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Classful

Young children naturally fidget, make unintelligible sounds, and self-soothe with repetitive motions.

However, when you spot an unusual or out-of-place behavior becoming more common or a pattern of sounds and movements that seem on a cycle, it may be time to get professional advice. There has been a great deal more public discussion about Tourette’s Syndrome recently. This is largely thanks to young people with this condition sharing their experiences on social media. As a result, you may be understandably concerned that your child’s tics are an early indicator of Tourette’s.

However, as we discuss here, that is just one of the explanations for childhood tics, and in many cases, tics are temporary, and children ‘grow out’ of them.

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What are childhood tics?

A tic is a rapid or sudden movement or sound that is repeated. A simple tic is one action, while a complex tic is a series of interlinked movements, sounds, or a combination of both.

Tics typically appear when children reach the age of five years. This is often a mild issue that lasts a short time. If tics start to happen in teens or adults, this is more likely to be a persistent, lifelong issue. The two main types of tics are vocal and motor.

Vocal tics

Vocal tics can be a word, phrase, or sound, including throat clearing, coughing, hissing, or grunting.

A complex vocal tic can involve whole sentences. Also, it is classified as a complex tic if the child repeats their own words (called palilalia). Alternatively, they may repeat what other people say (echolalia). A child or adult with Tourette’s Syndrome may say or shout swear words or obscenities (coprolalia). They have no more control over this than they do over involuntary movements in their limbs.

Motor tics

A motor (or movement) tic can occur anywhere on your body and includes things like:

  • Repetitive blinking
  • Eye rolling
  • Nose/face wrinkling
  • Finger clicking
  • A hand or foot jerk
  • Waving
  • Shoulder shrugs
  • Needing to touch everything
  • Copying someone else’s actions

Some motor tics are more severe and involve spasms in multiple muscles at once – there are classed as complex tics. Motor tics can also be further broken down into clonic (abrupt and fast movement), dystonic (slower movement or abnormal posture), and tonic (contractions that tense muscles).

Why can’t people stop a tic?

People who experience tics describe them as an unpleasant sensation that builds up, leading to a compulsion to make a sound or movement. Some tic urges can be partly or wholly suppressed, but a tic urge is often involuntary and impossible to control.

Can childhood tics go away?

‘Transient tics’ – temporary ones – are common in childhood and affect around 20% of school-age children.  This is also sometimes referred to as “provisional tic disorder,” involving behaviors lasting no more than 12 months.

Persistent Tic Disorder- or Chronic motor or vocal tic disorder – is when either motor or vocal tics last for more than a year. This can be a precursor to a diagnosis of Tourette’s Syndrome.

Why do some tics briefly appear and then go away? The causes of some temporary tics include stress and anxiety or an undiagnosed muscle problem. You may also find that a child displays a motor or vocal tic when tired or upset. Alternatively, it could be a reaction to excitement or happiness.

When are childhood tics severe?

Reference has already been made to the timescale that indicates childhood tics are cause for concern. Once they are evident for over 12 months, it is important to seek medical advice. However, parents and guardians should also ask for advice immediately if:

  • A child’s tics are frequent and prolonged, especially if vocal and motor tics are involved.
  • The tics put the child at risk.
  • The movements cause pain.
  • Tics are resulting in embarrassment, harassment, or bullying.
  • The child’s social and education opportunities are being limited by their tics.

Also, there are situations in which even temporary tics cause mental health issues in children, such as depression, that require medical intervention.

Tourettes and tics

The US CDC reports that it is impossible to know how many children have Tourette’s Syndrome, as many live with this condition without a formal diagnosis. However, this organization estimates that one in every 162 children (0.6%) has Tourette’s Syndrome, and around 50% of those are undiagnosed.

One of the main reasons for this is that the symptoms of Tourette’s can mimic other medical conditions. For example, persistent squinting or blinking can appear to be a vision issue, and sniffing could be associated with allergies. There could also be children with Tourette’s Syndrome who are viewed as problem child who displays erratic and inappropriate behavior. Many children whose childhood tics are linked to confirmed Tourette’s Syndrome may also have another medical condition. According to the CDC, this could be as many as 83%.

The sort of conditions that can co-exist with Tourette’s include:

Autism and childhood tics

It is common for children on the autism spectrum to have ‘tics’ though they may be mistaken for stims.

What is the difference between stimming and tics? Stimming is considered a purposeful action by a child to soothe or comfort themselves. As already discussed, tics are involuntary urges that are hard – if not impossible – to suppress.

Treating a child with both autism and tics, including Tourette’s Syndrome, would involve the same methods as we explore later in this article.

What causes childhood tics and Tourette’s Disorder?

One of the reasons that they are so problematic to treat is that childhood tics have no apparent cause. The most widespread view is that they are a temporary or permanent neurological (brain) issue, resulting in a physical response. One factor may be the levels of certain chemicals that transmit nerve impulses (called neurotransmitters), such as dopamine and serotonin.

Evidence suggests that genetics can play a role in a child’s risk of developing tics. In other words, there can be a family history of tics or Tourette’s Syndrome.

Also, as mentioned above, tics can be linked to another diagnosis, such as attention deficit hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD).

Can you cure childhood tics?

There is currently no cure for Tourette’s Syndrome or a ‘quick fix’ way to stop childhood tics. However, there are ways to treat and alleviate some of the symptoms.

This includes medications used to adjust hormone levels and muscle reactions in severe cases. Botulinum (Botox) is sometimes used to relieve a simple motor or vocal tic. Research is underway to explore if anti-seizure medications (used for conditions like epilepsy) can help reduce the symptoms of Tourette’s.

However, many common ways to help children manage Tourette’s Syndrome are therapy-based or involve teaching coping strategies they can use daily. Similar methods can help children manage and ‘grow out’ of Transient childhood tics too.

The sorts of therapies that can be used include CBT (Cognitive Behavioral Therapy) to deliver habit-reversal training; mindfulness and breathing exercises; and psychotherapy, which can also tackle associated issues such as anxiety and depression. There are also studies underway to back up anecdotal evidence that music can be a way to manage and prevent tics.

What is habit reversal therapy (HRT)?

This is the most common therapy used to treat childhood tics. Does it work?

One study reported that habit reversal therapy had been shown to deliver: “Significant post-treatment reductions in tic severity scores (range: 18.3%–37.5%)”. It added, “Current evidence suggests that HRT can reduce tic severity in both adults and children” who have Tourette’s Syndrome and other chronic tic disorders.

Habit reversal therapy works to help children become more aware of the build-up to a tic. When they become more familiar with the feeling they get before the movement or sound, they can start to try out a “competing” response. In other words, they can do something instead of the tic to prevent it.

An example would be if a child has the compulsion to cough or shout, they take deep breaths instead.

Coping and ‘self-help strategies

One of the most important ways a parent can support a child with tics is to stay calm and downplay the issue’s significance. As well as to not make any demands on them to stop their movement or sound.

Parents can be more ‘bothered’ by their child’s behavior than the child is and inadvertently start to transfer their anxiety and embarrassment. A tense, self-conscious and unhappy child is not going to tic less. Also, if a child feels compelled to concentrate hard on suppressing a tic at school – as a parent or teacher demanded – this will be very unpleasant, an obstacle to learning, and pretty much impossible in many cases. When the child gets into trouble for ‘acting out’ or being disruptive, it can be deeply distressing, as they have no control over this movement or sound.

“Tics like attention. Making comments about tics as they happen, asking the child to stop, laughing about tics, comforting a child when he has difficult tics, or even teasing a child about tics are all forms of attention that tics feed on,” according to a report by the Center for OCD, Anxiety, & Related Disorders.

Acceptance, rest, and relaxation are more conducive to your son or daughter growing out of mild childhood tics. It is also recommended that you:

  • Manage the understanding of educators and other adults without your child hearing you.
  • Don’t limit a child’s experiences due to their tics.
  • Play up their strengths and achievements.
  • Let them take the lead on discussing their tics, including laughing if they find one amusing.
  • Provide pleasurable mental and physical distractions.
  • Establish a regular bedtime and sleep pattern.

That’s not to say you should entirely ignore the issue, though. Parents need to help their children understand what is happening.

Also, as soon as the tics cross any of the boundaries listed above – including becoming persistent or prolonged – it is important to ask for medical help, as the tics may be linked to some other undiagnosed issue.