Stress is believed to be the most probable aggravating factor of tics. Most tics go away as children become older. However, complex tics that lead to strong discomfort, physical damage, and functional disorders require close consultation with specialists. Children affected by chronic tic disorders or Tourette’s Disorder, with motor tics or vocal tics that persist for more than a year, must seek psychiatric help.

Signs and symptoms

A tic is an involuntary, recurrent and sudden movement of a part of the body or a sound. Most tics are mild and often pass unnoticed, but some tics can continue to increase in complexity and frequency.

Repeated blinking, head shaking, shoulder shrugging, and other sudden movements that involve certain parts of the body are referred to as motor tics. Repeatedly making noises, such as throat clearing and coughing, are vocal tics. Children suffering from complex vocal tics may blurt out obscene words uncontrollably and repetitively. These movements and sounds can be stopped for brief periods, but not for long.

About two out of every ten children develop tics that go away by themselves within several weeks or months. However, a tic that continues to recur for more than one year is diagnosed as a chronic tic. Approximately 1 percent of all children are affected by chronic tics.

Tourette’s Disorder

Children suffering from Tourette’s Disorder display both motor tics and vocal tics. Different symptoms may occur, disappear, and sometimes recur. Tourette’s Disorder often accompanies problems such as attention deficit, hyperactivity, impulsive activity, learning disabilities, and obsessions and compulsions.

Patients with Tourette’s Disorder or other tic disorders cannot control the sounds and movements they make, and should not be blamed for them. If parents or teachers punish and scold them for their tics, it will only further affect the child’s self-esteem. Tics become more frequent and noticeable when the child tries to concentrate or is placed in stressful situations. In most cases, the child is unaware of the sounds and movements he or she is making, and scolding only aggravates their distress. The best way to deal with transient tics is to ignore them until they pass.

Notes for parents and teachers

If a tic continues to recur, parents and teachers should strive to find and deal with the cause of stress, instead of scolding them or attempting to stop the tic by force. Dealing with the cause makes tics go away faster by helping the child feel at ease. Reduce the amount of study and extracurricular activities so that the child can fully relax and rest, and refrain from scolding. However, as it is both impossible and undesirable to eliminate all stress factors, parents are advised to support the child in learning how to face and overcome stress, thereby reinforcing self-confidence.

If a tic occurs too frequently, persists for more than a year, impedes the child’s school and social life, or disturbs themselves and others, it is recommended to visit a psychiatrist that specializes in treating children or adolescents. Psychiatrists can determine whether the child has Tourette’s Disorder or other types of tic disorders through a comprehensive evaluation. After an evaluation, the appropriate treatment can be planned.

Treatment

Treatment for children with Tourette’s Disorder includes medication such as Clonidine, Haloperidol, Pimozide, Risperidone, Aripiprazole, and Olanzapine. Medications may result in side effects, and therefore patients must strictly adhere to the psychiatrist’s instructions. The aforementioned medications do not serve as fundamental cures but can ease tic symptoms to reduce discomfort and lessen the disorder’s impact on the child’s day-to-day life. Whether or not medications are used for treatment, Tourette’s Disorder typically becomes milder or completely disappears in the late teens. Even if tics persist and become chronic, patients can still manage to lead healthy, normal lives by seeking medical help and trying to control stress.

By Joung Yoo-sook

The author is an associate professor at Department of Psychiatry of Sungkyunkwan University School of Medicine. ― Ed.