Tic Disorders in Kids Are Often Overlooked: How to Spot the Signs

Tic Disorders in Kids Are Often Overlooked: How to Spot the Signs
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Some common child behaviors such as throat clearing, coughing, or an inability to sit still can sometimes be an indicator of a tic disorder. Getty Images
  • Tic disorders and Tourette's syndrome affect about 1 in 100 children.
  • Many people with tics experience a physiological feeling that urges them to do the tic.
  • Comprehensive Behavioral Intervention for Tics (CBIT) is used to treat tic disorders.

The average person's awareness of attention deficit hyperactivity disorder (ADHD) and anxiety in children has improved in recent years. However, strides in awareness of tic disorders and Tourette's syndrome haven't been as strong — despite that they affect about 1 in 100 children.

"There is still a stigma with tic disorders and Tourette's syndrome. We often see Tourette's syndrome only associated with coprolalia, which is the technical term for [involuntary] swearing. However, that is one of the rarest symptoms of a tic disorder," Katrina Lindsay, PhD, a pediatric psychologist at Akron Children's Hospital, told Healthline.

Because swearing and inappropriate behavior are perceived as the most telling sign of tic disorders, Lindsay says many parents may miss other more common symptoms.

"Families may not realize that some of the functional behaviors we do every day like throat clearing, coughing, sniffing, or blinking are considered the most common tics," she said.

To better understand if your child has a tic, Jerry Bubrick, PhD, senior clinical psychologist and director of the obsessive-compulsive disorder service at Child Mind Institute, says it's important to understand what a tic is.

While tics are defined as an involuntary movement, he says many times they are voluntary.

"A lot of people who have a tic disorder will have a premonitory urge — a physiological feeling you get in the body that precedes the tics," Bubrick told Healthline.

He says the best comparison is the tingly feeling that occurs in your nose right before a sneeze.

"The only time it comes is when a sneeze is going to come and the only thing that makes the feeling go away is the sneeze. Many people who have tic disorders will have that kind of sensation in their body, usually where the tic is about to occur, and doing the tic makes that feeling go away," he said.

While nervous twitches are similar to tics, Bubrick says the difference tends to be that when a person can identify the feeling in their body before the tic or twitch comes and if doing the twitch makes them feel better, they are experiencing a tic. If doing the twitch or tic does not make them feel better, a nervous habit may be the cause.

"It's not just the behavior of the tic or twitch we are looking at, it's the function of the behavior that's important," said Bubrick.

As far as allergies go, Lindsay says many allergies can trigger physiological symptoms that resemble a tic, such as eye blinking, coughing, throat clearing, or sniffing.

"A lot of times if parents see these symptoms, they might first go to their pediatrician and then when that initial intervention doesn't work, they see a specialist. I have a lot of children come to me who have spent a lot of years on allergy or pulmonology medicine and treatment to find out that they had a tic disorder all along," she said.

Seeing a pediatrician first makes sense because determining the cause can be difficult, adds Lindsay.

For instance, she explains that a child may take allergy medication for throat clearing or coughing that is thought to be related to pollen in the autumn months, yet the symptoms continue during other times of the year when pollen is low.

After seeing an allergist and receiving no relief, Lindsay says, "We may determine that in fact [the symptoms] are related to the excitement and stress of a new school year not leaves falling. So we look at the pattern of behavior and how long it's lasted," she said.

Bubrick says it's common for children to experience transient tics in childhood for a few weeks at a time. However, a pediatrician can assess whether or not your child should see a specialist.

"We can't diagnose it as a tic disorder unless we know for sure that something medical isn't explaining [the symptoms]. It is somewhat common to go to a neurologist or allergist or ENT to verify there is nothing medical going on that is causing the symptoms. If medical tests show nothing is going on it's easier to diagnose as a tic disorder," said Bubrick.

If it's determined that a child may have a tic disorder, they are referred to a behavioral health provider, such as a pediatric psychologist or therapist.

When a child is referred to Lindsay, she determines if they have any comorbidities often associated with tic disorders, such as anxiety, obsessive-compulsive disorder (OCD), or ADHD. Then she diagnoses the type of tic disorder.

She says that a tic disorder means the child has either motor tics only (any body movement, such eye-twitching or shoulder rolling) or vocal tics only (anything that makes a sound, such as coughing or throat clearing).

Tourette's syndrome is a type of tic disorder in which the child has multiple motor tics and at least one vocal tic. For instance, the child might do a chin roll, touch their hair, and then clear their throat.

"When I work with families, a lot of times they think Tourette's syndrome might be the most serious of the conditions. But that is not true. I work with kids who cannot sit in a chair because their motor tics are so bad, but they never make a sound," she said.

The treatment for tic disorders and Tourette's syndrome is the same–Comprehensive Behavioral Intervention for Tics (CBIT), which focuses on giving children the skills to manage their tics.

Bubrick says there are three phases to the therapy:

1. Awareness training

This teaches the child to understand how the tic looks and feels and what triggers it.

"Does it occur more in math class because the child struggles there or because there is a kid making fun of them or does it happen in stressful or crowded situations?" says Bubrick.

To become more aware of how their body feels when the tic happens, Bubrick says he walks children through exactly what their body is doing.

"I might say, 'I noticed that the first motion that happened was that your eyes blinked hard, and then you brought your shoulder up to your ear, and then you grunted. Did you notice that order?' The child might say they noticed the grunt but not the eye and so I'll ask them to pay more attention to what happens to their body when they have the tic the next time," he said.

2. Relaxation strategies

This includes deep breathing techniques and guided meditation.

"No one tics when the body is relaxed during sleep. Stress and tics are best friends. When you get stressed out your body becomes very tight and when your body becomes very tight, you're more likely to have a tic. It's not cause and effect, but they are related," said Bubrick.

3. Finding a competing response

This is so that the muscles used during a tic are used in a different way when the urge to tic arises.

"When a child has a tic, the brain… sends signals to the eyes for example, and says, 'We need to feel the eye muscle move quickly and when we feel the eye muscles move quickly, we can move on with our day,'" explained Bubrick.

CBIT teaches a way to trick the brain in a simplified way, he adds.

"Instead of closing the eye rapidly, we are using the same muscle in the eyelid to open the eye wide and we keep it there until the urge to do the tic passes. So the brain gets a signal from the eyelid muscles and thinks it's not quite what I had in mind but it's good enough and we move on," said Bubrick. "Opening the eye wide is a little more socially acceptable than blinking rapidly."

Both Bubrick and Lindsay say CBIT takes practice, but gets easier over time, and is effective.

In some cases, medication may be prescribed to children in addition to therapy.

"There are not specific medications for tics, but sometimes providers might use anxiety or ADHD or even blood pressure meds to help children with tic disorders," said Lindsay.

If you're concerned your child may have a tic disorder, both experts say the sooner your child gets help, the better.

"And don't let the negative association and stigma around tics keep you from seeing a doctor. Parents should know that they didn't do something bad that warranted this condition for their child," said Bubrick. "If your child is diagnosed with a tic disorder, be proactive and educate yourself just as you would if you learned your child had a condition like diabetes."


Cathy Cassata is a freelance writer who specializes in stories about health, mental health, and human behavior. She has a knack for writing with emotion and connecting with readers in an insightful and engaging way. Read more of her work here.

Tic Disorders in Kids Are Often Overlooked: How to Spot the Signs, Source:https://www.healthline.com/health-news/tic-disorders-in-children

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