Tics and Torrettes

What are tics?
Tics are sudden, repetitive movements (motor tics) or sounds (phonic tics). Tics are involuntary and can involve any body part. A facial tic, especially blinking the eyes, is the most common and is referred to as a simple motor tic. Complex motor tics are characterized by slower, more purposeful, coordinated motor movements involving more than one muscle group. This can involve jumping, sitting, turning etc. Simple vocal tics are characterized by one sound such as sniffing or snorting or throat clearing. Complex vocal tics involve a combination of sounds, such as repetitive syllables, words or strings of words. The child is able to suppress the tic voluntarily for minutes to hours. The tic may occur more frequently at certain times and not at others. They are fairly common.

How common are tics?
Tics are quite common among school aged children. Some studies report 20-25% of school age children will experience tics for at least one month but less than one year. These are known as transient tics. Chronic tic disorders, such as Tourette’s disorder (TD) are neurologically based movement disorders that begin typically between the ages of 5 to 18. In clinical settings, tic disorders frequently co-occur with other neuropsychiatric disorders such as Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD), and other anxiety based and mood disorders.

What is the cause of TD?
Problems with sensory processing, motor planning and motor control seem to be at the ‘heart’ of both tics and TD. Converging lines of evidence from multiple scientific studies point to dysfunction of both cortical and subcortical circuitry as playing a major pathophysiological role in these disorders. Recent brain imaging studies of people with chronic tics have suggested a faulty organization within specific regions of the sensorimotor and supplementary motor cortex.

Is TD inherited?
Genetic studies indicate that TD is inherited, however, the exact gene or combination of genes is unknown at present. It appears that family members of a child with TD may be affected by Obsessive Compulsive Disorder (OCD).

How are tic disorders and TD diagnosed?
Diagnosis is made by an evaluation of the history of onset of symptoms. Detailed checklists such as provided by the Yale-Global Tic Severity Scale and Yale-Brown Obsessive Compulsive Scale can be helpful adjuncts to determining the severity as well as examining coexisting diagnoses.

How are tic disorders treated?
Medication is the treatment of choice for the management of symptoms. Chief among these are clonidine and guanfacine which require some time before optimal dosing is obtained. In addition these medications have notable side-effects to include lethargy and low blood pressure.

What can Parents Do about Tics?
Parents can implement the following Tic Management Strategies
1. If the child is embarrassed by the tics or if the tics are causing problems in the classroom or at home, it is helpful to use a “tic room”, a private place where the child can go for brief periods. Usually the use of quiet places and reduction in stimulation/excitement/anxiety will facilitate reduction of the symptoms.
2. Allowing the child to exit the classroom for brief periods can be helpful in reducing tics.
3. Development of simple relaxation techniques, such as breathing exercises can be helpful.
4. If tics are socially embarrassing, such as spitting or shirt chewing, your child can be encouraged to develop tic substitution strategies. For example, your child can be taught to chew sugarless gum instead of his shirt

Books:
1. Living with Tourette Syndrome by Elaine Shimberg (poignant autobiography of child onset tics)
2. Front of the Class: How Tourette Syndrome Made Me the Teacher I Never Had (Hardcover) by Brad Cohen, Lisa Wysocky

Websites and Organizations:
1. The homepage of the Tourette Syndrome Association website (www.tsa-usa.org).
2. Factsheet_American Academy of Child and Adolescent Psychiatry (www.aacap.org/page.ww?section=Facts+for+Families&name=Tic+Disorders )

Does the Children’s Neuroscience and Rehabilitation Center offer Programs for children with TD and tics?
The Children’s Neuroscience and Rehabilitation Center provides comprehensive clinical evaluation, consultation and treatment for children and adolescents with tics, Tourette’s Disorder and related problems.