Understanding Tics

If you have noticed your child or teen displaying repetitive, involuntary movements or sounds, you may be concerned. You might wonder if this behavior is normal or if it’s something that requires medical attention. This newsletter will describe tics, their causes, and what you can do to support your child if you suspect they are experiencing tics.

What Are Tics?

Tics are sudden, repetitive movements or sounds that a person makes unintentionally. These can be physical (motor tics) or vocal (phonic tics), and they can vary in severity. Common motor tics include blinking, head jerking, or shoulder shrugging, while vocal tics might involve throat clearing, sniffing, or repeating words. 

Tics are common in children, occurring at some point in approximately 1 out of 5 children. They typically appear around age 6, peak between ages 10 to 12, and decline into adulthood. Most tics are temporary and go away on their own over time, but for some children, they may persist or even develop into more complex patterns.

What Causes Tics?

Tics are believed to be linked to a combination of genetic and environmental factors. Tics may also be influenced by neurobiological factors that affect the brain regions responsible for motor control.

Additionally, tics can be triggered or worsened by stress, anxiety, fatigue, or excitement. Understanding your child’s triggers can help you support your child during difficult moments. 

When Should You Seek Professional Help?

For most children, tics are temporary and do not interfere significantly with daily life. However, in some cases, tics can become more frequent or severe, lasting longer than a year or causing distress. If your child’s tics are affecting their social life, school performance, or emotional well-being, it may be time to consult a healthcare professional.

Your pediatrician can help determine whether your child has a tic disorder such as Tourette Syndrome or Chronic Tic Disorder or refer you to a tic specialist such as a pediatric neurologist, psychologist, or psychiatrist. Tourette Syndrome is a type of tic disorder that involves both motor and vocal tics that persist for at least a year. It typically emerges between the ages of 5 and 10 and can vary in severity. Many people think of coprolalia, saying obscene words, when they think of Tourette Syndrome, but that symptom is relatively rare and only occurs in about 10% of people with Tourette Syndrome.

How Can Parents Support Their Child with Tics?

Remain Calm and Supportive: It can be challenging to see your child experience tics, but remaining calm and not drawing attention to the tics will help your child feel less self-conscious. Avoiding punishment or unintentional reinforcement (e.g. attention, comfort, instructions to stop) is important, as this can increase stress and exacerbate the tics.

Educate Yourself and Others: Understanding tics can help reduce fear and confusion. Share information with teachers, family members, and friends so they can provide support to your child in different environments and prevent inadvertent reinforcement of tics.

Help Manage Stress: Since stress can worsen tics, encourage your child to engage in relaxing activities like deep breathing, mindfulness, or even creative activities like drawing or playing music. Ensuring your child gets enough sleep is also important, as fatigue can contribute to tic exacerbation.

Consider Therapy: Behavioral therapy, such as a type of Habit Reversal Training (HRT) therapy called Cognitive Behavioral Intervention for Tics (CBIT), is effective in helping children manage their tics. CBIT involves teaching the child alternative behaviors to replace the tics, allowing them to gain more control over their movements and sounds. CFI can provide CBIT for youth with tic disorders. 

Seek Professional Guidance: If tics are severe, persistent, or interfere with your child’s daily life, a healthcare professional, such as your child’s pediatrician, a pediatric neurologist, or a mental health professional who specializes in tic disorders, may recommend treatments such as medications, cognitive-behavioral therapy, or other interventions. It’s important to remember that treatment plans are individualized to meet the specific needs of your child. At CFI, we collaborate with your family to individualize a treatment plan for your family.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

Centers for Disease Control and Prevention. (2024, May 15). Tourette Syndrome. Data and Statistics on Tourette Syndrome. https://www.cdc.gov/tourette-syndrome/data/index.html

Hirschtritt, M. E., Lee, P. C., Pauls, D. L., Dion, Y., Grados, M. A., Illmann, C., … Mathews, C. A. (2015). Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome. JAMA Psychiatry, 72(4), 325–333.

Leckman, J. F. (2022). Chapter Two-The neurobiology of Gilles de la Tourette syndrome and chronic tics, International Review of Movement Disorders, Volume 3, Academic Press Pages 69-101. ISSN 2666-7878, ISBN: 9780323910347

Piacentini, J., Woods, D. W., Scahill, L., Wilhelm, S., Peterson, A. L., Chang, S., … Walkup, J. T. (2010). Behavior therapy for children with Tourette disorder: A randomized controlled trial, JAMA, 303(19), 1929-1937.