TICS

What are tics? 

Tics are sudden, rapid, recurrent, non-rhythmic movements or vocalizations that usually appear in bouts. They can wax and wane in frequency, intensity, number, complexity, and kind of tic, and are sometimes referred to as 'habits.' 

What can you see? 

Tics may include grimaces in the face, eye blinking, shoulder movements, neck movements, and sometimes throat clearing. Children often repeat the same movement multiple times. 

What are the different kinds of tics? 

Motor tics arise in muscle groups, while vocal tics produce sounds through the flow of air from the voice box or nose.

 Simple tics are limited to single movements like eye blinking, nose twitching, or simple sounds such as grunting or throat clearing. 

Complex tics involve multiple muscle groups and can include behaviors like repetitive touching of objects, mimicking others, or echolalia (repeating what others say). 

What age group do tics occur in? 

Tics can affect individuals across all age groups, but they are most commonly observed in school-aged children, typically starting around 5 years of age, with peak severity between 8-12 years. 

What causes tics? 

The exact cause of tics is not fully understood, but they may sometimes occur after stressful situations.

 How are tics classified?

 Tics are classified as provisional tic disorder or Tourette syndrome, with a spectrum existing between the two.

 Since my child has tics, does it also mean they have Tourette syndrome? 

This is very unlikely, as Tourette syndrome is a relatively uncommon condition. 

Will tics persist throughout life? 

Studies, both clinical and population-based, indicate that up to 80% of individuals who present with a tic disorder before the age of 10 experience a significant decrease in tic frequency or intensity during adolescence. 

By 18 years of age, many individuals find that tic intensity and frequency have reduced to a point where they no longer experience significant impairment from tics, although mild tics may persist. 

What is Tourette syndrome? 

Tourette syndrome (TS) typically first appears in childhood, mainly between the ages of 5 and 6. TS is characterized by a combination of chronic motor and vocal tics lasting more than one year. 

Tics may also be associated with other conditions such as ADHD (Attention Deficit Hyperactivity Disorder), OCD (Obsessive-Compulsive Disorder), ASD (Autism Spectrum Disorder), rage attacks, and other neuropsychological impairments. 

How will tics be evaluated? 

A paediatric neurologist will conduct a detailed history of the tics, assess their impact on daily life, review videos, and perform a thorough neurological examination. They may recommend tests if considering other diagnoses/causes.

 How are tics managed? 

Once a doctor confirms that other potential causes have been ruled out, they will educate parents and children about tics and typically adopt a watch-and-wait approach, as 80% of children who develop tics before 10 years of age experience significant reductions in adolescence. Parents often feel reassured with an explanation for the tics and may not seek treatment.

 Some children may require psychological treatment for tics, which can include Comprehensive Behavioral Intervention for Tics (CBIT), where Habit Reversal Training (HRT) is a key component. 

Medications used for tics may have potential side effects, so your doctor will carefully evaluate and discuss these options with you. 

References: 1. Szejko N, et al. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part I: assessment. Eur Child Adolesc Psychiatry. 2022 Mar;31(3):383-402. 2. Andrén P, et al. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part II: psychological interventions. Eur Child Adolesc Psychiatry. 2022 Mar;31(3):403-423. 3. Roessner V, et al. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part III: pharmacological treatment. Eur Child Adolesc Psychiatry. 2022 Mar;31(3):425-441. 

Dr Rashmi Adiga, 

MBBS, DCH, MRCPCH(U.K), CCT(U.K), FRCPCH. 

Consultant Paediatric Neurologist.