Tics

By Dr Megan Yap - PaediatricianGeneral21 May 2018

Ticks are disgusting little parasites that I have pulled out of the scalp or from behind the ear of many a child that has come through kids emergency (to great satisfaction I might add, back in the day when I actually worked in an emergency department).  They suck on the blood of animals and are related to spiders, and just like their 8 legged relatives, they are creepy and revolting.

 

Thankfully, this is not the type of tic I am going to blog about today!

 

TICS (motor, vocal and tic disorders)

By contrast, tics are repetitive, brisk and non-rhythmic motor movements or vocal sounds that children produce, that they ultimately cannot control (even though they may be able to suppress them for short periods of time).  Motor tics are ones that involve some kind of movement, whilst vocal tics are ones involving sound.  Tics are classified as being simple when they are short in duration, or complex when long in duration.

A LOT of children are seen through paediatric clinics who are experiencing or have had tics.  In the vast majority of cases, these are mild and need no intervention. Most people will have their tics improve or completely resolve in their late teens and into early adulthood.

 

Who gets tics? 

Tics usually start in children between the ages of 4 and 6 years.  They are common, and depending on where you source your information, can occur in 20-25% of children at some stage of childhood and the peak severity is said to be between 10-12 years of age. Boys are (3-4x) more commonly affected than girls, and they seem to happen more commonly in children with a family history of tics.  Both genetic (that is, inherited) and environmental causes exist and certain factors like mum’s smoking during pregnancy, low birth weight, children born to older dads and pregnancy complications have been linked to tic disorders that are more severe. They also occur more commonly in association with other conditions like Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD).

 

What do they look like?

There are lots of different types of tics, and they can vary widely in severity.  In some children, they can be really mild (and some children appear to not even notice they are present), and in other cases they can be very severe and prevent the child from being able to participate fully in every day activities.

Some examples are:

Simple Motor tics (these are probably the most common ones I see in practice and involve only a single muscle group)

  • Blinking
  • Grimacing
  • Nose wrinkling
  • Shoulder shrugging

Complex Motor Tics (these are of longer duration and involve several movements in succession, multiple muscle groups and can sometimes look like the child is doing it on purpose)

  • Kicking
  • Jumping
  • Twirling
  • A series of simple motor tics strung together (eg a head jerk with a shoulder shrug)

Simple vocal tics (involve a single, simple sound)

  • Sniffing
  • Grunting
  • Throat clearing
  • Coughing

Complex Vocal Tics (involve meaningful words)

  • Saying words or phrases that seem out of context or odd
  • Repeating words/phrases of someone else or of themselves
  • Socially inappropriate words (eg swear words, socially unacceptable phrases) that are grunted or “barked” suddenly

 

Tic Disorders

There are a few types of tic disorders and the way they are classified and diagnosed depends on the TYPE of tics the person is having, how long they have been occurring, how old the person is when the tics first appeared.  In children, tics often come and go – present for months, then gone for days to weeks at a time and then, may or may not reappear.  The tics can also change from one type to another at different times. Only a very small number of the children who have tics in childhood will progress to have a chronic tic disorder or Tourette’s.

  1. Provisional tic disorder: single or multiple motor and/or vocal tics that have been ongoing for LESS than 12 months
  2. Persistent/chronic motor or vocal tic disorder: single or multiple motor and/or vocal tics ongoing for MORE than 12 months.
  3. Tourette’s disorder/syndrome:  onset before 18 years of age, more than one motor tic AND one or more vocal tics that have been ongoing for over 12 months.

 

What can I do to help a child who is experiencing tics?

By far the best thing you can do for a child who is having tics is to pay as little attention to it (the tic that is, not the child – ha ha) as possible.

Explain to the child that tics are really common, not harmful and mostly go away on their own.  Worry and embarrassment can actually make the tic worse.  Pointing out a tic to a child who has one, only makes them think about it more and often makes it worse so sharing this information with school teachers/carers (and often the child’s friends too) can be of benefit.

Trying to avoid things that exacerbate tics:

  • Chill out and help the child avoid stressful situations if possible
  • Get enough sleep! Fatigue and being overtired can make tics worse
  • Don’t draw attention to it. Encourage the child to not focus on their own tic by distracting them with something else.
  • Let kids do what they have to. Don’t ask them to hold it back, because even though some children can suppress their tic for a short time (some say they have no control over them at all), this causes the urge of the tic to build until the child HAS to release the pressure, and it is often then much worse.

 

There are various strategies that can be taught to children to help them to control their tics usually in some form of therapy for anxiety, stress and to improve resilience.  These can include mindfulness exercises (in kids with anxiety or low mood), social skills training (in kids with social difficulties or concerns) and other therapy to help with emotional regulation and anxiety.  If you feel that your child would benefit from these, then speak to your GP or paediatrician about how to go about it.

Hope you have found this post helpful – catch you on Friday!!

 

xxDr Megs

For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at http://www.kids-health.guru/

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