Understanding WHAT ARE TICS: Causes, Types, and Management Strategies

Understanding Tics

Many of you may have heard me talk about tics and what we struggled with but what are tics? 

Tics are brief, sudden movements or sounds. They may happen at random times and many times each day. A tic is complex to stop, but you are awake and aware during a tic. Tics do not cause you to lose consciousness and usually do not happen in your sleep. 

Tourette’s are both vocal and motor tics that last for more than one year.

Many people will tell you that their child’s tics come and go (wax and wane). That was true for us, but what we didn’t realize was that there were particular triggers that caused the tics to come and go. 

Definition and Types

Both kinds of tics can be either simple or complex. Meaning that they may only have one or they may do many of these actions. We experienced the complex tics and my son dealt with many vocal and motor tics.

Tics can also be transient or chronic. Many children diagnosed with tics have transient tics, which means that the tics last for a few days to months and then never come back. 

Tics that last for more than a year are called chronic tics. People with chronic tics have what is referred to as chronic tic disorder. Chronic tics can be either motor or vocal and can change over time.

Although our tics were diagnosed as transient, they align more with a chronic diagnosis. People with chronic tics can experience a motor tic such as head/neck twitches for some time, morphing into something like eye blinking or throat clearing.

Two main types of tics exist motor tics and vocal tics.

• • Motor Tics: These tics involve body movements. Blinking, shoulder shrugging, head jerking, and grimacing are common motor tics. They can be simple, involving one muscle group, or complex, involving multiple muscle groups and coordinated movement patterns.

• • Vocal Tics: Vocal tics involve sounds. Throat clearing, grunting, sniffing, and repeating words or phrases exemplify vocal tics. Like motor tics, they can also be simple or complex.

Characteristics

Tics often accompany an unpleasant sensation or urge in the body. The tic relieves this premonitory urge, albeit temporarily. This repetitive cycle can cause significant distress, especially when the tics are frequent or severe. It’s not uncommon for a child to feel frustrated or embarrassed, particularly in social settings.

Types Of Tics

Understanding the types of tics helps in recognizing and managing them effectively. They can be categorized into motor and vocal tics, each with distinct characteristics.

Motor Tics

Motor tics involve the movement of some part of your body. You may notice your child do some of the following:

• • Nose wrinkling

• • Shoulder shrugging

• • Eye blinking

• • Rubbing their hands or feet together

• • Repetitive or obsessive touching

• • Head twitching/jerking

• • Kicking

• • Jumping

In addition, motor tics involve physical movements ranging from simple to complex.

• • Simple Motor Tics: Brief, repetitive movements like eye blinking, grimacing, or shoulder shrugging. These are more common than vocal tics, often intensifying during stress, excitement, or lack of sleep. For instance, a child might blink rapidly or twitch their nose when overwhelmed.

• • Complex Motor Tics are intricate movements such as kicking, twirling, or complex sequences. They can involve multiple body parts and are often preceded by a “premonitory urge,” a robust and irresistible sensation that is temporarily relieved after performing the tic. Imagine a child who spins in a circle or performs a series of movements in a specific order before feeling momentary relief.

Vocal Tics

Vocal tics involve making some kind of sound with your mouth or vocal cords. Symptoms can include:

• • Coughing

• • Throat clearing

• • Barking

• • Grunting

• • Sniffing

They also be simple or complex:

• • Simple Vocal Tics are quick, repetitive sounds like throat clearing, grunting, or sniffing. These tics often go unnoticed initially but can become more apparent in quiet settings or moments of high stress.

• • Complex Vocal Tics Involve more sophisticated sounds, including words or phrases. These tics can be socially disruptive, sometimes resulting in inappropriate or out-of-context utterances. Picture a child who intermittently shouts a word or phrase, struggling to suppress the urge.

Causes Of Tics

Tics have roots in a complex interplay of genetic, neurological, and environmental factors. While science continues to unravel the intricacies, several core causes are widely recognized.

Genetic Factors

The research underscores the heritability of tics. If your child has a family history of tic disorders or conditions like Tourette Syndrome, there’s a higher probability they’ll experience tics. Gene studies indicate multiple risk genes rather than a single culprit.

Neurological Factors

Tics are strongly correlated with brain chemistry and structure. Dopamine, a neurotransmitter, often plays a critical role in tic disorders. Irregular dopamine regulation can disrupt signals to the brain regions responsible for movement and control, leading to tics. Also, specific brain areas, such as the basal ganglia and prefrontal cortex, often show differences in individuals with tics.

Environmental Factors

Environmental triggers can exacerbate tics. Stress, excitement, or anxiety frequently make tics more pronounced. Infections, particularly Streptococcus, have been linked to sudden onset of tics, part of a condition known as PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections). Understanding and mitigating these factors can significantly aid in managing tics.

Developmental Factors

Rapid neurological changes occur during childhood and adolescence. These developmental milestones often coincide with the onset or worsening of tics. For some children, tics emerge after a viral infection or traumatic event, making monitoring changes closely during these stages pivotal.

Immunological Factors

The immune system might play a hidden role in tic disorders. Research on PANDAS reveals that autoimmune reactions could lead to tics. In these cases, the body’s immune system mistakenly attacks parts of the brain, mistaking them for harmful invaders. This often results in sudden and severe tics.

Impact of Diet

The gut-brain axis suggests that diet can influence tics. Foods that affect gut bacteria may impact brain function. Nutrient deficiencies often show correlations with increased tic severity. While dietary changes aren’t an aid, many parents find that adjusting their child’s diet reduces tic frequency.

Understanding these causes equips you with knowledge and offers avenues to explore how to manage your child’s tics more effectively. Each child is unique, and uncovering the root cause often requires a multi-faceted approach.

Diagnosing Tics

Diagnosing tics involves a comprehensive evaluation by a healthcare professional, usually a pediatric neurologist or psychiatrist. The process starts with a detailed medical history and physical examination. Although you might notice your child performing repetitive movements or sounds, a professional evaluation ensures you focus on the right signs.

Medical History

The medical history review serves as the foundation for accurate recognition. It includes questions about the onset, frequency, triggers, and family history of tic disorders. This detailed history can help distinguish between types of tic disorders, such as Tourette’s Syndrome or Persistent Motor/Vocal Tic Disorder.

Physical Examination

A thorough physical examination helps rule out other conditions that might mimic tics. During this step, the healthcare provider observes your child for typical tic behaviors. This observation is essential, as tics often fluctuate in severity, making them sometimes hard to catch during a brief exam.

Differential Recognition

To confirm a tic disorder, professionals often perform a differential recognition. This involves eliminating other potential causes for your child’s signs. Conditions like epilepsy, developmental disorders, and obsessive-compulsive disorder (OCD) can have overlapping signs with tic disorders. By ruling these out, the focus narrows to tic-specific treatments.

Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), provides criteria for diagnosing tic disorders. For example, to recognize Tourette’s Syndrome, both motor and vocal tics must have been present for at least one year. These structured criteria help differentiate various tic disorders and ensure consistent, reliable recognition.

Additional Tests

Additional tests, such as neuroimaging, might be recommended in some cases. These tests can’t identify tics but can rule out other neurological conditions. Blood tests might also be necessary to check for underlying issues, particularly if an autoimmune condition like PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is suspected.

Parental Observation

Your observations as a parent provide invaluable information. You see patterns and triggers that might not be evident in a clinical setting. Keeping a diary of your child’s tics, noting the time, context, and intensity, can provide essential insights that aid in recognition and eventual assistance planning.

Accurate recognition is the first step in effectively managing and treating tics. Working closely with healthcare professionals ensures your child receives the best care possible.

Treatment Options

Several assistance options are available to help manage tics effectively. These primarily focus on reducing signs and improving quality of life.

Behavioral Therapy

Behavioral therapy is a primary treatment method, and it is an exceptionally comprehensive behavioral intervention for tics (CBIT). CBIT teaches you to become more aware of your tics and the sensations that precede them. By recognizing these premonitory urges, you can develop competing responses to counteract the tics. According to the Centers for Condition Control and Prevention (CDC), CBIT has significantly reduced tic severity.

Another approach within behavioral therapy is Habit Reversal Training (HRT), which involves identifying early signs of the tic and substituting it with a less noticeable action. HRT aims to break the cycle by using competing responses, enhancing a person’s control over their urges. While there are pharmaceutical solutions, we focus on getting to the root cause

Living With Tics

Daily Challenges

Managing daily life with tics can be demanding. Simple tasks often become complex. Children might experience embarrassment or frustration, particularly in social interactions. These moments can feel isolating, making it essential to foster a supportive environment.

Coping Strategies

Understanding and support from family and friends are essential. Encourage open conversations about tics to reduce stigma. Techniques like mindfulness and relaxation exercises help manage stress, potentially reducing tic severity. Keeping a routine can provide stability.

School Environment

Exploring school with tics requires collaboration. Teachers and staff should be informed about the child’s condition. This ensures appropriate accommodations, like extended test times or breaks. Creating a safe space in the classroom allows the child to manage tics discreetly.

Social Interactions

Social situations can be stressful. Equip your child with strategies to explain tics to peers. Role-playing potential scenarios can build confidence. Encourage participation in activities where tics might be less noticeable, fostering inclusion and self-esteem.

Professional Help

Professional support is vital. Behavioral therapies, such as Comprehensive Behavioral Intervention for Tics (CBIT) and Habit Reversal Training (HRT), provide tools for managing tics. Consult with healthcare providers to tailor interventions specific to your child’s needs.

Alternative Approaches

Exploring natural remedies, dietary adjustments, and supplements offers additional ways to manage tic symptoms. Consider essential oils or homeopathic treatments, but consult healthcare professionals to ensure safety and effectiveness.

Building Resilience

Living with tics builds resilience. Celebrate small victories and progress. Fostering a positive outlook helps your child face challenges with confidence and strength. Resilience is nurtured through empathy, understanding, and consistent support.

Conclusion

Getting the hang of tics is essential for managing and giving support. Knowing the kinds and why they happen helps us figure out the best ways to help kids. Stuff like CBIT and HRT for therapy, and even some meds, are showing some good results. A supportive vibe at home and school, the ability to talk openly, and coping strategies that fit the child’s needs help reduce stress and stigma, letting kids tackle social stuff confidently.

If you are ready to dig into your child’s diagnosis, you can book a discovery call here.

I work with families just like mine I help stressed, frustrated, overwhelmed parents who are struggling with their child’s tics diagnosis and giving them a step-by-step process so they no longer feel suffocated by a diagnosis and can have happy & healthy kids.

Symptoms can be far removed from what is causing the dysfunction in someone’s body.

I want to help you and your family focus, function, and FLOURISH!

References:

Specht, M., Woods, D., Nicotra, C., Kelly, L., Ricketts, E., Conelea, C., Grados, M., Ostrander, R., & Walkup, J. (2013). Effects of tic suppression: ability to suppress, rebound, negative reinforcement, and habituation to the premonitory urge.. Behaviour research and therapy, 51 1, 24-30 . https://doi.org/10.1016/j.brat.2012.09.009.