What are Tic Disorders? A healthy child does not continuously worry about unpredictably doing something embarrassing, but a child with a chronic tic disorder is often anxious that the unintentional movements or noises they make will draw attention to themselves.1 A tic is a sudden, rapid movement of some of the muscles in the body or vocalization that occurs over and over and doesn’t serve any purpose.2 The location, frequency, and complexity of tics can change over time.3 In most cases tics decrease during adolescence and early adulthood, and sometimes disappear entirely.4 Often the social and emotional consequences of the behavior problems associated with tics are more impairing and disruptive than the tics themselves. Tics can impact children’s social relationships and self-esteem, putting them at greater risk for having poor peer relationships and becoming withdrawn and aggressive.5 Types of tics:3 Motor tics: frequently involve the head, central body, legs, and arms. Can result in simple movements like eye blinking, coughing, limb twitching, or more complex movements like hitting, jumping, and squatting. Motor tics can begin as early as age 3. Vocal tics: can include sounds such as humming, grunts, barks, sniffs, snorts, coughs, and obscenities (obscenities are more uncommon). What are symptoms? Children with Tourette’s Syndrome and Persistent Motor or Vocal Tic Disorder are able to suppress tics for varying periods of time, particularly under social pressure or when they are deeply focused on a task or activity. When children and teens are not suppressing their tics parents and teachers may think that they are “choosing” to tic, that their tics are intentional or habits that can easily be stopped, but this is not the case. Tics appear to be sensitive to environmental stimuli and can be worsened by temperature changes, stress, illness, and fatigue.6 There are two classifications of tic disorders, chronic and transient, chronic conditions are long lasting and include Persistent Motor or Vocal Tic Disorder and Tourette’s Syndrome, transient tic disorders only last for a relatively short period of time. Prevalence rates for all tics (chronic or transient) range from 6-18% for boys and 3-11% for girls.6 Types of Tic Disorders:6,7,8 Transient (Provisional) Tic Disorder: The most common disorder, transient tic disorder may affect up to 10% of children during the early school years. Transient tics go away by themselves, some may get worse with anxiety, tiredness, and some medications. With transient tic disorder, a child shows a single or multiple motor or vocal tic many times a day, almost every day for at least 4 weeks, but symptoms last no longer than 12 consecutive months. Children diagnosed with Transient Tic Disorder have never met the criteria for a chronic tic disorder and are under 18 years of age. Persistent (Chronic) Motor or Vocal Tic Disorder: Before age 18, a child shows either single or multiple motor tics, or vocal tics, but not both motor and vocal tics. Tics occur many times a day, nearly every day or intermittently for over a year, with no tic-free period longer than three consecutive months. Chronic tics affect less than 1% of children. Tourette’s Disorder: A child before age 18 shows multiple motor tics and at least one vocal tic. Tics occur many times a day, nearly every day or intermittently for over a year, with no tic-free period longer than three consecutive months. Tourette’s most commonly appears around age 7. The Center for Disease Control has found 1 of every 360 children ages 6-17 in the US have been diagnosed with Tourette’s. 37% of diagnosed children have moderate or severe forms of Tourette’s. Symptoms are usually present for life. Tourette’s occurs 3-5 times more often in boys than girls. Teens with Tourette’s often also have problems with obsessions, compulsions, hyperactivity, distractibility, and impulsiveness, learning disabilities, and anxiety. 86% of children diagnosed with Tourette’s are diagnosed with at least one additional mental health, behavioral, or developmental condition, most commonly: ADHD (63%), anxiety problems (49%), learning disability (47%). More than a third of people with Tourette’s also have obsessive-compulsive disorder. Tic Disorder, Not Otherwise Specified: For tic disorders characterized by tics that do not meet criteria for a specific tic disorder (for example: tics lasting less than 4 weeks, or tics with an onset after age 18) What causes Tic Disorders? Tourette’s is a neurobehavioral disorder characterized by a chronic inability to suppress an urge to perform patterned, repetitive movements.9 The common occurrence of dual diagnoses among children and teens with Tourette’s may be due to the shared genetic relationships between obsessive-compulsive disorder, ADHD, and Tourette’s.10 Tourette’s may also be linked to abnormalities in the brain, especially the basal ganglia, which helps to regulate one’s body and eye movements.1 But researchers are yet to find a single cause of tic disorders. What can be done to treat Tic Disorders? Research supports treatment using habit reversal training, a behavioral therapy, as well as family emotional support and an appropriate educational environment for children with tic disorders.3 The use of cognitive behavioral therapy (CBT) to treat tics has been shown to be as effective as and even superior to medication in certain cases. CBT has an effect not only on tics, behavior, and thoughts, but also on brain activity.11 Tics can indicate the presence of atypical neurodevelopment, it’s important for anyone who is newly diagnosed with tics to have a thorough medical and neurological exam to rule out any other condition that may cause similar symptoms.2,9 Interventions that may be used in treatment:2,5 Counseling and relaxation techniques to reduce anxiety can reduce tics that are triggered by anxiety. Training in tic reduction can result in 50-60% decrease in tics, but there is little evidence to suggest that they can be entirely controlled. Offering scheduled “release” times where a child can go to a private place to have tics without embarrassment can be helpful. Parents and professionals can work with children to identify and eliminate triggers. Social skills training to address social skill deficits can help with general adjustment and coping skills development. Social skills can include making friends, resolving conflicts, talking with adults, etc. Individual or group counseling can help children and teens develop coping skills and appropriate emotional responses to the challenges of tic disorders. Resources: 1 British Psychological Society 2 National Alliance on Mental Illness 3 American Academy of Child & Adolescent Psychiatry 4 Centers for Disease Control and Prevention (CDC) 5 National Association of School Psychologists 6 Journal of the American Academy of Child & Adolescent Psychiatry 7 Depression and Anxiety 8 Centers for Disease Control and Prevention 9 Journal of Child Neurology 10 University of California, San Francisco 11 University of Montreal
