Childhood tics come in all shapes and sizes. Tics can range from a subtle nasal sniff or throat clearing to a more severe head snap or vocal outburst.
Tics that start in elementary school and continue during adolescence are also common. According to Dr. Dararat Mingbunjerdsuk, a neurologist that specializes in movement disorders at Seattle Children’s Neurosciences Center, up to 10-20% of school-age children may exhibit a tic at one point in their life.
“Tics that come and go are the most common cause of movement disorder we see in the clinic,” she said. “The vast majority of children eventually outgrow their tics or the tics become less frequent or less severe as the person enters adulthood.”
Understanding childhood tics
To understand how childhood tics are evaluated and managed, it’s helpful to first understand how they occur. Typically, a child will have a sensory urge just before the tic symptom.
“It’s this feeling that, ‘something is wrong with my body and I have to move,’ or ‘I have to make a noise to get rid of this urge,’” Mingbunjerdsuk said.
If parents notice their child displaying frequent tic symptoms, a pediatrician can usually provide an initial evaluation. The pediatrician may then recommend the child see a neurologist to rule out any other underlying conditions.
“The neurologist’s role is to differentiate whether the tic is the form we see in a general population – and will likely go away with time – or whether it warrants further work up to identify other causes that can mimic tics,” Mingbunjerdsuk said.
While less common, other genetic neurological conditions or neurodegenerative disorders may cause other types of movement disorder or seizure which need to be distinguished from tics. Mingbunjerdsuk says it’s important to identify such causes early since some of these conditions require further medical investigations and treatments.
She also notes that other conditions such as ADHD, ADD, anxiety and OCD or mental and behavioral health issues like eating disorders accompany tics in about half of all children and adolescents. For this reason, Mingbunjerdsuk says it shouldn’t surprise parents if a child’s provider also recommends the child see a psychologist or psychiatrist.
“Oftentimes if we co-manage the psychiatric condition, the tic symptoms will get better without specific interventions for them,” she said.
Treatment for severe and chronic childhood tics
Likewise, since the majority of childhood tics often go away without any specific treatment or intervention, Mingbunjerdsuk likes to use a wait and see approach before starting an intervention.
“I suggest that parents look for signs that the tic is impacting their child’s daily life,” she said. “If a child is complaining of headache or neck pain from frequent head movements or if they are having a hard time making friends or are getting bullied because of their tic, those are the type of situations where we would want to intervene.”
New guidelines released by the American Academy of Neurology in 2019 outline the course of treatment for patients with chronic tic disorders. The guidelines encourage the use of a newer behavioral therapy called Comprehensive Behavioral Intervention for Tics (CBIT), replacing pharmacological treatments as the first line intervention for tics. The CBIT treatment is designed to extinguish unwanted impulses and tics by teaching patients to recognize problematic urges and counteract them.
“This is the type of intervention that I am glad the psychology team at Seattle Children’s and other providers in our region can offer to children,” Mingbunjerdsuk said. “Studies have shown CBIT is just as effective as medication in managing tics. This means we can forgo the potential side effects of the medication and provide long-lasting benefit to the patient.”
Providing peace of mind for parents
Mingbunjerdsuk offers additional information for parents concerned about their child.
- A cold, allergy or a tic? While symptoms of a cold or allergy can often mimic tics, tics are not triggered by any clear allergen and would not have any redness or inflammation present in an ear, nose and throat exam. Mingbunjerdsuk says tics less frequently occur during sleep, so if parents observe the tic symptoms while their child is sleeping, it’s worth asking their pediatrician whether they should consider other possible causes.
- Capture the tic symptoms using a smartphone before your doctor visit. “Since it’s likely your child may not have any tic symptoms while you are at the doctor’s office, it can be helpful to have a video recording when the tic is apparent to give the pediatrician or neurologist a better sense of what is going on,” Mingbunjerdsuk said.
- Be careful not to draw attention to the tics. Focusing on a child’s tics can actually exacerbate their symptoms, and so Mingbunjerdsuk discourages parents from asking their child lots of questions about the tics or tell them to control their tics. For this reason, it’s important that parents also work with their child’s school, teachers and other caregivers to support the child when they are not at home.
Mingbunjerdsuk shares the resources on the Tourette Association of America website with parents seeking more information about navigating childhood tics.
“In clinic, I always spend a lot time explaining the typical natural progression of childhood tics with the family,” she said. “My goal is that by the end of the visit I can give families peace of mind. I want parents to be reassured knowing that most childhood tics will go away and that they know when to call if the tic starts to interfere with the child’s well-being.”