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Ask Dr. Sue
TIC DISORDERS IN CHILDHOOD
Dear Dr. Sue,
My son recently saw a neurologist because he has
developed a couple of repetitive behaviors (eye blinking
and throat clearing) that we thought for a long time
might be allergy-related. The neurologist feels
that they are tics, but was very reassuring, saying that
about 50% of the time these tics go away completely.
Then I began hearing more and more about Tourette’s
syndrome, and I’m feeling increasingly worried.
How likely is this to be a significant problem for my
son, both now and in adulthood?
Dear parent,
Tic disorders are actually very common during childhood.
Up to 13% of all boys and 11% of all girls experience
tics at some time. Motor tics can include such
things as eye blinking, frowning or grimacing, shrugging
of the shoulders or jerking of the head. Vocal
tics are things like throat clearing or grunting (and
only very rarely the more disturbing and sensational
blurting out of swear words).
You don’t say how long your son has been having these
tics, but the length of time they have persisted may
help to sort out whether he may still have a transient
tic disorder or whether he has a chronic tic disorder,
of which Tourette’s syndrome is one.
Transient tic disorder, by definition, lasts from four
weeks up to 12 months. Tics occur many times
daily, and nearly every day, but they do resolve
completely. Some of these children may develop a
new tic at some point later in their childhood. As
you can see, if your son fell into this category, he
would have virtually a 100% chance of being free from
tics during adulthood. That being said, however,
sometimes even transient tics can be quite problematic,
depending on the frequency and the severity of the tic.
It is best to try to ignore the tics when they are
happening, as calling attention to them often makes them
worse. They are also usually increased during
periods of stress or excitement. It is rare for
transient tics of childhood to need treatment, but if
they are causing problems in school or making the child
feel extremely out of place, behavioral modification or
counseling can sometimes help. Therapists try to
train the child to substitute a different motor movement
for the tic that they feel coming on, as well as
teaching relaxation techniques that may diminish the
need to “tic.”
If your son’s tics have persisted for more than one
year, then by definition he has a chronic tic disorder,
which is much less common than transient tics.
Fewer than 1% of children suffer from a true chronic tic
disorder. Tourette’s symptoms include the
following:
-
Both multiple motor and one or more
vocal tics must be present at some time during the
illness, though not necessarily at the same time.
-
Tics occurs many times a day, nearly
every day or intermittently for more than one year.
-
Periodic changes in the number,
frequency, type and location of the tics occur, and
they wax and wane in severity. Symptoms can
sometimes disappear for weeks or months at a time.
-
Onset must occur before age 18.
Tourette’s syndrome can exist in very
mild or very severe form, with all degrees in-between.
Most children have mild symptoms. It is not
uncommon, though, for other disorders to co-exist with
Tourette’s syndrome, and the other disorders can be more
disabling than Tourette’s. It is estimated that up
to 50% of children with Tourette’s syndrome have ADHD,
which is often noticed before tics even develop.
Children with ADHD have trouble focusing, trouble
sitting still, and may have difficulty controlling their
impulses.
30-50% of Tourette’s patients may suffer from symptoms
of obsessive-compulsive disorder. Obsessions are
repetitive, unwanted thoughts and compulsions are the
need to perform ritualized, meaningless behaviors over
and over (such as repetitive handwashing, or always
having to do a thing a certain number of times, or
sometimes erasing and re-doing the same schoolwork over
and over, because it just doesn’t feel right.)
Other disorders that can co-exist with Tourette’s
syndrome include Learning Disabilities and Sleep
Disorders.
Tourette’s Syndrome can also be helped to some degree by
behavioral modification and other psychotherapy, but
when symptoms are severe, treatment with one of several
medications might be considered.
Tourette’s syndrome does get better over time, nearly
always. The Tourette Syndrome Association (TSA)
states that as many as 1/3 of patients have complete
resolution of their symptoms by adulthood. Other
sources have stated that symptoms remit by age 18 in
about 75% of patients.
Tourette’s Syndrome is a genetic disorder, though even
if a person inherits the gene associated with the
disorder, they may have no symptoms at all, or mild
symptoms, or severe ones. Only about 10% of the
children who inherit the gene will have symptoms
requiring medical attention, according to TSA.
I’m happy that your son is seeing a neurologist. A
skilled pediatric neurologist or pediatrician can help
you decide whether and when medication might be
advisable for your son’s tics and can screen him for
co-existing conditions. A chronic tic disorder,
left untreated, could be a mild nuisance for your son or
it could seriously disrupt his ability to function in
school, among his peers and in the family, as well as
leaving him with a feeling of alienation. If he
has a chronic tic disorder, please join the excellent
Tourette Syndrome Association, which includes a monthly
newsletter. Your child will have the opportunity
to see examples of famous people as well as other kids
who have thrived in spite of their Tourette’s Syndrome!
References:
1. Tourette Syndrome Association, Inc.
www.tsa-usa.org.
2.
www.psychnet-UK.com.
3. Evidente, MD, Gerald H. “Is it a tic or Tourette’s?”
Postgraduate Medicine, Vol.108, No. 5, Oct. 2000.
4. For your son to receive the children’s newsletter
from TSA: “If you're a child with TS and would like to
receive our Kids Newsletter, That Darn Tic, by mail (or,
even help us by writing articles or drawing pictures),
please email your name, date of birth, and mailing
address to tracy.flynn@tsa-usa.org.”
 
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