What are tics and when do they tend to happen?
Tics are sudden and repetitive body movements and/or vocalizations that are common in children. Tics can occur in different locations (e.g., face, legs) and range in complexity, from simple eye blinks/throat clearing up to multi-step movements/multi-word phrases. Typically, tics first occur early in childhood (i.e., ages 5-8), are most common and at their worst in pre-adolescence (i.e. ages 10-12), and then begin to decline during adolescence. Of youth who initially develop tics, only a small portion (around 20%) continue to have moderate or severe tics in adulthood. Depending on the number of tics, youth may be diagnosed with Tourette’s Syndrome or another tic disorder diagnosis.
If you believe your child has tics, the following provides a brief description of what you might expect when meeting a psychologist trained in assessing and treating tic disorders. At Cornerstone, Dr. Selles, Dr. Slavec, and Dr. McConnell have training and experience in treating tics.
Effective treatment of tics begins with a thorough assessment.
Assessment includes making sure there are no other causes of your child’s tics, as well as getting a thorough picture of the tics, including how many tics are present, how frequently they occur, their intensity and complexity, as well as the extent of impairment that they cause (in other words, how much they get in the way of your child’s life). In addition, clinicians may inquire about other difficulties that children with tics also may experience, such as attention problems, obsessive-compulsive symptoms, anxiety, and depressive symptoms.
Once assessed, clinicians will provide families with information about tics.
Evidence suggests that learning more about tics can reduce misunderstanding and stigma about tics and help lower the emotional consequences or reduce the stress that tics may be causing. This will include information about tics like why they happen, how they change over time, what they look like, as well as potential options for treatment. They may also share information on how to develop basic coping strategies related to tics (e.g., tic acceptance; strategies for talking about tics with others) and may provide guidance around obtaining accommodations for school or activities if necessary (e.g., extra time, permission to leave the classroom).
What if my chid’s tics are mild?
In youth with mild tics, this information and preliminary guidance may be sufficient to reduce tic-related impairment. If symptoms other than tics cause the most difficulties for a child, a psychologist will likely recommend that these symptoms be addressed first. Addressing the biggest problem is likely to help the child most overall. In addition, this approach will often lead to improvements in tics because treating other concerns can help reduce triggers for tics (e.g., anxiety) and may teach similar skills (e.g., tolerating uncomfortable feelings).
What if my child’s tics are more severe?
For youth whose primary difficulty is tics that are cumbersome, invasive, noticeable, time-consuming, and distressing more direct intervention may be helpful. Specifically, the scientific evidence supports Comprehensive Behavioural Intervention for Tics (CBIT) as a treatment that helps youth better manage their tics and reduce the extent to which tics interfere in their lives. The core parts of the treatment involve: A) helping youth become more aware of when their tics occur and how tic-urges feel; B) developing an alternative response to tic urges that make it difficult for the tic to occur; and C) identifying other behavioural strategies that can help minimize the tics and their associated impairment. If tics are particularly severe or injurious, a psychologist may refer the family to a psychiatrist for consultation regarding medication options that may help supplement the behavioural approach.
Families are encouraged to find more information about tics and their treatment at the webpages of Tourette Canada and the Tourette Association of America.
This blog post was developed by Dr. Robert Selles using the following resources:
McGuire, J. F., Piacentini, J., Brennan, E. A., Lewin, A. B., Murphy, T. K., Small, B. J., & Storch, E. A. (2014). A meta-analysis of behavior therapy for Tourette Syndrome. Journal of Psychiatric Research, 50, 106-112.
Murphy, T. K., Lewin, A. B., Storch, E. A., Stock, S. & The American Academy of Child and Adolescent Psychiatry Committee on Quality Issues. (2013). Practice parameter for the assessment and treatment of children and adolescents with tic disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 1341-1359.
Parraga, H. C., Harris, K. M., Parraga, K. L., Balen, G. M., & Cruz, C. (2010). An overview of the treatment of Tourette’s disorder and tics. Journal of Child and Adolescent Psychopharmacology, 20, 249-262.
Selles, R. R., Murphy, T. K., Obregon, D. , Storch, E. A., & Lewin, A. B. (2013). Treatment decisions for chronic tic disorders. Clinical Practice, 10, 765-780.
Steeves, T., McKinlay, B. D., Gorman, D., Billinghurst, L., Day, L., Carroll, A., . . . Pringsheim, T. (2012). Canadian guidelines for the evidence-based treatment of tic disorders: behavioural therapy, deep brain stimulation, and transcranial magnetic stimulation. Canadian Journal of Psychiatry, 57, 144-151.
Verdellen, C., van de Griendt, J., Hartmann, A., & Murphy, T. (2011). European clinical guidelines for Tourette syndrome and other tic disorders. Part III: behavioural and psychosocial interventions. European Child and Adolescent Psychiatry, 20, 197-207.