Eye-blinking, throat-clearing, facial grimacing and sniffing – tics are brief and sudden unwanted, repetitive, stereotyped movements or sounds. Though alarming to many parents, about 20 percent of school age children develop tics at some point, though less than 3 percent of them display those tics for more than a year. If tics persist for beyond 12 months, you may hear the diagnosis “Persistent Tic Disorder.” If all of the tics are movements, we make the diagnosis “Persistent Motor Tic Disorder.” If all of the tics are vocalizations, we call it “Persistent Vocal Tic Disorder.” If both motor and vocal tics persist more than a year, that defines “Tourette syndrome.”
Tics typically become apparent at age 6-7 years and peak around 10-12 years. Somewhere between 50-80 percent of children with persistent tics will see them dissipate or disappear before adulthood.
For most, the unwanted sounds and movements are no more than a nuisance. One of the most important messages I emphasize is that if the person experiencing the tics is not bothered by them, then others should not be bothered, either. Of course, there are some exceptions to that rule – if the tic is, or has the potential to be, self-injurious, or is socially inappropriate, then it needs to be treated, but that only occurs in about 10 percent of patients.
Most children with a persistent tic disorder have at least one co-occurring problem, a so-called “comorbidity.” The most common comorbidities are ADHD, OCD, and anxiety. Accordingly, children with tic disorders need to be assessed for these comorbidities and receive education regarding the potential for these conditions to emerge.
While environmental factors and illness may influence ticcing, the weight of evidence argues that tic disorders and their comorbidities are inherited/genetic. The inheritance pattern can be subtle and unexpected. In clinic, we often see a parent, while either indicating that they experienced childhood tics that remitted or that no one in the immediate family ever had tics, demonstrating frequent subtle tics.
The majority of children with tics do not need any therapy. Many children and families benefit from education, de-stigmatization and bolstering of coping strategies. The adults in that child’s life need to learn how to support the child without insisting on medication or suppressing the tics. Asking a person with tics to actively suppress them is like asking a person with seasonal allergies to not sneeze—it is unfair and unrealistic. If that child also has ADHD and/or anxiety, the request to suppress taxes an already challenged attention system and/or produces additional anxiety.
Roughly a dozen different medications have strong clinical trial evidence for reducing tics. In addition, a behavioral therapy called Comprehensive Behavioral Intervention for Tics (CBIT) has been subjected to rigorous clinical trial demands and is as effective as any medication for tics. CBIT is a great tool, because it teaches a child how to eliminate the most burdensome tic. Medications are not as “smart” and are intended to help with ticcing, per se. To reiterate, though, only a fraction of patients with tics require any therapy, whether medication, behavioral, or both.