Tic disorders are diagnoses where children display motor tics (involuntary physical movements) and/or vocal tics (involuntary sounds).
Tics are classified into two categories: simple and complex.
- Simple motor tics are sudden, brief, repetitive movements that involve a limited number of muscle groups, such as: eye blinking, eye darting, finger flexing, facial grimacing, shoulder shrugging, sticking the tongue out, and head or shoulder jerking to name a few.
- Simple vocalizations can include repeated throat-clearing, sniffing/snorting, yelling, hiccupping, grunting sounds, etc.
- Complex tics are unique, coordinated patterns of movements that involve more than one muscle group. These can include: facial grimacing combined with a head twist and a shoulder shrug, hopping, touching others, gestures, smelling objects, jumping, twisting, and more.
- Complex vocal tics contain words or phrases. A few examples of this include the use of varying tones of voice as one speaks, repeating oneself, or repeating the phrases of others’.
The American Psychiatric Association describes a tic as a sudden, rapid, recurrent, non-rhythmic motor movement or vocalization. In other words, a tic is an ongoing movement or sound that happens suddenly, quickly and has no set regularity.
Simple tics are normally seen as the beginning signs of a tic disorder. Tics generally start at the head and become more frequent in other areas of one’s body over time.
The best way to describe Tourette’s syndrome is to think of the nervous system not working as consistently as it should. Our nervous system controls our movement; and for the most part, these movements occur on a voluntary basis. For people with Tourette’s syndrome, their nervous system sends messages for movement and vocal sounds to occur without their choosing. These movements and sounds are referred to as motor and vocal tics.
Although tics are irresistible to ignore, many people diagnosed with Tourette’s syndrome can suppress tics for a limited time, such as while in a social situation. However, there is a build up of the need to express these tics and they must be “let out” at some point during the day.
Tics seem to happen much more frequently when the person feels tired, excited, or nervous. Prior to some tics occurring, the person feels a sensation in the muscle group where the tic will be preformed. In order to relieve this sensation, the person must complete the tic and may even need to complete it in a certain way before the sensation will go away.
Criteria that must be met for a diagnosis of Tourette’s syndrome are:
- the presence of motor tics and at least one vocal tic for at least one year
- the child must be under the age of 18. If over the age of 18, the child will most likely be diagnosed with Tourette’s syndrome, NOS.
Generally speaking, most people with Tourette’s syndrome experience most tics while they are teenagers which seem to improve as a person grows into adulthood. Tics change over time in severity and also in type.
Persistent (Chronic) Motor or Vocal Tic Disorder
This type of tic disorder may be diagnosed when single or multiple motor OR vocal tic(s) have occurred – but not both motor and vocal tics. The presenting motor OR vocal tic(s) may come and go but need to have continued for more than 1 year since the first tic started. Lastly, the tics in question are not the effects of substance use, of another medical condition, and the person must never have met the criteria for Tourette’s disorder.
Provisional Tic Disorder
Provisional Tic Disorder is suspected when single or multiple motor and/or vocal tics occur many times a day. Tics can be described as movements or sounds that a person has difficulty controlling.
Provisional tic disorder is characterized by the presence of temporary tics (not lasting for more than 12 months). Provisional tic disorder is common in children and may be caused by physical or mental reasons.
When a tic occurs due to a physical reason, it is common for the tic to start during an illness. When a child is sick and coughs or clears their throat for extended time, that behavior may continue and turn into a tic even after the illness has resolved.
When a tic occurs due to a mental reason, many factors may be contributing to the behavior. Commonly seen reasons include the birth of a new sibling, a move, or a separation or divorce within the immediate family.
- Motor and/or vocal tics (eye blinking, throat clearing, shrugging shoulders, sniffing, moaning, clicking, clenching fists, opening the mouth, involuntary body movements…).
- Irresistible need to complete movements that occur over and over, yet these movements do not follow a rhythm.
- Tics occur many times a day, nearly every day, for no longer than 12 consecutive months. *If the tic(s) last for longer than 12 months, the person would be considered to have persistent symptoms.
- The tics cause difficulty in daily functioning for the individual.
- An increase in intensity and frequency is seen when the person is tired, nervous, or excited.
- Tics generally occur prior to age 18.
Treatment and tips
- Contact your child’s doctor if you are concerned about your child showing tics.. Tics that cause disruptions to your child’s daily functioning need to be addressed immediately. A medical doctor and a mental health professional can work together to get the needs of your child and of your family met.
- A call to your child’s doctor should be the first step if you suspect your child has tics. Only a medical or mental health professional can diagnose your child appropriately. Medications that are available for tic disorders that help to relax your child’s nervous system so that their tics don’t happen as often. Medication is not right for everyone, and this must be first discussed with your child’s doctor and supportive team.
- When you notice your child exhibiting tic-like behaviors, do NOT call attention to the act at first. Unwanted attention may make the tics worse. Many childhood tics disappear on their own within several months. Drawing too much attention to the behavior may promote the tics to remain for longer periods of time. Treat your child as you were prior to the tic starting. Chances are, these issues will resolve on their own and your child needs to know that life with you remains stable and nurturing despite these life hiccups.
- Ensure that your child gets plenty of sleep and exercise.
- Educate those who spend a lot of time with your child about your child’s tic disorder. Depending on your child’s comfort level, this can include your child’s classmates at school. Your child should not be made to feel embarrassed about their tics, nor should they be made fun of.
- An evaluation and a school plan such as an Individualized Education Plan (IEP) or a 504 plan should be put into place. These plans are based on your child’s strengths and needs. They provide for accommodations to be made to your child’s school day in order to help them find success despite having a tic disorder or any other accompanying diagnosis. ADHD, depressive disorders, sleep disorders, learning disabilities, obsessive compulsive disorder, and anxiety are some disorders that are commonly seen in conjunction with tic disorders.
- Offer patient and caring support, and help your child complete tasks. Their tics may make many responsibilities harder to do such as schoolwork.
- Remind your child that they have not done anything wrong to cause their tics. It is nobody’s fault.
- Make a plan with your child, their medical and mental health providers, school staff, and other caregivers so that tics can be managed appropriately.
- Seeking out the support of a mental health provider can help your child to learn how to become more aware of their tics and how to respond differently in a way that may reduce the amount. In addition, supportive social functioning surrounding living with a tic disorder can be provided.
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