Tics in Children and Adolescents

What are Tics and is there something seriously wrong with my child?

Tics are sudden, repetitive movements or sounds that people make involuntarily.  They are common and affect around 1 in 8 school aged children.  They usually start around between 5 – 10 years of age but can appear later in life.  Tics can come and go but are usually worse during periods of stress, excitement, or strong emotions.  They are suggestible in that when one draws attention to them, they tend to get worse.  Tics tend to calm down during periods of calm and intense concentration.  Whilst tics are generally harmless and not a sign of a serious underlying problem, they can be very disruptive to the individual.

Tics are classified as motor or vocal.  Motor tics can involve any part of the body but usually consist of blinking, shrugging, facial grimacing or head shaking.  Any movement can be a tic if it is repetitive and is made without a clear purpose.  A vocal tic involves sounds such as throat clearing, sniffing, grunting, squeaking to words.

Tics can be simple or complex.  A complex motor tic might involve jumping in a circle whereas a simple motor tic is a head jerk.  A complex vocal tic is repeating a whole word or phrase, whereas a simple one might be a sniff or bark.

The type of tic your child has may change over time, this is not uncommon.

Causes of Tics

We do not know the exact cause of tics.  There are certainly genetic factors and if one family member has a tic, there is an increased risk of another family member having a tic.  There are some neurological factors that can increase the risk of developing a tic such as a head injury and there are also environmental risk factors.  Anxiety, stress, and tiredness can all make tics worse, but they are not causal factors.

If a tic lasts for less than a year, it is called a provisional tic disorder.  However, if a tic, either motor or vocal (NOT BOTH) last more than 12 months, it is called a chronic tic.  If a child has BOTH motor and vocal tics for more than 12 months, Tourette disorder needs to be considered as a diagnosis.

Associations with Tics

Children with tics often have co-existing conditions such as

• ADHD

• Angry outbursts

• Sleep difficulties

• Learning difficulties

• Anxiety or obsessive-compulsive disorder

• Low mood

Effects on Children and Adolescents

Most young children do not notice tics.  Older children may notice a build-up of tension, that they feel they need to release before a tic comes on.  They may be able to suppress the tic for a little while but then no longer.  The primary effects tics have on children is that they can cause embarrassment, anxiety and stress and occasionally they may interfere with learning and concentration at school.  Severe tics such as constant head shaking might cause physical symptoms such as pain.

How are Tics diagnosed?

It is important to see a doctor if you or your child are worried about the tics.  Other reasons to see a doctor would be if the tic is causing social problems for your child, or you think it might be affecting their concentration or learning or if it is causing any physical symptoms such as pain.

The diagnosis is clinical.  A GP or paediatrian can make the diagnosis by examining your child.  It is very helpful if you can take a video of your child beforehand.  Imaging is very rarely needed and usually only if the doctor is not sure if the diagnosis is a tic.

Management and Support

• The most important thing is trying not to draw too much attention to the tic as this can make it worse.

• Remembering that the tic is involuntary, it is not a sign of bad behaviour.

• Stress management – mindfulness, relaxation, regular routines.

• Work with the school so the school understands that the tic is involuntary and gets worse when attention is drawn to it.

• Managing anxiety or low mood if present with the help of a psychologist if needed. Cognitive behavioural intervention for tics can be extremely helpful to teach children to manage their symptoms and redirect tics.

• Good sleep habits.

• Supporting learning in school if learning difficulties are present.

• Treating any co-existing conditions such as ADHD with the support of a paediatrician.

• Medication is seldom needed but may be necessary if tics are ongoing and severely impact daily life.

Conclusion

• Tics in children and adolescents are common and usually temporary.

• They are not usually a sign of a serious underlying problem and do not usually require any medication.

• They can be associated with other underlying conditions, such as anxiety, or ADHD, and possible learning difficulties.

• In most children, tics will resolve by late adolescence.

References

1.      The Royal Children’s Hospital Melbourne: [https://www.rch.org.au/kidsinfo/fact_sheets/Tics/].

2.     Raising Children [https://raisingchildren.net.au/guides/a-z-health-reference/tics-tourette-disorder].