Tourette Syndrome And Tics

What are tics? What is Tourette syndrome?

Tics are short, repetitive, stereotypic movements of muscles or vocalizations. Examples may include eye blinking, facial grimacing, leg twitching, sniffling, grunting, or throat clearing. When a particular tic involves multiple muscle groups, such as extending one’s arm and then making a fist, it is called a complex tic. When an individual has multiple motor and at least one phonic tic, he is often diagnosed with Tourette syndrome (TS). Though originally assumed to be quite rare, tics are thought to affect 12-18% of school-age children; TS, however, is significantly less common.

How do tics impact my child’s life?

Many children are distressed by their tics. Tics can interfere with completing school work, cause body soreness, or trigger feelings of embarrassment, especially if one is teased as a result. In those cases, an evaluation to determine the appropriate course of treatment would be encouraged.It is important to know that many youth with tics may not be bothered by them. If the tics are not causing any interference at home or at school, the best approach may be to just wait and watch, or perhaps arrange a consultation to learn more about tic disorders.

What are the best treatment options for tics?

For decades, the treatment of choice for tic disorders, including TS, was medication. While medications can be effective, many parents prefer not to place their children on medications unless necessary, either on principle or due to concerns about adverse side effects. Fortunately, there has been a resurgence of research supporting a behavior therapy for tics called habit reversal training (HRT), which can be implemented alone or in conjunction with medication management. HRT is considered a first-line, research-supported intervention for children, adolescents, and adults with tics.

How does habit reversal training (HRT) work?

HRT is a behavior therapy designed to help individuals reduce their tics. The first step is to teach individuals to become more aware of their tics, and specifically the “warning signs” which immediately precede their occurrence. Though tics may seem to come out of the blue, a behavior therapist can help someone learn to detect them before theyhappen. Next, individuals are taught to engage in a specific behavior which is incompatible with exhibiting the tic. The exact behavior, called a “competing response,” is determined based on the specific tic. The goal of this treatment is to try and teach the brain to resist the urge to tic, even when it thinks that it must. Eventually, the urge to tic may even go away. You can think of it as learning to experience the itch from a mosquito bite but not actually scratch. In addition to HRT, treatment typically includes education about tics and their course, strategies to reduce stressful situations which can make tics worse, and relaxation training.

 

Is it typical for children or adults with tics to be diagnosed with other conditions?

Yes, a significant number of youth with TS also have co-occurring psychological disorders. The most common ones are attention deficit hyperactivity disorder and obsessive-compulsive disorder, followed by other anxiety disorders. It is common for children and adolescents with TS to receive treatment for one or more disorders, even when their tics are manageable or well-controlled with medication. In such cases, many families find it helpful to work with a provider who has expertise in tic disorders as well as the co-occurring conditions.

As a parent of parent or teacher of a child with tics, where is the best place to start?

Education, education, education. Increasing your knowledge is the first place to start for parents and educators dealing with a child who has tics. Learning about the course of the disorder, what makes tics worse, and the treatment options generally helps adults feel much more comfortable around youth with tics and flows nicely into making changes to accommodate such children. Attending a consultation or in-service about tics and related disorders is a great way to do this. A clinical evaluation by a psychologist, neurologist, or psychiatrist with expertise in tics is another. Evaluations offer the advantage of receiving feedback catered to the specific needs of your child across school, home, and other areas of his life. Regardless of your steps for action, remember to never punish a child as a result of his/her tics. In fact, the stress a child experiences in response to such reprimand will likely make his/her tics even worse!