Tics and Tic Disorders

Tics are quick, sudden, repeated movements or sounds that your child makes and cannot control. Tics can happen anywhere in the body, including your child’s shoulders, hands, arms, legs and face.

People tend not to notice most tics, but sometimes they are more obvious. Tics can be embarrassing for your child, especially teenagers. A tic disorder is when tics affect your child’s daily life.

• Eye blinking
• Mouth twitching
• Nose wrinkling
• Sniffing
• Throat clearing
• Grunting

Many children have tics. They are more common in boys than girls.

We do not know what causes tics. We think that they might be related to an undetectable chemical imbalance in the brain. They often seem to be passed down from a family member (inherited).

Many children develop tics during their early school years. Most children outgrow them by the end of puberty.

Yes, some factors may make your child’s tics worse. These include:

• Taking certain medicines, including some stimulants used to treat attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD)
• Stress or high emotions
• Anxiety
• Excitement
• Being tired
• Drawing attention to your child’s tic

Tics are unvoluntary movements (motor tics) or sounds (vocal tics) that your child makes over and over. Tics can be simple or complex, which is explained below.

Tics typically come and go and may change over time. Some children can suppress their tic for a short time, but the urge to have it is difficult to stop.

• Simple motor tics: Tics that involve 1 muscle group. They are fast and meaningless, such as eye blinking, eye rolling, lip pouting, head jerking, fingers moving, frowning, grimacing, belly (abdominal) tensing, jaw snapping, nose twitching, arm jerking, kicking or tooth clicking.
• Complex motor tics: Tics that are more involved, slower and may appear purposeful involving 2 or more muscle groups. Some examples include funny expressions, hopping, twirling, biting, head banging, pinching, throwing, bending or obsessively touching.
• Simple vocal tics: Tics that are meaningless sounds or noises that involve only 1 sound or noise, such as throat clearing, grunting, nose sniffing, coughing, hissing or barking. Vocal tics can sometimes affect the way your child speaks, because it can be hard to get words out during tics
• Complex vocal tics: Tics that sound like repeating one’s own words or phrases, repeating others’ words or phrases or more rarely, using vulgar, obscene or swear words.

Tics are also classified depending on how long your child has had the tic. The most common tic disorder types include:

• Provisional tic disorder: These tics can happen once or come and go. They last less than 1 year and go away. They can be motor or vocal.
• Persistent motor or vocal tic disorder: These tics occur many times a day nearly every day or on and off for more than 1 year. They are either vocal or motor tics but not both.
• Tourette (too-RET) syndrome: These tics consist of 2 or more motor tics and at least 1 vocal tic, although they might not always happen at the same time. These tics last at least 1 year and can occur many times a day (usually in bouts) nearly every day, or on and off.

We can usually diagnose tics by giving your child a physical examination and talking with you about their symptoms. We will ask you and your child a few questions about their tics. You will describe the tic, how long it lasts, what makes it worse, and how they feel just before the tic starts and when it is over.

There are no specific medical tests used to diagnose tics or tic disorders. However, in rare cases, if we think your child’s tics might be caused by another condition, we may run some tests such as an EEG (electroencephalogram) or an MRI (magnetic resonance imaging) on their brain to rule out other problems.

Most of the time, people cannot prevent tics. However, you can do the following to help them from getting worse:

• Reduce stress. Since stress may make tics worse, try to reduce your child’s stress level to prevent or reduce the tics. For example, stay organized and avoid waiting until the last minute to complete homework assignments or other tasks.
• Help your child try not to focus on the tic. Thinking about it or feeling embarrassed about the tic can make it worse. Explain to your child that it is OK to have the tic and not to worry about it.
• Do not draw attention to the tic. Teach your child’s friends and family members to ignore the tics whenever possible. Pointing them out may make them worse. Talk with your child’s teachers and childcare providers, so they can intervene if your child is teased or bullied.
• Make sure your child gets enough sleep. Make sure your child avoids becoming too tired, because fatigue can trigger tics.
• Discuss with schoolteacher and supporting staff. Ask about accommodations when your child has tics at school.

Make sure your child knows to talk with you or another trusted adult about things that bother them. We offer many resources to help your child cope with stress, including referral to other clinics.

Most of the time, your child will outgrow tics on their own without treatment. Tics can continue into the teenage years, but they usually go away or improve in adulthood.

Treatment is focused on helping your child minimize their tics and usually does not involve medicine.

Comprehensive Behavioral Intervention for tics or CBIT (pronounced “seebit”) is a therapy that reduces tics. This treatment is weekly, for 8 sessions over 10 weeks with a therapist. Providers can adjust the exact schedule to meet the needs of your child and family. CBIT has 3 components:

1. Train your child to be more aware of the tics and the urge to tic
2. Help your child do a competing behavior when they feel the urge to tic
3. Change daily activities to reduce tics

We may prescribe medicine to help control the tics if they interfere with your child’s wellbeing, including:

• How they feel about themselves
• Their relationships with others
• If the tic causes physical harm or pain to your child

Using medicine is a serious decision. We will talk with you about the risks and benefits if we feel your child needs medicine for tics.

Getting emotional support from family, friends and a psychologist or counselor can help you and your child. Severe or chronic tics can be challenging for children to live with, especially teenagers. Having information on tics and tic disorders for other family members and teachers can be helpful. We can help you with this, as well as referral to other clinics, such as Psychiatry and Behavioral Medicine or the Biofeedback Program.

If your child suddenly develops severe tics, or if the tics worsen, schedule an appointment with your doctor. Your child’s doctor can evaluate your child and provide helpful resources. Your child’s doctor can refer your child for medicine evaluation at Seattle Children’s Neurology, Psychiatry and Behavioral Medicine or Neurodevelopmental Program.