All About Tics: Do You Experience Them?

Tics are sudden, uncontrollable sounds and/or actions such as eye blinking, throat clearing, or limb movements. They can significantly impact an individual's daily routine and may feel inconvenient, uncomfortable, or embarrassing for the person who experiences them, especially during childhood or teenage years. Tic episodes can be linked to a category of conditions known as tic disorders. Below, you can learn how and why tics can manifest in children and adolescents in particular and discover common tic-related syndromes and their symptoms that those under 18 may experience.

What exactly are tics?

The term "tic" is often used to describe a muscle movement, body movement, or verbalization characterized as sudden, irregular, undesired, uncontrollable, and/or repetitive. The muscles that move uncontrollably can be located at any place in the body. Tic disorders usually first present during childhood, around five to ten years old. Those assigned male at birth may be more likely to develop a tic disorder than those assigned female at birth.

Tic disorders are often temporary, and symptoms subside in many people within a year. However, there are cases where symptoms rise to the level of a chronic tic disorder, which may continue to affect a person over time. Tic disorders are thought to affect approximately one in five school-age children.

Understanding tic symptoms

Motor tics

Motor tics are inadvertent and uncontrollable physical movements that often involve the limbs or the head and neck area. Motor tics can be complex or simple. Simple motor tics are movements that require only one muscle group to move (eye blinking, sticking out the tongue, head twitching, etc.). A complex motor tic can involve multiple muscle groups and may require more coordination (head banging, facial grimacing, and touching others). 

Vocal tics

Vocal tics, also called phonic tics, refer to when a person finds themselves making uncontrollable vocalizations or sounds. As with motor tics, vocal tics can be complex or simple. Simple vocal tics may be quick noises without a meaning, such as throat clearing, barking, or hissing. Complex vocal tics may include repeating words, swearing, singing, or completing sentences. Simple tics and complex tics both have the potential to disrupt a person’s day-to-day life, depending on severity and frequency.

Before a motor or vocal tic, an individual might feel the urge to engage in the tic. This feeling can be described as a prickling itch. For many, it’s difficult or impossible to overcome this sensation and refrain from completing the tic. The urge is often resolved, at least temporarily, after the individual engages in the tic.

The symptoms of tic disorders are not always consistent in terms of severity. In many cases, for example, tic behaviors can become more severe with various factors that can include strong emotions, anxiety, tiredness, sickness, or extreme temperatures. Additionally, tics might occur while an individual sleeps. Over time, many tics and tic behaviors can improve. However, chronic tic disorders or Tourette's syndrome may not. 

Tic disorders

Three key tic disorders are characterized by the above symptoms: transient tic disorder, chronic tic disorder, and Tourette's syndrome. In most cases, tics must be experienced in at least one form for a minimum of 12 consecutive months in order for a tic disorder diagnosis to be considered. Those associated with Tourette's syndrome often present in the form of both motor tics and vocal tics. Motor or vocal tics in general can be transient or chronic, although Tourette's syndrome is typically a chronic condition.

Transient tic disorder

According to research by the American Academy of Child and Adolescent Psychiatry, 10% of children are impacted by transient tic disorder. To have a distinguishable transient tic disorder, the child will exhibit at least one tic for one to 12 months before 18 years of age. While the most common transient tics are motor tics, vocal tics can also be transient. Transient tics can change and adapt over time, potentially changing in frequency and form. 

Chronic tic disorder

For a tic to be labeled as chronic, it must last for at least one year. Chronic tics can be either motor or vocal. Chronic tics are less prevalent than transient tics. When people develop a chronic tic at a young age, they may have a better chance of recovering than if they develop a chronic tic in adulthood.

Tourette's syndrome

Characterized by vocal and motor tics, Tourette's syndrome is a nervous system disorder that may be diagnosed after an individual exhibits symptoms for more than a year. It is the most severe form of tic disorder and the least common. While the precise number of children with Tourette's syndrome is currently unknown, statistics from the Centers for Disease Control and Prevention (CDC) suggest that the prevalence of Tourette’s syndrome may be around 0.6%, but that at least half of the children who have it are likely undiagnosed. 

In many cases, people with Tourette's syndrome see a decrease in symptoms from childhood to adulthood. By the time people with Tourette's reach adulthood, they will often note significant improvements in frequency or severity. Tics may continue, but they may no longer qualify as a syndrome. 

What causes tics?

Researchers do not know the exact cause of tics. However, there seem to be two primary risk factors, including assigned sex at birth and genetics. Those assigned male at birth are more likely to develop tics, and tic disorders can run in families, with researchers pointing to mutations in genes that may contribute to the development of the condition. 

On a biochemical level, brain chemistry could also play a role. Specifically, having an imbalance in levels of the neurotransmitters serotonin, dopamine, and glutamate is thought to contribute to the development of tics.

Tics can also present due to stroke, infection, surgery, brain injury, or poisoning as well, among others. Conditions like Creutzfeldt-Jakob disease and Huntington's disease have been known to cause tics too.

Comorbidities 

Tic disorders—especially Tourette's syndrome—often occur alongside, or comorbid with, other conditions, including:

• Attention-deficit/hyperactivity disorder (ADHD)
• Autism spectrum disorder (ASD) 
• Depressive disorders
• Obsessive-compulsive disorder (OCD)
• Anxiety disorders
• Sleep disorders

Diagnosing tic disorders

The diagnosis of a motor or vocal tic disorder may be predicated on the observation of signs by a professional and the description of symptoms by the individual. Often, the individual must be under 18 years of age to be diagnosed with motor or vocal tics. To diagnose tic disorders, a physician may choose to conduct blood analyses or use medical imaging techniques. If you believe you may be experiencing tics, you can talk to your primary care physician about a neurological referral. 

Treatment for tics

The course of treatment for tic disorders depends on the type and severity of the tic. Managing stress and receiving quality sleep are two simple techniques that can often help decrease the severity and frequency of a tic. Behavioral treatments and therapy options may be useful for tics that do not fade with time or lifestyle improvements. 

Therapy options include habit reversal therapy and exposure and response prevention (ERP). Habit reversal therapy is a therapeutic technique to teach individuals movements or sounds that "compete" with tics. ERP is used to help individuals cope with the uncomfortable sensations that might arise before a tic, which could help them learn to prevent the tic from occurring.

Cognitive behavioral therapy and similar behavioral interventions have also been suggested to be effective in treating Tourette's syndrome and other tic disorders. Certain medications may be utilized when treating tic disorders as well, in some cases. Consult a healthcare provider before starting, changing, or stopping any medication.

Counseling options 

Many options are available if you're interested in trying therapy for tic disorders. You might be able to find a provider in person or through your insurance company. However, if you feel anxious about leaving home due to your tics or would otherwise feel more comfortable talking to a professional virtually, you might also consider online therapy. 

Research suggests that online therapy can help reduce symptoms of tic disorders, adding to the already substantial body of evidence that points to the efficacy of online therapy for addressing various mental health-related concerns in general. If you're interested in pursuing treatment for tic disorders or other challenges related to mental health, you might consider an online therapy platform like BetterHelp for adults or TeenCounseling for those aged 13 to 19. With either of these, you can participate in therapy with a licensed provider through phone, video, and/or in-app messaging from the comfort of home.