Tics & Tic Disorders

What are tics?
Tics are sudden, involuntary, repetitive movements or sounds, like eye blinking or throat clearing. As many as 20% of healthy children may have one or two tics. These may be present for short periods of time (weeks to a few months) and may not interfere with normal daily life. Some individuals have tics that last for more than a year.

Tics can look very different from person to person. Tics can range from mild (infrequent and/or not bothersome) to severe (frequent, bothersome).  Many people with tics and tic disorders have “simple” tics, which are sudden, brief, involuntary, and meaningless movements or sounds, such as eye blinking, twitching, mouth stretching, sniffing, grunting, or shouting.  Tics can also be more complicated.  These “complex” tics can involve clusters of involuntary movements and/or sounds that appear coordinated. Examples of complex tics include touching, gesturing, tapping, and jumping.  Others have tics that involve repeating what people say (echolalia) or repeating their own words (palilalia). A small number of people may have tics that look like obscene gestures (copropraxia) or are socially inappropriate or offensive words (coprolalia). Despite the publicity about copropraxia and coprolalia, these symptoms are not common in people with tic disorders. 

People’s tics can change over time. This means that the tics that you or your child have today may be different from the tics that were present last year, or that you will see a year from now.  Also, tics can ‘wax’ and ‘wane’, meaning that they may be more or less frequent at different times during the year. Finally, we know that the environment can “push and pull” at tics. Thus, tics might also be more noticeable during certain activities or when the person is feeling a certain way. Everyone has different situations that may increase or reduce tics, but common ‘triggers’ that increase tics are feeling excited, stressed, or a change in routine. For example, it is not unusual to see an increase in tics during the ‘back to school’ period in late summer and early fall.  It is important to help children find ways to continue participating in their usual activities, even when tics increase. It is also important that individuals with tics learn skills to manage their ‘tic triggers’ such as stress. Deep breathing exercises and other relaxation strategies can be helpful for stress reduction.

Some individuals with tics may also experience one or more of the following: obsessive compulsive behavior, hyperactivity/impulsivity, problems paying attention, anxiety, and rage episodes.

What are Tic Disorders?

“Tic disorder” refers to a specific diagnosis. That diagnosis is based on the duration and types of symptoms. There are three main tic disorders: Tourette Syndrome, Persistent Motor Tic Disorder and Persistent Phonic (Vocal) Tic Disorder. If the tics include both movements and sounds, the individual is diagnosed with Tourette Syndrome. If tics are only movements or only sounds (but not both), the individual is diagnosed with a Persistent Motor or Phonic Tic Disorder. 
1. Tourette Syndrome (TS): 

• Multiple motor tics
• At least one vocal tic
• Tics must appear before age 18 years
• Tics may wax and wane in frequency, but must persist for more than one year. Both motor and vocal tics have been present during this time, but do not have to occur simultaneously.
• Tics cannot be caused by the physiological effects of a substance, or be due to a general medical condition.
   

2. Persistent (Chronic) Motor Tic Disorder:

• Single or multiple motor tics (but not phonic tics) are present
• Tics may wax and wane in frequency, but have persisted for more than one year
• Tics must appear before age 18 years
• Tics cannot be caused by the physiological effects of a substance, or be due to a general medical condition.
• The individual has never met diagnostic criteria for Tourette Syndrome (see above)
   

3. Persistent (Chronic) Phonic Tic Disorder:

• Single or multiple phonic (vocal) tics (but not motor tics) are present
• Tics may wax and wane in frequency, but have persisted for more than one year
• Tics must appear before age 18 years
• Tics cannot be caused by the physiological effects of a substance, or be due to a general medical condition.
• The individual has never met diagnostic criteria for Tourette Syndrome (see above)

 
If tics have been present for less than one year, the term “Provisional Tic Disorder” is used, meaning that there is uncertainty about whether tics will persist.
Provisional Tic Disorder:

• Single or multiple motor and/or vocal tics
• The tics have been present for less than one year since first tic onset
• Onset is before 18 years
• Tics cannot be caused by the physiological effects of a substance, or be due to a general medical condition.
• The individual has never met diagnostic criteria for Tourette Syndrome or a persistent (chronic) motor or vocal tic disorder (see above).