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Tic Disorders

Tics are sudden, uncontrolled movements or sounds that are repeated frequently, such as throat clearing or eye squinting. Tic disorders can affect children and adults, and they usually last less than a year. Tics often become worse when a person is stressed, tired or anxious. Tic disorders are substantially more frequent in boys than in girls, and a family history of tics is common.

A tic disorder that includes at least one vocal tic and lasts for more than a year is considered Tourette syndrome. Tourette syndrome is an inherited neurological disorder, with symptoms generally appearing before age 18.

What are the Symptoms of Tic Disorders?

Tic Disorders symptoms can be grouped in two categories depending on their characteristics:
  • Simple Tics. Simple tics are sudden, brief movements that involve a small number of muscle groups, often around the head and neck. They occur in an isolated fashion, and are often repetitive. Some of the more common examples of simple tics include eye blinking, shoulder shrugging, facial grimacing, head jerking, yelping and sniffing.
  • Complex Tics. Complex tics are distinct, coordinated patterns of successive movements involving several muscle groups. Complex tics may include jumping, smelling objects, touching the nose, touching other people, shouting obscenities, echoing the words of other people or self-harming behaviors.
Tics associated with Tourette syndrome tend to worsen in stressful situations. However, they improve when the person is relaxed or absorbed in an activity. In most cases, tics decrease markedly during sleep. Symptoms may subside for weeks or months at a time, and recur later. Other conditions associated with tic disorders can include:
  • Obsessive-Compulsive Disorder. The person is compelled to perform certain tasks repeatedly (e.g., washing hands or checking that a door is locked).
  • Attention Deficit/Hyperactivity Disorder. The individual has difficulty concentrating, is easily distracted or has overly impulsive behavior.
  • Learning Disorders. This includes problems with reading, writing, math and perceptual difficulties.
  • Sleep Disorders. These include frequent awakenings or talking in one’s sleep. Learn more about sleep disorders.

Types of Tic Disorders

Tic disorders are classified into 3 categories:

Transient Tic Disorders

Involves motor or vocal tics that last for more than 4 weeks but less than a year.

Chronic Tic Disorders

Involve either motor tics or vocal tics (but not both) that last for more than a year.

Tourette Syndrome

Tourette syndrome, the most severe kind of tic disorder, involves both motor and vocal tics that go on for at least a year.

How are Tic Disorders Diagnosed?

When diagnosing tics, the major features that distinguish tics from other movement disorders are the sudden, rapid and temporary nature of the movement, and with the lack of an underlying neurological disorder; their repetitiveness; their disappearance during sleep; and the ease with which they may be voluntarily reproduced or suppressed. Neuroimaging studies such as magnetic resonance imaging (MRI), computerized tomography (CT), electroencephalography (EEG) or certain blood tests may be used to rule out other conditions that could mimic Tourette syndrome.

Tic Disorder Treatment

A combination of psychological therapy and medication has been found to be an effective tic disorder treatment. Our pediatric psychologists use behavioral modification therapy to help a child learn how to suppress or release a tic at the appropriate times. A psychologist can also help a child maintain self-esteem when tics interfere with social situations, and relaxation techniques and biofeedback may be useful in alleviating stress, which can worsen the symptoms. Although tic disorder medications are available to reduce specific symptoms, there is no one medication that is helpful to all patients with tic disorders. Since all medications have side effects, their usefulness must be weighed against problems they may cause. Your child’s neurologist or doctor can help you find the best treatment options.

What Can I Do if My Child is Diagnosed With a Tic Disorder?

Tic disorders typically start to improve after about age 11 and do not cause complications beyond the tics themselves. Some studies indicate that most people with tic disorders are free of tics or considerably improved by the time they reach adulthood. Tics alone will not hurt a child but may affect a child’s self-esteem due to embarrassment of their tics. Vocals tics can be especially problematic in the school setting. Often times, the biggest treatment of tics is reassurance to the child and family, in addition to providing education on when it is appropriate to suppress a tic or not. Family and child counseling are often important, so that the child maintains his or her self-confidence.