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A tic is a ‘sudden, rapid, recurrent, non-rhythmic motor movement or vocalisation’ (DSM-V, 2013). Tics usually start between 4 and 6 years of age and peak in severity between 10 and 12 years of age. Each child with a tic disorder will be affected in different ways. In some cases tics can be very mild and thus be merely aggravating and annoying, whereas in other cases tics can be very severe and thus be debilitating. The severity and frequency of tics can wax and wane and the nature of the tics can also change over time. In addition, a number of factors can influence the severity of the tics, for example tics are often worse during periods of anxiety, excitement and exhaustion.
There are two kinds of tics: vocal and motor. They can be simple or complex.
Simple (short in duration)
For example: sniffing, throat clearing, grunting, hooting, shouting, etc.
For example: eye blinking, jaw movements, shoulder shrugging, head bobbing/jerking, facial grimacing, neck stretching, arm jerking, etc.
Complex (long in duration)
Saying words or phrases that seem inappropriate because they aren’t part of the conversation.
May repeat their own words/phrases or repeat the last-heard words/phrases of someone else.
May use socially unacceptable words (e.g., use of obscenities or socially inappropriate words or phrases) that are barked or grunted.
Often involve a combination of simple motor tics (e.g., a head jerk with a shoulder shrug and a facial grimace)
Sometimes they can appear purposeful (e.g., jumping, twirling, hopping, or making an obscene gesture).
Sometimes they can look like an imitation of someone else’s movements.
Diagnosis of Tic disorders
There are four different types of Tic disorders: Tourette’s Disorder, Persistent (Chronic) Motor or Vocal Tic Disorder, Provisional Tic Disorder and the other specified or unspecified tic disorders. To be diagnosed with Tourette’s, Persistent or Provisional, a young person has to start experiencing tics before 18 years of age and the tics cannot be a result of another medical condition or substance. The diagnosis of these three tic disorders also depends on the types of tics that are occurring and the length of time the tics have been present.
- Tourette’s disorder (syndrome): Multiple motor tics AND one or more vocal tics that have persisted for more than one year since onset of the tics.
- Persistent (chronic) motor or vocal tic disorder: Single or multiple motor OR vocal tics that have persisted for more than one year since onset of the tics.
- Provisional tic disorder: Single or multiple motor and/or vocal tics that have been present for less than one year.
Because these diagnoses are hierarchical, children may be diagnosed initially with Provisional tic disorder and later be diagnosed with Persistent (chronic) motor or vocal tic disorder or Tourette’s disorder if their tics persist for at least a year. Likewise, children with Persistent (chronic) motor or vocal tic disorder may be later diagnosed with Tourette’s disorder if they develop both motor and vocal tics.
Frequency of Tic disorders
Tic disorders are common; up to 20% of young people have tics at some point in their childhood (Tourette Syndrome Association-USA, 2014). Tics are more common in children than in adults. Tourette’s syndrome affects approximately 6 in 1,000 children. While both sexes can experience tic disorders, boys are 3 to 4 times more likely to have a tic disorder.
Cause of Tic disorders
Tic disorders are neurological disorders; this means that young people with tic disorders have brains that work differently than people without tic disorders. Researchers have identified genetic and environmental causes for Tourette’s syndrome. This means that young people inherit the disorder and that certain factors, such as older paternal age, obstetrical complications, maternal smoking during pregnancy and lower birth weight, have been associated with worse tic severity.
Outcomes for young people with Tic disorders
In most cases tics are mild and don’t require treatment. When tics are more severe, doctors may treat the tics using medicine. Most people with tic disorders find that their tics improve in late adolescence and early adulthood. Some young people are tic-free in adulthood. A small percentage of people with Tourette’s syndrome continue to have very severe and persistent tics into adulthood (Tourette Syndrome Association, 2014).
Related concerns for young people with Tic Disorders
It is common for young people with a Tic disorder to have attention-deficit/hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD). Young people with a Tic disorder may also have anxiety, depression, sleeping problems, social concerns, poor self-esteem, executive functioning problems, oppositional defiant disorder or learning disorders (such as dyslexia or dyscalculia).
Assessment of tic disorders
During your first session we meet with you and your child to conduct a clinical interview to determine if your child has a tic disorder and to identify any other underlying behavioural, emotional or educational concerns your child may have. Finally, we develop a personalised, evidence-based treatment plan to help your child and your family.
Treatment of tic disorders
We can provide strategies to help your child manage their tics. We can also use a number of approaches to treat any underlying emotional, behavioural, educational or social concerns that your child may have, such as:
- Cognitive behavioural therapy (for treating emotional regulation, anxiety, obsessive-compulsive disorder and depression),
- Mindfulness/relaxation (for low mood and anxiety)
- Exposure-response therapy (for treating anxiety and obsessive-compulsive disorder),
- Social skills training (intervention for social concerns),
- Resilience training, and
- Assertiveness training (for social concerns).