Tics and Tic Disorders

What are tics?

Tics are sudden, quick movements or sounds that you do repeatedly and involuntarily. If you have tics, you can’t stop your body from doing these things. They can occur in any part of your body, including your face, shoulders, hands and legs. For example, if you have a motor tic, you might blink your eyes repeatedly or shrug your shoulders over and over again. If you have a vocal tic, you may make a grunting sound unwillingly or feel the need to constantly clear your throat. The tics you do often change over time.

Tics frequently begin with an unpleasant sensation or urge that builds up in your body. People are sometimes able to suppress or delay their tics, but this may cause discomfort they can only relieve by performing the tic.

Tics are common in children, typically starting between the ages of 5 and 10. They’re usually not serious and often improve or stop on their own over time. But sometimes, the presence of tics can be a sign of a more serious tic disorder that requires treatment.

Types of tics

People may experience simple or complex motor tics and vocal tics. Simple tics are brief and sudden repetitive movements that involve just a few muscle groups. They’re more common than complex tics.

Motor tics involve body movements, like shoulder shrugging. Vocal tics involve your voice, like throat clearing. Motor tics tend to develop before vocal tics, and simple tics develop before complex tics.

Simple motor tics include:

• Eye blinking, eye rolling and other eye movements.
• Facial grimacing.
• Shoulder shrugging.
• Shoulder or head jerking.

Simple vocal tics include:

• Repetitive throat clearing.
• Sniffing.
• Barking.
• Grunting.

Complex tics are coordinated and distinct patterns of movement that involve several different muscle groups in areas throughout your body.

Complex motor tics include:

• Facial grimacing combined with a shoulder shrug and a head twist.
• Touching or sniffing an object.
• Hopping.
• Jumping.
• Bending.
• Twisting.

Complex vocal tics include:

• Repeating your own words or phrases.
• Repeating other people’s words or phrases (echolalia).
• Using obscene, vulgar or swear words (coprolalia).

What are tic disorders?

Tic disorders are a spectrum of neurological conditions that cause you to perform tics. Tics and their associated symptoms may range from mild to severe. In many cases, tics are mild and don’t require treatment. Tics often go away as children get older. In other cases, treatment is necessary to manage tics and other health conditions that occur with them.

What are the different types of tic disorders?

There are three main types of tic disorders. They differ from each other based on the type of tics and how long symptoms have lasted. Tic disorders include provisional tic disorder, persistent (chronic) tic disorder and Tourette syndrome.

Provisional tic disorder (transient tic disorder)

People with provisional tic disorder, or transient tic disorder, have motor or vocal tics (one or both) for less than one year. This is the most common type of tic disorder. It may affect up to 10% of children in their early school years. According to the DSM-5, a person must have the following to receive a diagnosis of provisional tic disorder:

• One or more motor tics or vocal tics.
• Tics present for no more than one year.
• Tics that begin before 18 years of age.
• Symptoms that aren’t due to having a medical condition that can cause tics or due to taking medicine or other drugs.
• No other tic disorder diagnosis.

Persistent (chronic) tic disorder

People with persistent (chronic) tic disorder have motor or vocal tics (not both) for more than one year. Persistent tic disorder affects less than 1% of school-age children. According to the DSM-5, to get a diagnosis of persistent tic disorder, you must have:

• One or more motor tics or vocal tics, but not both.
• Tics that happen many times each day nearly every day, or off and on throughout a period of more than 12 months.
• Tics that begin before 18 years of age.
• Symptoms that aren’t due to having a medical condition that can cause tics or due to taking medicine or other drugs.
• No Tourette syndrome diagnosis.

Tourette syndrome

People with Tourette syndrome have motor and vocal tics (both) for more than one year. This is the most severe type of tic disorder. According to the DSM-5, you must have the following to receive a diagnosis of Tourette syndrome:

• Two or more motor tics and at least one vocal tic, but not necessarily at the same time.
• Tics for at least one year that can happen many times a day (typically in bouts) nearly every day, or on and off.
• Tics that start before 18 years of age.
• Symptoms that aren’t due to having a medical condition that can cause tics or due to taking medicine or other drugs.

How common are tic disorders?

Tic disorders are fairly common. Researchers estimate that 1 out of every 50 children has Tourette syndrome or another tic disorder.

What does a tic feel like?

Before a tic occurs, you may feel an urge to perform the tic. This urge is similar to the need to scratch an itch or sneeze. A feeling of tension builds up in the affected part of your body, and giving in to the tic provides momentary relief. You may be able to postpone a tic for seconds to minutes, but you need to put in conscious effort. Typically, the urge to perform the tic ultimately becomes irresistible.

Trying to control a tic is often very hard, particularly during times of emotional stress. Stress and fatigue often make tics worse. But tics frequently become worse when your body’s relaxed or you are alone. Calling attention to a tic can also make it worse. Tics typically don’t occur during sleep, and they may lessen when you’re concentrating on a task like work activities or schoolwork.

Are there more serious or harmful types of tics?

Some tics can be harmful, like motor tics that cause someone to hit themselves in the face or repeated large neck movements that start to cause pain. A vocal tic called coprolalia leads to swearing or inappropriate language. This type of tic can make someone seem purposefully disruptive or offensive, even though it’s an uncontrollable impulse. Children with coprolalia might receive unwarranted punishment at school or at home. They may also experience bullying. This type of tic affects 10% to 15% of children with Tourette syndrome.

What causes tics?

Researchers don’t know the exact cause of tics, but some scientists believe they occur due to changes in the part of your brain that controls movement. In addition, as tics can run in biological families, scientists believe the condition could also have a genetic component. Tic disorders also occur alongside other conditions, including:

• Attention-deficit/hyperactivity disorder (ADHD).
• Anxiety disorder.
• Obsessive-compulsive disorder (OCD).

Sometimes, people with other health conditions, like Huntington’s disease or encephalitis, develop tics or movements similar to tics. Tics can also occur after using recreational drugs like cocaine or amphetamines. But tics that happen because of other conditions or drug use aren’t considered a tic disorder.

What are the risk factors for this condition?

Tics occur most often in children during early childhood. Children as young as age 4 can have tics, but the incidence peaks between the ages of 5 and 10. Tics also affect children assigned male at birth (AMAB) more frequently than children assigned female at birth (AFAB).

How are tic disorders diagnosed?

Your child’s healthcare provider will perform a physical exam and evaluate their symptoms. If possible, it’s helpful to bring along a video or two of your child performing their tics so their provider can see what exactly your child is experiencing.

Based on what type of tics and their duration, your child’s provider may make a diagnosis of a certain type of tic disorder. Your child’s provider may also evaluate them for other disorders that often accompany tics, like ADHD and OCD.

How are tic disorders treated?

Tic disorder treatment depends on the type and severity of your child’s condition. If their condition is mild, they may not need any treatment, and their tics may resolve on their own. Self-help tips, like avoiding fatigue and stress, can be very helpful for most children.

In other cases, if your child’s tics are severe and interfering with their daily life, their healthcare provider may recommend behavioral therapy, medication or both.

Behavioral therapy

Through a type of behavioral therapy called habit reversal training, your child will learn how to manage their symptoms and come up with a different behavior to take the tic’s place. For instance, if your child’s tic involves shrugging their shoulders, their therapist may teach them to stretch out their arms until the urge to shrug has passed.

Another type of therapy your child’s provider may recommend is called comprehensive behavioral intervention for tics (CBIT). This type of therapy is helpful for older children to learn how to manage their tics. It includes habit reversal training, as well as education about tics and relaxation techniques.

Along with offering behavioral therapy, your child’s psychiatrist can help advise you on how to provide support as a family and make sure your child is receiving appropriate educational support.

Medication

If the tics persist and are interfering with your child’s life, medications for tics may help.

For mild tics, medications that may help include clonidine and guanfacine. Providers also recommend these medications to help control ADHD and anxiety, which can accompany a tic disorder.

For more severe tics, neuroleptic medications, including aripiprazole and olanzapine, may be effective. These medications work by altering the effects of neurotransmitters that control body movements.

Can tics be prevented?

Because scientists don’t know exactly why tics affect some people and not others, you can’t prevent them.

How long do tics last?

Tics usually improve on their own over time and may stop completely. Sometimes, a tic may last for just a few months, but more frequently, they come and go over several years.

Tics are most severe between the ages of 8 and 17. They usually start to improve and go away on their own after puberty.

How do I take care of my child if they have tics?

If your child has mild tics, you may be able to help them with some simple self-care tips, including:

• Avoid anxiety and stress: Try to find an enjoyable activity for your child to do, like a sport or a hobby. Tics often occur when your child feels stress or anxiety and an activity can keep them occupied and relieve stress.
• Avoid fatigue: Tics also frequently occur when your child is too tired. Make sure they get a good night’s sleep.
• Try to ignore your child’s tics: Try not to draw too much attention to your child’s tics. Talking about them can make your child’s tics worse.
• Don’t discipline: Don’t yell at your child or tell them to stop performing their tic, as they have no control over it, and getting mad or blaming them won’t solve the problem.
• Reassure your child: Make sure your child knows that everything’s fine and they don’t need to feel embarrassed by their tics.
• Give others a heads-up: Alert friends and loved ones about your child’s tics so they can be aware of them and know not to react when they occur.
• Work with your child’s school: Make sure your child’s teachers and other staff are aware of your child’s tics and work with them to find solutions if the tics become a problem for your child during school hours.

When should my child see their healthcare provider?

Some tics aren’t serious. You don’t need to see your child’s provider if their tics are mild and not causing any problems. The tics may even disappear as quickly as they appeared. But you should schedule an appointment with your child’s provider if you’re concerned about their tics or the tics:

• Happen regularly or become more severe or frequent.
• Cause social or emotional issues, like bullying or embarrassment.
• Cause pain or discomfort.
• Interfere with school or other daily activities.
• Come along with anger, depression or self-harm.

What questions should I ask my child’s healthcare provider?

If your child has tics, you may want to ask their provider:

• Are my child’s tics mild or more serious?
• Does my child have a tic disorder?
• What type of tic disorder does my child have?
• What treatment options do you recommend?
• Will the tics go away on their own?