Tics and Tourette's Syndrome in Children

Hannah is an 8-year-old girl who attends elementary school in Birmingham, Alabama. Around a year ago, her parents noticed her clearing her throat, sniffing, and blinking her eyes a lot, so they took her to see an allergy doctor. Because her doctor ruled out allergies as the cause of her symptoms, she was referred to an otolaryngologist (ENT). When this doctor told them there were no medical issues causing her symptoms, they felt stumped and frustrated. What was causing Hannah’s symptoms, and why weren’t they going away? Finally, her family made their way to a neurologist, who diagnosed her with Tourette Syndrome. It turns out that these symptoms were actually something known as “tics” all along!

Hannah's story is not unique. Many families face the challenges associated with tic disorders, which can often be misunderstood or misdiagnosed. To better understand these disorders, it’s essential to delve deeper into what tics are and how they manifest in children.

Understanding Tic Disorders in Children

What Are Tics?

Tics are involuntary, repetitive movements or sounds that can be classified into two main categories: vocal tics and motor tics. Vocal tics might include throat clearing, grunting, or sniffing, while motor tics encompass movements such as eye blinking, head jerking, and facial grimacing.

Types of Tics: Simple vs. Complex

Tics can be further divided into simple and complex categories. Simple tics are brief and sudden, involving a limited number of muscle groups (like a single blink). In contrast, complex tics involve coordinated movements that may appear more intentional, such as a series of head jerks combined with arm movements.

The Spectrum of Tic Disorders

Tic disorders are classified into several categories based on their duration and types of tics exhibited:

• Chronic (Persistent) Motor Tic Disorder: Involves only motor tics lasting for more than a year.
• Chronic (Persistent) Vocal Tic Disorder: Involves only vocal tics lasting for more than a year.
• Provisional Tic Disorder: Involves motor and/or vocal tics that have been present for less than a year.
• Tourette Syndrome: This diagnosis requires the presence of both vocal and motor tics for over a year.

The Genetic and Neurobiological Underpinnings of Tics

While the precise cause of tic disorders remains unclear, research indicates a significant genetic component. Families often report a history of tics, suggesting a hereditary link. Moreover, neuroimaging studies have revealed differences in brain structure and functioning in children with tic disorders, particularly in areas linked to movement control.

Prevalence of Tic Disorders in Children

Tics are more common than many parents realize. Research shows that approximately 1 in 5 children may experience tics at some point during their childhood. However, for most, these tics are transient and resolve on their own.

The Onset and Development of Tics

Typically, tics emerge between the ages of 5 and 7, with frequency and severity often escalating between ages 8 and 12. While many children see a decrease in tics as they enter late adolescence, others may continue to experience them into adulthood.

Effective Treatments for Tic Disorders

For children like Hannah, understanding the available treatment options is crucial. Several approaches can help manage tics effectively, ensuring that children lead fulfilling lives.

Comprehensive Behavioral Intervention for Tics (CBIT)

CBIT is one of the most effective behavioral treatments available for tics. This evidence-based approach consists of:

• Psychoeducation: Teaching families and children about tics to demystify the condition and reduce stigma.
• Function-based Interventions: Identifying triggers or situations that may exacerbate tics.
• Habit Reversal Training: Helping children become more aware of their tics and learn alternative responses.

CBIT is particularly effective for children who are aware of their tics and feel bothered by them, which is essential for successful treatment outcomes.

Medication Management for Tics

For some children, medication may be a necessary option. Guanfacine and clonidine are examples of medications that have shown moderate effectiveness in reducing tics with minimal side effects. More potent options, such as haloperidol or pimozide, may be considered in severe cases, although they come with a risk of side effects.

Combining Treatments for Optimal Results

Many families find that a combination of CBIT and medication yields the best results, providing a holistic approach to managing tics. Each child is unique, and treatment plans should be tailored to fit individual needs.

Deep Brain Stimulation (DBS) for Severe Cases

In extreme cases where other treatments have failed, Deep Brain Stimulation (DBS) may be considered. This surgical procedure involves implanting a device that sends electrical impulses to specific brain areas, helping to alleviate severe tic symptoms.

Monitoring and the Importance of Support

In many instances, it may be appropriate to monitor symptoms without immediate intervention. Tics themselves are not inherently harmful, and if they do not interfere with daily functioning, treatment may not be necessary.

Support from family, schools, and peers is crucial in ensuring that children with tic disorders feel understood and accepted.

The “Tic Iceberg”: Understanding Co-Occurring Conditions

Often, it’s not just tics that present challenges for children like Hannah. Many children with tic disorders also experience co-occurring conditions such as ADHD, OCD, and anxiety. This phenomenon is often referred to as the “tic iceberg,” where the visible tics are just the tip, while underlying challenges lurk beneath the surface.

Seeking Support from the Community

If you or someone you know is navigating the complexities of tic disorders, it’s comforting to know that you are not alone. The tic and Tourette community is large, supportive, and thriving. At Upward Behavioral Health, we are dedicated to providing CBIT for both children and adults across all PSYPACT states.

Take the First Step Towards Support

Ready to learn more about managing tic disorders? Schedule a free consultation call with us today to explore your options: Upward Behavioral Health Appointment Request.

Conclusion: Empowering Families and Children

Tic disorders can be challenging, but with the right information and support, families can effectively manage symptoms. By understanding the nature of tics and exploring treatment options like CBIT, families can empower their children to thrive despite the challenges posed by tic disorders.

Additional Resources

For further information and support, consider exploring these valuable resources:

• Tourette Association of America: Resource Directory
• Child Mind Institute's article on CBIT: The Best Treatment for Tics and Tourette's
• CBIT Providers in Alabama:
  • Children’s of Alabama: Children's of Alabama CBIT
  • University of Alabama at Birmingham (UAB): UAB CBIT