What Is a TIC DISORDER?

Definition

A tic is when a child involuntarily and repeatedly moves a part of their body, such as their face, neck, shoulders, or torso, very quickly and repeatedly, or makes strange sounds, for no particular reason.

The former are called motor tics (muscle tics) and the latter are called vocal tics. When both types of tics are present and the total duration of the disorder exceeds one year, it is called Tourette’s Disorder.

Causes

Genetic factors, structural and functional abnormalities in the brain, biochemical abnormalities in the brain, hormones, brain damage during childbirth, and abnormalities in the immune response to bacterial infections have been linked to the development of tics.

In addition, learning and psychological factors have been implicated in the development and worsening of tics. For example, mild, transient tics may be reinforced by attention or environmental factors, or may be associated with certain social situations.

If a family member misunderstands the symptoms of a tic and tries to control it by shaming or punishing the child, the child may become emotionally disturbed, making the symptoms worse. However, tics are not always caused by psychological factors.

Symptoms

Tics are very common in children. Between 10 and 20 per cent of all children may have episodic tics, with symptoms peaking between the ages of 7 and 11. Episodic tics occur in 5-15% of school-aged children, and chronic tics affect 1% of children.

Common characteristics of tics include Tics are involuntary, meaning the child is not doing it on purpose, so it’s not a good idea for parents or teachers to get angry or scold the child. The severity of symptoms changes over time.

Like a tidal wave, symptoms can come on suddenly and then subside after a few days. The anatomical location of the tics can also change, from blinking one day to snorting the next.

There are muscle tics and vocal tics, which are divided into simple and complex types as follows.

1) Simple muscle tics: blinking, grimacing, head shaking, mouth opening, and shoulder shaking.

2) Complex muscle tics: hitting yourself, jumping out of place, touching other people or objects, throwing objects, sniffing your hands, copying other people’s actions, touching your own genitals, and acting obscene.

3) Simple vocal tics: sniffing, making sputum-clearing sounds, coughing, sucking, hissing, spitting, etc.

4) Complex vocal tics: saying words that are not relevant to the social situation, spitting profanities, imitating others Moving parts of the body, such as the face, neck, shoulders, or torso, very quickly and repeatedly, or making strange sounds, without realising it, for no particular reason.

Diagnosis/Testing

Diagnostic criteria for chronic motor tics or chronic vocal tic disorder include

1) One or more motor tics or vocal tics (sudden, rapid, repetitive, rhythmic, repeating the same action over and over (homophonic) movements or sounds) are present for some period of time during the course of the disorder, but the two disorders do not occur together.

2) The tics occur almost daily or intermittently several times a day for a period of one year or more, during which time there are no periods of time without tics lasting more than three consecutive months.

3) Cause significant distress or impairment in social, occupational, or other important areas of functioning.

4) Onset is before the age of 18.

5) The impairment is not due to a direct physiological effect of a substance such as an irritant or a common medical condition (e.g., Huntington’s disease, viral encephalitis).

6) The person does not meet the criteria for Tourette’s disorder.

The diagnostic criteria for Tourette’s disorder are

1) Multiple motor tics and one or more vocal tics are present for some period of time during the course of the disorder. The tics are not necessarily present at the same time.

2) Tics occur almost daily or intermittently several times a day (usually in paroxysms) for a period of 1 year or more, with no periods of time without tics lasting longer than 3 months.

3) Cause significant distress or impairment in social, occupational, or other important areas of functioning.

4) Onset is before the age of 18.

5) The impairment is not due to a direct physiological effect of a substance such as a stimulant or a common medical condition (e.g., Huntington’s disease, viral encephalitis). When motor and vocal tics occur simultaneously and the overall duration of the disorder exceeds one year, it is called Tourette’s Disorder.

The diagnosis of tics requires a thorough examination to rule out other neurological and internal medicine problems, and depending on the symptoms, tests such as brain magnetic resonance imaging, blood tests, and an electroencephalogram may be performed for differential diagnosis.

Other psychiatric conditions such as depressive disorders, attention deficit/hyperactivity disorder, and oppositional defiant disorder often co-exist and require careful diagnostic consideration.

Treatment

Medication is currently considered the most effective treatment for clinically problematic moderate and severe tics. In the case of chronic tics, Tourette’s disease, and not episodic tics, medication is usually administered.

The duration of medication depends on the degree of improvement in the patient’s symptoms, but usually lasts for 12 to 18 months before being tapered. Although tics are definitely a chronic condition, the overall prognosis is good. Vocal tics often disappear completely, and muscle tics often improve.

The condition is usually most severe between the ages of 7 and 15, but it usually waxes and wanes and gradually becomes less severe. Between 30 and 40 per cent of children with Tourette’s are completely asymptomatic, and 30 per cent have less severe symptoms.

However, the remaining children may continue to have symptoms into adulthood.

Progression/Complications

The course of tics is highly variable. They usually start between the ages of 2 and 13, with the most common onset between the ages of 7 and 11. The tics most commonly start with eye blinking, but over time, one symptom may disappear and a new symptom may appear, such as eye blinking one day and snorting a few days later. In many cases, symptoms may come and go spontaneously over the course of days or months.

The severity of the tics can also fluctuate, like a tidal wave, with symptoms suddenly becoming more severe and then subsiding after a few days. Temporary tics usually go away on their own, but some people develop chronic tics or Tourette’s disease.

Diet and lifestyle

It’s best to avoid blaming, criticising, teasing or pointing out tics to your child as they are not deliberate or intentional and are caused by an abnormality in the brain. In the early stages, the best thing to do is to ignore the symptoms and not pay attention to them.

For the sake of the child with tics, as well as the other children in the household, it’s important to work with a school teacher who understands the condition. It can be very helpful for teachers to provide a positive and supportive environment in the classroom, as it is often difficult for children with tics to socialise if their peers do not accept them and ostracise them.

Scroll to Top