Tics and Tourette’s

What is a Tic?
y48“…a sudden, rapid, recurrent, non-rhythmic stereotyped motor movement or vocalization.”

Prevalence of Tic Disorders:
Studies have shown that between 12-18% of children are affected by tics.  Studies also show that Tourette’s Syndrome may be as common as 1-8 children per 1,000 and occurrence of milder forms of the disorder known as chronic tic disorder (CTD) may be as high as 1.5-3%.

What kind of tics are there?

Motor Tics:
Simple Motor Tics:

  • Sudden brief, meaningless movements such as:
    • eye blinking, eye movements, grimace, twitch, mouth movements, head jerks, shoulder shrugs, rapid jerks or twitches
    • Specific muscle group

Complex Motor Tics (they may be perceived as a voluntary behavior, but it’s not):

  • Slower, longer, more “purposeful”
    • Facial gestures, touching objects or self, arm thrusts, hand gestures, gyrating or bending, dystonic postures, copropraxia (obcene gestures)
    • Multiple muscle groups

Vocal Tics
Simple Vocal Tics

  • Sudden meaningless sounds or noises
    • Throat clearing, coughing, sniffing, spitting, animal noises, grunting, hissing, sucking, other simple sounds

Complex Vocal Tics

  • Sudden, more “meaningful” utterances
    • Syllables, words, phrases (“shut up”, “stop that”)
    • Coprolalia (obscene, aggressive words)
    • Palilalia (echo self)
    • Echolalia (echo others)

DSM-IV Tic Disorders

Transient Tic Disorder
Tics occurring longer than 4 weeks but less than 1 year

Chronic Motor or Vocal Tic Disorder
Motor or vocal tics (not both) occurring longer than 1 year

Tourette’s Disorder
Motor and vocal tics occurring longer than 1 year

Tic Disorder, NOS
Tic disorder not meeting any of the above criteria

All categories except NOS require onset prior to age 18

Treatment:
In the past, treatment for tic disorders was done only by psychiatrists and neurologists and medications were the treatment of choice.  Medications are effective in managing the symptoms.  However, researchers and experts treating these disorders have discovered that Behavior Therapy for tic disorders can be very effective if the provider is trained to treat these disorders.

Treatment can consist of medication and behavior therapy.  Function-based interventions are used to address external factors in an individualized fashion.  Habit reversal training is used to address internal factors.

The training program is to help clients learn to manage their tics.  It involves becoming aware of tics and the situations that make them worse.  Clients will learn to restructure their environment to make tics less frequent as they learn specific exercises to help decrease the tics. Part of the program is learning relaxation and mindfulness techniques to reduce stress.  It is possible to decrease the tics, but it requires commitment on the part of clients.  Clients are taught techniques that need to be practiced not only during sessions but every day in order to begin making progress.  The program is designed to be eight weeks long.  This allows you to learn the skills and understand how you can help yourself in the future.

[Information partly gathered from Susanna W. Chang)