Tics are sudden, involuntary movements that serve
no purpose except to frighten and worry parents. About 10% to 25% of otherwise healthy
children, usually boys five to 12 years of age, develop these abnormal movements.
Typically, tics (from the French word for spasm) are quick, uncontrollable
movements of the eyes, face, neck, and shoulders. Eye blinking, facial grimacing, head
jerking, and shoulder shrugging are the types most commonly observed. Tics can also be
vocal or phonic, such as throat clearing, sniffing, coughing, or grunting. Some are mild
and hardly noticeable, while others are more frequent and severe, affecting many areas of
the child’s life. The youngster is fully alert and usually unaware of the tic and the
movement disorder usually stops when the child is sleeping. They also disappear when the
youngster is engaged in some inactive or boring activity, like watching television. On the
other hand, bringing a tic to the child’s attention often makes it worse.
The cause of simple tics is not known. The common
belief that the child has an underlying behavioral or emotional problem is not supported
by medical research. On the other hand, tics can be made worse by any stress in a
youngster’s life. For example, many parents describe an increase in tics at the
beginning of the school year or during episodes of tension and excitement. At times, the
source of the stress may be apparent only to the child. A child with a simple tic is
usually a good, careful student who tends to be a perfectionist about things at home.
Punishment by parents, teasing by classmates, and
scolding by teachers will not help tics and usually makes matters worse. Occasionally,
simple tics disappear in school or (of all places) in the physician’s office.
Although involuntary, some children can consciously suppress their abnormal movements. But
the youngster pays a price - there is usually a compensatory buildup of tension, which
explains why tics occur more frequently at home. The youngster might even try to hide the
tic with a purposeful movement (like pretending to have a cold with a sniffing tic).
Parents should also be alert to the fact that
simple tics can be caused by medications, such as decongestants, stimulant drugs used to
improve attention span, and anticonvulsants. In addition, soft drinks with caffeine may
increase the frequency of tics in a child who already has them.
There are no specific diagnostic tests for this
disorder and most physicians will recognize the condition simply from the parent's
description. Occasionally, other procedures are needed if a neurological examination is
abnormal (for example, an EEG for seizure disorder or MRI scan for brain tumor).
The good news about tics is that they usually stop
entirely on their own. Most disappear within three months to one year of onset. If an
extra effort is made to promote understanding and tolerance within the child’s
environment, the tics usually improve quicker. But even if the child continues to feel
stress, all but a few will stop their abnormal movements during adolescence. Therefore,
the treatment of choice for most children is "elixir of time."
Medication and more intensive psychotherapy are
indicated for tics when they interfere with a youngster’s progress in school, their
social development, outside activities or family relationships. In addition, as with other
chronic illnesses, successful treatment also depends on helping the child adapt to the
A discussion about childhood tics would not be
complete with commenting on the tic medical condition first described by Gilles de la
Tourette over 100 years ago. Tourette studied children and adults who had severe
involuntary body jerks with bizarre, repetitive behavior, yelping noises, and the shouting
of obscenities. Children afflicted with this condition often imitate other person's
speech, and frequently repeat their own words. In addition, these youngsters develop
concentration and attention problems more frequently than kids with simple tics. They
usually act impulsively and have many strange obsessions and compulsions.
Fortunately, most children with simple tics to do
develop Tourette syndrome (the odds increase if there is a positive family history). The
treatment of choice for Tourette syndrome is referral to a specialist who is familiar with
the condition and its management.
Early identification and proper education will help prevent the
psychological damage to the young child with any movement disorder. Parents should consult
their child’s physician if the tics last longer than a year or interfere with the
youngster's friendships or studies at school. In addition, tics that involve sounds or
words, particularly the use of profanity, should be checked. Remember, neither simple
motor tics nor Tourette syndrome causes intellectual problems, and with a little love and
support, the outlook for these children is excellent.