necessary and appropriate, that do not impose a disproportionate and undue burden, where needed in a particular case, to ensure that the person with a disability can enjoy or exercise” their rights (Lei 13.146/2015, art. 3, VI). And Lei 15.492, in art. 4, speaks of discrimination “on grounds of disability”. On this reading, the biopsychosocial assessment comes first, then the right, and anyone with mild tics can count only on the employer’s goodwill. It is a reading consistent with the system.

The second reading finds the right in the text itself. Art. 3 lists the rights “of the person with Tourette syndrome”, without the condition that the legislator knew how to write, two articles earlier, when dealing with the classification. If adaptation depended on the assessment, item V would be useless: anyone who had been classified would already have the right under the Statute, which treats “the refusal of reasonable adaptations” as discrimination (art. 4, § 1). When Lei 15.492 merely repeats another law, it says so, as in art. 5; in item V, the reference is to “principles”, not to requirements. The Statute becomes the yardstick of the measure (necessity, appropriateness, absence of a disproportionate burden), and the assessment under art. 1, § 2, decides access to the other protections of persons with disabilities, such as the quota. The practical effect is immediate: someone whose tics get worse in long meetings does not need to wait for an assessment whose criteria the law left to acts of the Executive in order to ask for a break. The price is that proportionality comes to do all the work, and a vague request, unrelated to a specific task, tends to be refused with good reason.

Leave and the INSS: when the pause becomes a benefit

An artist can cancel the tour; an employee depends on a different architecture. In the first 15 consecutive days of sick leave, the employer pays the full salary (Lei 8.213/1991, art. 60, § 3). From the 16th day, sickness benefit is due from the INSS to the insured person who is incapacitated “for their work or their habitual activity for more than 15 (fifteen) consecutive days” (arts. 59 and 60). The qualifying period is 12 monthly contributions (art. 25, I), and Tourette syndrome is not on the list of diseases exempt from it (art. 151). The criterion is incapacity for the habitual activity, not the diagnosis: someone may be incapacitated for their specific job without being unable to do any work.

There is a point that tends to surprise those who have had Tourette since childhood. The law denies the benefit to an insured person who joined the social-security system “already suffering from the disease or injury invoked as the ground for the benefit, except where the incapacity arises from its progression or worsening” (art. 59, § 1). The disease predates the first job in almost every case; what needs to come later is the incapacity. A report that records the pattern over the years and the recent worsening in the face of the demands of the job is what separates the worsening from the pre-existing condition. When the medical examination denies the benefit and the employer does not accept the return, the dispute moves to the appeal or the court-ordered medical examination (in Portuguese) and, in the meantime, to the limbo between discharge by the INSS and unfitness at the company (in Portuguese).

Leave is not the only social-security route. Vocational rehabilitation must give the incapacitated beneficiary and persons with disabilities the means of readaptation “indicated for participation in the labour market” (Lei 8.213, art. 89), and the Statute requires the public authorities to maintain programmes so that persons with disabilities can “enter, remain in or return to the field of work” (Lei 13.146, art. 36). A company with 100 or more employees must reserve 2% to 5% of its positions for rehabilitated beneficiaries or qualified persons with disabilities (Lei 8.213, art. 93). This is where the classification under art. 1, § 2, makes a difference: without it, a person with Tourette enters the quota only as a rehabilitated worker, the subject of the article on vocational rehabilitation through the INSS (in Portuguese).

Three countries: who decides whether the tic counts

In Great Britain, Capaldi’s homeland, the Equality Act 2010 does not ask for the diagnosis. Disability is a physical or mental impairment with a “substantial and long-term” adverse effect on the ability to carry out normal day-to-day activities (section 6). Long-term is an effect that has lasted or is likely to last at least 12 months, and, if the effect ceases, it continues to be treated as present “if that effect is likely to recur” (Schedule 1, paragraph 2). The employer must take reasonable steps to prevent a provision, criterion or practice from putting the protected worker at a substantial disadvantage (sections 20 and 39(5)). The condition that comes and goes is within the law by express rule.

The United States reached the same point by another route. The Americans with Disabilities Act defines disability as an impairment that substantially limits one or more major life activities, and the statutory list includes speaking, communicating, concentrating and working (42 U.S.C. § 12102, (1) and (2)). The rules of construction, which go back to the 2008 reform (ADA Amendments Act), require the definition to be read in favour of broad coverage and state that an impairment that is “episodic or in remission” is a disability if it would substantially limit a major life activity when active (§ 12102(4)(D)). Reasonable accommodation is illustrated in the statute itself: job restructuring, part-time or modified work schedules, reassignment to a vacant position, adjustment of examinations and policies (§ 12111(9)). Failing to provide it is discrimination, unless the employer demonstrates undue hardship (§ 12112(b)(5)(A)).

Spain is the closest mirror of the Brazilian dilemma. The General Law on the Rights of Persons with Disabilities (Real Decreto Legislativo 1/2013) has two doors: art. 4.1 defines the person with a disability by a foreseeably permanent impairment in interaction with barriers, and art. 4.2 adds, “a los efectos de esta ley”, anyone with a recognized degree of disability equal to or above 33%. Failure to make a reasonable adjustment “supone una discriminación” (art. 2, m); in the wording given by Law 4/2026, in force from 23 October 2026, companies must adopt “las medidas adecuadas para la adaptación del puesto de trabajo”, except where this is an excessive burden (art. 40.2); and the guarantees against discrimination apply “con independencia de la existencia de reconocimiento oficial de la situación de discapacidad o de su transitoriedad” (art. 64.2). The 33% certificate widens the reach of the law; protection against the refusal of an adjustment does not wait for it. It is the solution of the second reading of Lei 15.492, written down.

The three systems converge on the point that the effect, not the diagnosis, decides. Brazil has the duty to adapt, but no written rule on conditions that come and go; the Statute requires the assessment to consider “the limitation in the performance of activities” and “the restriction of participation” (art. 2, § 1), and an intermittent restriction is still a restriction.

What the employer cannot demand, and what it can refuse

The Constitution prohibits “any discrimination as to pay and admission criteria for workers with disabilities” (art. 7, XXXI). The Statute forbids discrimination including in pre-employment and periodic medical examinations and in remaining in employment, “as well as any requirement of full fitness” (art. 34, § 3). Requiring a worker to stay motionless and silent throughout the working day, when the job does not require it, is requiring full fitness under another name. The Convention on the Rights of Persons with Disabilities (Decreto 6.949/2009, with the status of a constitutional amendment) obliges the State to “ensure that reasonable accommodation is provided to persons with disabilities in the workplace” (art. 27, 1, i). And Lei 9.029/1995 prohibits “any discriminatory and restrictive practice for the purposes of access to an employment relationship, or its maintenance”, including on grounds of disability or vocational rehabilitation (art. 1); if the dismissal is discriminatory, the employee is entitled to compensation for moral damages and may opt for reinstatement with payment for the period away from work (art. 4).

For those who have not been classified as persons with disabilities, the Superior Labour Court (TST) offers a presumption: Súmula 443 treats as discriminatory the dismissal of an employee suffering “from another serious disease that gives rise to stigma or prejudice”. Whether Tourette syndrome fits that description is something to be examined on the facts. The stigma of the syndrome is documented by Capaldi himself, who said he had read comments on social media asking why he was twitching and whether he was on drugs.

None of this makes adaptation a blank cheque. An adjustment that imposes a disproportionate burden cannot be required, and there are jobs in which a motor or vocal tic has a real bearing on safety or on the essential task; there, refusal may be legitimate, if reasons are given. When a restriction is a technical criterion and when it is prejudice is the discussion in the article on those who fail a fitness examination because of a health condition (in Portuguese); reclassification after a finding of unfitness is covered in unfit for the job, and then? (in Portuguese). A well-formulated request is modest and verifiable: a short break in long meetings, a position less exposed to the public, a written answer instead of an oral presentation, working hours compatible with therapy, an agreed review after a few weeks. Made in writing, with a report that describes the functional limitation and the suggested adjustment, it requires a reasoned answer. The diagnosis need not circulate among the team; confidentiality follows the rules in the article on what the employer may know and demand on return to work (in Portuguese).

Before deciding

In my view, the second reading of Lei 15.492 is the correct one: the right to ask for workplace adaptation belongs to the person with Tourette, and the biopsychosocial assessment decides access to the other protections of persons with disabilities, not the possibility of asking for a break in a meeting. Brazil can reach the Spanish model without a new law. Anyone who has tics and works should ask their doctor for a report describing the pattern over time, the comorbidities and the relationship with the tasks of the job; put the request for adjustment in writing, tied to a specific task; keep the company’s answer; and, if the worsening leads to leave, record when the incapacity began. If the adjustment was refused without reasons, if dismissal came soon after the diagnosis was disclosed, if the INSS refused the benefit or if the health plan denied the indicated therapy, get in touch with the firm: the analysis starts from the medical report, the request made and the answer received, and does not replace clinical assessment.

About the author

Ramon Martins Andrade (OAB/RJ 188.374) is a lawyer who graduated from UFRJ in 2011, with master’s degrees from Université Sorbonne Nouvelle and from the Naval War College (EGN, Brazilian Navy). He is currently a researcher in Human Rights and Health at ENSP/Fiocruz.

This content is for information and education only. It does not constitute legal advice, advertising of results or any guarantee of outcome, under Rule 205/2021 of the Brazilian Bar Association (OAB).