Background: Previous studies indicate that a subset of children with Tourette syndrome (TS) experiences communication difficulties; however, the specific characteristics of these challenges remain underexplored. Aims: This study aimed to (1) quantify the proportion of children with TS within a North American cohort exhibiting communication challenges as assessed by a standardized parent questionnaire, (2) determine how many children with parent-reported communication challenges had been diagnosed with a communication disorder, (3) examine the relationship between parent-reported co-occurring conditions and parent-reported communication skills, and (4) evaluate the association between parent-reported communication skills and parent-reported psychosocial functioning. Methods and Procedures: Questionnaires were distributed to parents in North America through TS-focused social media groups and organizations (United States and Canada) and Canadian medical clinics specializing in TS care. Data collected included demographic information, information on tic severity and co-occurring conditions, parent-reported communication function using the Children's Communication Checklist, Second Edition (CCC-2), and psychosocial function using the Strengths and Difficulties Questionnaire (SDQ). Results: The questionnaire was completed by 61 parents of children with TS. On the CCC-2, 62% of children obtained scores consistent with age-appropriate communication skills, while 38% obtained scores suggestive of communication challenges (> 1SD below the mean on general communication and/or social-pragmatic communication). Ten percent of children were reported to have a formal language disorder diagnosis. A significant correlation was observed between communication proficiency and psychosocial functioning: lower scores for general and social-pragmatic communication skills were associated with increased psychosocial difficulties (r = -0.44, p < 0.001). Notably, the presence of specific co-occurring conditions did not predict general communication or social-pragmatic communication challenges. Conclusion and Implications: Speech-language pathologists (S-LPs) should anticipate that most children with TS will exhibit age-appropriate communication development; however, a substantial proportion will present with communication challenges in formal language and/or social communication. Medical practitioners are advised to promptly refer children for speech-language evaluation upon identifying potential communication challenges, particularly among those demonstrating heightened psychosocial difficulties. Comprehensive assessment by S-LPs should encompass both core language and social-communication dimensions.