Tics and Tourette’s Syndrome

I’ve had a lot of conversations with parents recently regarding their concerns about their children’s tics. Often (but not always), the children are boys, around 8 years of age, and absolutely well otherwise. Their parents have noticed them repeatedly jerking a shoulder, twitching part of their face or clearing their throat. And the question I’m always asked is, “Is my child ok?”

What are tics?

Tics are repetitive muscular movements or sounds that are often only partially controlled, such as the examples above of repeatedly shrugging a shoulder, twitching part of the face (motor tics) or clearing the throat (vocal, or phonic, tics). Someone once described it as similar to the urge to sneeze; possible to control for a short time, but nearly impossible to suppress for longer periods.

Children may describe the ability to control the tic for a short period of time, but are usually unable to control the tic for prolonged periods. Tics may occur in response to a stressful situation or a need to concentrate hard; many children don’t have a particular “reason” for the tics, though. Some children have persistent uncontrollable spasms or vocal outbursts, sometimes associated with the use of loud or socially inappropriate language; this is referred to as Tourette’s syndrome.

What causes tics?

Tics are extremely common in children; some studies suggest they may occur transiently in up to 25% of children. The peak age of onset is 8 years to early to mid- adolescence. It can occur in kids who also have ADHD or OCD, but often occurs in kids with no other diagnosis.

You may find that stress, anxiety or tiredness can precipitate your child’s tics or make them worse. Interestingly, people used to believe that avoiding stressful situations would help control the tics. However, recent studies suggest that it is better to teach your child coping mechanisms to handle them.

Although it’s really hard, try not to scold your child or tell him to stop it. Drawing attention to your child’s tics often makes them worse, which is why your doctor will usually advise you to “ignore it”. Your child’s tics are likely to resolve within 12 months without any intervention.

What can be done?

Most of the time, your child’s tics will get better without any need for treatment, which is another good reason to ignore the tics. Sometimes, it is appropriate to treat the tics, if they start to interfere with his normal life, or lead to bullying or stigmatisation by his friends in school.

Treatment for tics:

You can teach your child how to overcome the “urge” that comes before a tic. People usually describe a strong feeling or urge, that can only be relieved by the tic. You can teach your child to combat the urge by learning to respond with another, controlled, movement or response, such as stretching his arms or hands, or making circles with his ankles, etc. Some psychologists recommend teaching children techniques that directly combat the tic, such as pushing against the twitching or jerking muscle.

Another technique to learn how to control the impulse or urge is to force yourself to become “used to it”. You can try some of these techniques at home. If the symptoms persist, other techniques can be taught by a behavioural psychologist. Medication is hardly ever indicated.

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