Does your little one sometimes blink continuously? Or shrug their shoulders? Maybe just make a throat clearing sound? As a mother or father, it's normal for you to feel a little nervous and scared when you see things like this. These are what we call tics . These are not things you do intentionally, they happen spontaneously. There's nothing to be afraid of, let's talk about this in detail and simply.
What are Tics? Simply put...
Simply put, tics are sudden, rapid movements or sounds that occur in your body involuntarily and repeatedly. They are uncontrollable. They can be things like blinking your eyes, shrugging your shoulders, or just making a "hum" sound in your throat. They can occur anywhere on your body – your face, shoulders, arms, legs. Sometimes these tics can change from time to time.
Usually, a tic is preceded by some discomfort in the body, or a feeling of urgency. Some people can hold back the tic for a while, but it is very uncomfortable. The discomfort goes away after the tic is over.
These tics often occur in children, especially between the ages of 5 and 10. They are often not serious and may decrease or stop completely over time. However, sometimes these tics can be a sign of a more serious tic disorder that requires treatment.
What types of tics are there?
We divide tics into two main categories: Motor tics, which involve body movements, and Vocal tics, which involve the voice. Both of these are further divided into "simple" and "complex."
Motor tics usually appear first, followed by verbal tics. Also, simple tics appear before complex tics.
Simple Motor Tics
These are very short, sudden movements that involve only one or a few muscle groups.
- Eye movements such as frequent blinking and eye rolling
- To make a sour face, to make a fool of oneself
- Shoulder hug
- Head or shoulder shaking
Simple Vocal Tics
These are also short, sudden sounds.
- Frequent throat clearing
- Making a noise like scratching the nose
- Making a sound like a dog barking
- Making short sounds like "hum", "ah"
Complex Motor Tics
These are somewhat organized, interconnected movement patterns. They involve several different muscle groups in the body working at the same time.
- Related movements, like grabbing a shoulder and turning the head while making a face.
- To touch and examine something, to touch it (e.g., touching a corner of a table, touching a book).
- Jumping, jumping up.
- Bending, twisting.
Complex Vocal Tics
These are a little more complex than just sounds, and can be words or phrases.
- Repeating words or phrases they have said.
- Repeating words or phrases that others say exactly as they are said (we call this Echolalia ).
- Using inappropriate, vulgar, or obscene language (we call this Coprolalia ). This is not something the child does intentionally, but something that happens out of control.
So, what are tic disorders?
Tic Disorders are a group of conditions that affect the nervous system. They are what cause a person to have tics. These tics and their associated symptoms can range from mild to severe . Most of the time, tics are mild and don't require treatment. They often go away as children grow older. However, in some cases, treatment is needed to control tics and other health problems that come with them.
What are the main types of tic disorders?
There are three main types of tic disorders. These differ depending on the type of tics present (motor, verbal, or both) and how long the symptoms last.
1. Provisional Tic Disorder / Transient Tic Disorder:
- These people have had motor tics or verbal tics (one or both) for less than a year .
- This is the most common type of tic disorder, affecting about 10% of children in their early school years.
- According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) , a guide used by doctors to diagnose mental disorders, this diagnosis is given if:
- There must be one or more motor tics, or one or more verbal tics.
- Ticks cannot be present for more than a year.
- Tics must have started before the age of 18.
- These symptoms cannot be caused by another medical condition (e.g., a brain infection) or by medications or drugs being taken.
- It is also possible that you have received another tic diagnosis.
2. Persistent / Chronic Tic Disorder:
- These people have had motor tics or verbal tics (not both at the same time, only one type) for more than a year .
- This condition is seen in less than 1% of school-age children.
- According to the (DSM-5) , for this diagnosis:
- There must be one or more motor tics, or one or more verbal tics (not both).
- Tics must occur several times a day, almost every day, or occasionally, for more than 12 months.
- Tics must have started before the age of 18.
- These symptoms cannot be caused by another medical condition or by medications or drugs being taken.
- It is not possible to be diagnosed with Tourette Syndrome.
3. Tourette Syndrome:
- These people have had motor tics and verbal tics (both types) for more than a year .
- This is considered the most severe type of tick-borne disease.
- According to the (DSM-5) , for this diagnosis:
- There must be two or more motor tics and at least one verbal tic (these do not have to be present at the same time).
- Tics must be present for at least a year. These may occur several times a day (usually in small, continuous bouts), almost every day, or occasionally.
- Tics must have started before the age of 18.
- These symptoms cannot be caused by another medical condition or by medications or drugs being taken.
How common are tic disorders?
Tic disorders are actually more common than you might think. Researchers estimate that as many as one in every 50 children may have Tourette Syndrome or another tic disorder .
How does it feel when you get a tic?
Before a tic occurs, you may feel a strong urge to do it. Like the urge to scratch an itchy spot, or the feeling of a crotch coming on. A kind of tension builds up in the part of the body where the tic is about to occur, and when the tic occurs, that tension is temporarily relieved and you feel a sense of relief.
Sometimes it is possible to control the tic for a few seconds to a few minutes, but it takes a lot of effort. Eventually, the urge becomes unbearable.
It is especially difficult to control a tic when there is a lot of stress . Things like stress and fatigue can increase tics. Surprisingly, sometimes tics increase when the body is relaxed or when you are alone. If someone talks about the tic or points it out, the tics can also increase. However, tics usually do not occur while sleeping . Also, tics may decrease when you are concentrating on something (e.g. schoolwork, other work).
Are there any harmful, serious types of tics?
Yes, some tics can be harmful. For example, some motor tics can cause you to hit yourself in the face or cause neck pain by repeatedly shaking your neck.
Coprolalia , which we talked about earlier, is the spontaneous utterance of inappropriate words and phrases, and can also be a big problem. This can make the child seem like they are intentionally bothering others or behaving badly. But it is actually an uncontrollable urge. Children with coprolalia may be punished unnecessarily at school and at home, and may be bullied by other children . Coprolalia may affect between 10% and 15% of children with Tourette syndrome.
What causes tics?
Researchers still don't know the exact cause of tics, but some scientists believe they are caused by changes in the parts of the brain that control movement. They also believe there may be a genetic link , as tics can run in biological families.
Some other conditions that can be seen along with tick-borne diseases include:
- Attention-Deficit/Hyperactivity Disorder (ADHD)
- Anxiety Disorder
- Obsessive-Compulsive Disorder (OCD)
Sometimes, people with other health conditions, such as Huntington's disease or encephalitis (an infection of the brain), can also develop tics or tic-like movements. Tics can also occur after using drugs, such as cocaine or amphetamines . However, tics caused by these other conditions or drugs are not considered tic disorders.
What are the risk factors for this condition?
Tics are most common in childhood, especially early childhood . Children can develop tics as young as 4 years old. However, the condition is most common between the ages of 5 and 10. Also, boys are more likely to develop tics than girls.
How are tic disorders diagnosed?
Your child's healthcare provider will examine your child and listen carefully to their symptoms. If possible, take a video or two of your child having a tic . This will help the doctor see exactly what your child is going through.
Depending on the type of tics and how long they have been present, the doctor can determine whether the child has a tic disorder. The doctor may also want to check for other conditions that can accompany tics, such as ADHD or OCD .
How are tic disorders treated?
Treatment depends on the type and severity of the child's condition. If the child's condition is mild, no treatment may be needed . Tics may also go away on their own. Simple self-help tips, such as avoiding stress and fatigue, can be helpful for many children.
However, if your child's tics are severe and interfere with daily life , the doctor may recommend behavioral therapy , medication , or both.
Behavioral Therapy
Through a behavioral therapy called Habit Reversal Training , the child is taught to manage their symptoms and to practice a competing response to the tic. For example, if the child's tic is shoulder tapping, the therapist may practice holding the child's arms outstretched until the urge to tap the shoulder subsides.
Another treatment is Comprehensive Behavioral Intervention for Tics (CBIT) . This treatment helps older children manage their tics. It involves habit reversal training, tics education, and relaxation techniques.
While providing behavioral therapy, the child's psychiatrist can also advise you on how to support the child as a family and ensure that the child is receiving the educational support they need.
Medication
If tics persist and interfere with a child's life, medication for tics may help.
For minor tics: Medications such as clonidine and guanfacine may help. These medications are also used to treat ADHD and anxiety, as these conditions can coexist with tics.
For more severe tics: Neuroleptic medications , such as aripiprazole and olanzapine, may be effective. These medications work by altering the effects of neurotransmitters that control body movements.
How long can tics last?
Tics usually get better over time and may even stop altogether. Sometimes a tic may only last a few months, but more often they come and go for years.
Tics are most severe between the ages of 8 and 17. Tics usually decrease and disappear on their own after puberty.
Can tics be prevented?
Scientists still can't figure out exactly why some people get tics and others don't, so they can't be prevented .
If my child has tics, how do I take care of him?
If your child has minor tics, these simple tips can help you:
- Avoid anxiety and stress: Find an activity that your child enjoys and enjoys doing. For example, a game or a hobby. Tics may increase when your child is feeling stressed or anxious. When your child is engaged in an activity, they will be more engaged and less stressed.
- Avoid fatigue: Tics can increase as the child becomes more tired. Make sure the child gets a good night's sleep .
- Try to ignore your child's tics: Don't pay unnecessary attention to your child's tics. Talking about them and thinking about them can make the tics worse.
- Don't punish: Don't yell at your child when he tics or tell them to stop. This is something beyond his control. Getting angry or blaming him won't solve the problem.
- Comfort and encourage the child: Make the child understand that everything is fine and that tics are nothing to be ashamed of. Make them feel that you are with them.
- Inform others in advance: Inform friends and relatives about your child's tics in advance. This way, they will be aware of it and will not panic or react too much when a tic occurs.
- Work with your child's school: Keep your child's teachers and other school staff informed about your child's tics. If your child's tics are causing problems at school, work with them to find solutions. Your child may need a separate space or extra time during exams.
When should I take my child to the doctor?
Some tics are not serious. If your child's tics are minor and there is no problem, you may not need to see a doctor. The tics may go away on their own. However, if you are concerned about your child's tics, or if the tics are like these, make an appointment to see a doctor:
- If it happens frequently, or if it gets worse or happens more frequently.
- If it causes social or emotional problems (e.g. bullying from other children, embarrassment).
- If it causes pain or discomfort .
- If it interferes with schoolwork or other daily activities.
- If it comes with anger, depression, or thoughts of self-harm.
What questions should I ask my child's doctor?
If your child has tics, you can ask the doctor questions like these:
- Are my child's tics minor or more serious?
- Does my child have a tic disorder?
- If so, what type of tick-borne disease does my child have?
- What treatment options do you recommend?
- Will these ticks go away on their own?
- How can this situation affect my child's learning and social relationships? What should I do about it?
Finally, things to remember (Take-Home Message)
It's normal to feel worried, stressed, and scared when your child develops a tic. However, while tics can be scary, they are usually not serious . In fact, minor tics often go away on their own.
The most important thing is that your child receives your love, understanding, and support. Make the child understand that he is not alone, and that this is not his fault.
However, if your child's tics are frequent, severe, or interfering with daily activities or schoolwork, see a doctor immediately. The doctor will be able to carefully examine your child's tics and determine what treatment is best, if any. The most important thing is not to panic, but to get accurate information and medical advice.
` Tics, tic disorders, neurological diseases, behavioral therapy, Tourette syndrome, children's mental health, movement disorders
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