Tics are movements or sounds that happen suddenly and repeatedly, without rhythm. When a child or teen gets a tic, it can be scary for caregivers. They might worry if the little coughs or blinks will ever stop or if they mean something more serious. If a child has a tic, experts suggest seeing a doctor to make sure it is a tic. But most of the time, parents are told to watch and wait before doing anything else. Treatment is only needed when tics become long-lasting and cause problems.
What are the symptoms of a Tic Disorder?
Tics are quick, repeated movements or sounds. Most are called “simple” tics, which means they are one movement, like a squint or a quick head nod. Some are called “complex” tics, which means they are bigger combinations of movements or sounds, like reaching up and shaking your head, or a blink followed by throat clearing.
Motor Tics
- Shoulder shrugging
- Eye blinking
- Lip biting
- Facial grimacing
Vocal Tics
- Clearing the throat
- Humming, sniffing, snorting, or squealing
- Repeating words
There are different types of Tic Disorders, each with slightly different symptoms:
- Provisional Tic Disorder: Involves single or multiple motor and/or vocal tics that have been present for less than one year.
- Persistent (Chronic) Motor or Vocal Tic Disorder: Involves single or multiple motor or vocal tics, but not both, that have been present for more than one year.
- Tourette’s Disorder: Involves both multiple motor and one or more vocal tics that have been present for more than one year.
A child’s or teen’s tics may come and go over time, but the tics must start before 18 years of age. Also, the tics must not be caused by a substance or a medical condition to be diagnosed as a Tic Disorder.
How are Tic Disorders diagnosed?
A medical professional or an appropriately trained and experienced child and adolescent mental health professional (psychiatrists or psychologists) will diagnose a child or teen with a Tic Disorder after checking if the movements or sounds meet the diagnostic criteria and how long the tics have lasted.
The child and adolescent mental health professional may interview and/or assess both the child or teen and a caregiver to figure out the specific nature of the tics. The practitioner will also try to determine that the tics are not related to something unexpected.
Tic Disorder Facts
Worldwide frequency of the condition:
Tics are present in about 0.03% to 3% of the world’s population, and Tourette’s Disorder is present in about 0.03% to 0.77%.
Gender ratio:
Male-female comparative data for Tics and Tourette’s Disorder vary, ranging from 2:1 to 4:1.
Peak age of onset:
Tics tend to start in childhood, between 4 and 6 years of age, and peak between 10 and 12 years of age. The peak age of onset for neurodevelopmental disorders, in general, is 5.5 years of age.
Proportion of the condition that emerges before age 18:
Tics that are not caused by a substance or medical illness must start before 18 years of age. So, 100% of individuals with a Tic Disorder will have been diagnosed by the time they are 18 years old. By contrast, the proportion of neurodevelopmental disorders in general, including Tic Disorders, that emerge before 18 years of age is 83.2%.
Burden of the condition in South Africa:
One recent study reporting on he prevalence of Tic Disorder among children and adolescents in South Africa, sampling children between 6 and 16 at a local clinic in one of the South African provinces, reported an incidence of 0.7.
What are the associated factors for Tic Disorders?
Some common factors linked with Tic Disorders are:
- Genetic and familial factors: Most likely a combination of multiple genes interacting with environmental factors.
- Developmental factors: These include premature birth and low birth weight.
- Complications during pregnancy: These include nicotine or caffeine use during pregnancy.
- Complications during childbirth: These include lack of oxygen (hypoxia).
- Environmental factors: Excitement, anxiety, or tiredness may make tics worse.
- Infections and immune response: Paediatric acute-onset neuropsychiatric syndrome (PANS) results from a bacterial or viral infection, triggering an autoimmune response in certain children. Paediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) is a specific subtype of PANS resulting from a streptococcal infection. The symptoms of PANS and PANDAS are sudden tics, OCD symptoms, and mood swings.
What other disorders co-occur with Tic Disorders?
Even though each child and teen is different, Tic Disorders might often happen with other mental health disorders, including ADHD and OCD.
How are Tic Disorders treated?
Tic Disorders are usually treated with therapy or a combination of therapy and medication.
Therapy for Tic Disorder often involves cognitive-behavioural therapy (CBT) with a part called habit reversal training (HRT). If a child gets a feeling before a tic, they’re taught to recognise it and identify situations that may trigger it. The child and therapist develop a “competing” response—an action the child does when they feel the urge—that is different from the tic and less noticeable to others. For example, a child whose tic involves sniffing their nose may do a breathing exercise instead. Kids may also learn relaxation techniques to decrease the frequency of the tics. Another part of CBT, exposure and response prevention (ERP), helps kids prevent tics by learning about and resisting the feelings they get before their tics happen. When kids resist tics for a long time, they learn to handle the warning feelings better (i.e., habituation).
Children and teens with Tic Disorders tend to respond well to certain medications, especially when symptoms are moderate to severe. All psychiatric medication needs to be prescribed by a psychiatrist, a medical officer or a psychiatric nurse.
The medication most commonly used is called aripiprazole. While other types of medications have been studied as well (such as risperidone and tiapride), evidence of their effectiveness for kids is limited. When symptoms occur with Attention Deficit-Hyperactivity Disorder, medications such as clonidine and guanfacine can also be considered.
Please refer to the SAHPRA (South African Health Products Regulatory Authority) for up-to-date professional and patient information leaflets on psychiatric or other medication.
Medications can have side effects, but they are safe for kids to use with proper monitoring by their doctor and close supervision from their caregivers. A child or teen taking one of these medications should see their doctor regularly, especially if their dosage has recently changed. The combination of CBT and medication can also be considered.
Where to find more information
For more details on tics and reasons for concerns, visit our guides for caregivers, educators and adolescents.
To learn more about the technical work behind this guide, please see our reference list below.
References
Robertson, B.A., et al., Prevalence and detection of psychiatric disorders among children and adolescents attending a primary health care clinic. Southern African Journal of Child and Adolescent Mental Health, 2001. 13(1): p. 30-40.+A4:L9