If you see your child making repetitive sounds or movements, you are bound to be worried. But most of these ‘tics’ are a natural part of development and temporary. In fact, up to 20 per cent of all children will present with motor tics that will last a few weeks or months.
Tics are characterised by sudden, rapid, recurrent semi-voluntary movements or vocalisations.
What can tics look like?
It may be a:
- Persistent involuntary shrugging of shoulders,
- Bending of neck,
- Rapid blinking,
- Repetitive clearing of throat, or
Why does it happen?
It’s a semi-voluntary movement, which means that the person suffering from it has some control over it. The reason younger kids are more likely to develop them is because it’s a mode of expression; where older people can verbalize their tensions or anxieties, younger children are not. Tics help them relieve their stresses.
Tics usually develop from the age of five or six, and they can peak between eight to twelve years of age. They usually tend to reduce after that and disappear in most cases.
The exact cause of tics is still unknown. However, it’s believed that there is some form of dysfunction in the brain that cannot be seen or identified using magnetic resonance imaging (MRI) or other brain scans. There is surely a genetic component to tics as it’s been noted that tics run in families. But this is not a direct link.
Many conditions such as obsessive compulsive disorders, learning problems, anxiety, sleep disorders and attention deficit hyperactivity disorder (ADHD) are commonly associated with tics.
A neuropsychiatric disorder called paediatric autoimmune neuropsychiatric disorder associated with a bacterial infection streptococcus can also have tics as one of its manifestations. But this link hasn’t yet been conclusively shown.
Type of tics
There are two basic variations of tics: motor and vocal.
They are short-spanned, swift movements. Tics are frequently repetitive, with multiple occurrences of the same action.
Motor tic disorders include:
- Jerking the head,
- Biting lips,
- Twitching nose,
- Shrugging shoulders, and
- Rapid blinking.
Unlike motor tics, this variation makes a person produce unnatural sounds with their voice. Common examples are:
- Clearing throat over and over,
- Making a buzzing sound,
- Hissing, or
- Yelling out a word or phrase.
When to worry about childhood tics
If you feel that your child has developed a tic, get them checked out by a doctor. A trained doctor must rule out other causes before diagnosing it as a simple motor tic.
Tics are usually transient and tend to disappear within a year. They can come and go during this period. If your child has a motor or vocal tic that has lasted more than a year, then it will be classified as persistent tic disorder. If the tics become persistent then you should seek the opinion of a specialist like, a paediatric neurologist or a child psychiatrist. They will make sure that there is no co-existing condition like ADHD, obsessive compulsive disorder or any anxiety disorder that requires treatment.
In case a tic irritates your child or is causing them to be fatigued, or painful muscles due to shoulder jerking or inability to read due to frequent blinking, seek medical help.
If you feel your child is in any distress owing to their tics - embarrassed in public or bullied by their peers - it may be time to enrol them into psychological counselling and some habit reversal techniques. Look for signs of anxiety and lack of focus - these will need to be addressed first.
What can you do as parents to help your child?
- Ignore your child’s tics, so they don’t become overly conscious of them.
- Reassure your child that everything is okay and there is no reason to feel embarrassed.
- Ensure that people who are in regular contact with him/her are aware of the tics and tell them about the appropriate responses to these tics.
- If he/she is finding school difficult, then talk to their teacher about ways to deal with it.
What are the treatment options?
Parents are often amazed to learn that most childhood tics do not require any sort of treatment and tend to remit without interventions.
The purpose of treatment should be to improve a child’s quality of life if he/she is struggling with confidence or suffering emotional stress or social deprivation at school.
A lot of educational awareness needs to spread among parents, explaining the triggers - such as stress and anxiety - for tics.
The more one points out that a tic exists, the more likely they are to show up. The worst things one can say to a child who has tic are:
- Why are you doing that?
- Have you done it today?
- Does it hurt you?
Build the kid’s confidence and if you see them having these tics uncontrollably then try to distract them by asking unrelated questions.
In cases where interventions are required, the option would be to refer them for comprehensive behavioural therapies with a child psychologist. Here they will learn how to manage their tics better using stress management techniques with the assistance of psychologists trained in Comprehensive Behavioural Intervention for Tics (CBIT). In severe cases or where all other interventions have failed medications could be prescribed under the supervision of a trained physician.
Become more aware of their tics and the urge to tic;
Carefully choose and practice a new behaviour instead of the tic. This “new behaviour” (competing response) helps reduce and, in some cases, even eliminate the tic;
Identify situations that can make tics worse and find ways to change them; and
Learn ways to prevent or cope with stress
Source: CDC, US
In summary, tics are common in children. In most cases, it doesn’t warrant any treatment. In severe cases, however, get a professional opinion. Appropriate assessments will lead to the most beneficial intervention for your child.
- Dr Arif Khan is a UAE-based Paediatric Neurologist and Founder of the Neuropedia clinic. Kindly note the above information is in no way meant to replace a direct consultation with a qualified medical practitioner. It is an article that can be seen as a guideline to what to look out for.