Tic Disorder — What are they and How We Treat Them 

By Wasim Kakroo

BLINKING, coughing, sniffing, clicking the fingers, repeating a phrase or a sound and many other uncontrollable repetitive movements in children often bring the world of worry dawn over parents. These are tics.

Tics are rapid, repetitive muscular movements that cause bodily jolts or sounds that are difficult to control. They’re fairly frequent among children, and they usually appear around the age of 3 to 9 years and are most severe between the ages of 9 and 11. Boys are more likely to have tics than girls. Children with tic condition are more likely to have additional mental health issues. Attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), anxiety, and depression are examples of these conditions. Tics can also start in adulthood but such occurrences are less common. Tics are usually not serious and become better with time. However, they might be frustrating and obstruct daily activities of a child or an adolescent.

A tic is an issue in which a part of the body moves uncontrollably, repeatedly, swiftly, and suddenly. Tics can affect any region of the body, including the face, shoulders, hands, and legs. They can be voluntarily stopped for short periods of time. The majority of tics are minor and barely detectable. However, in certain circumstances, they are frequent and severe, affecting a child’s life in a variety of ways.

When a child develops a tic, it can be frightening for parents, who wonder if the small repetitive coughs or blinks will ever go away or if they are an indication of something more serious. The good news is that most tics will go away on their own and will not return. If you believe your child has developed a tic, you should consult a paediatrician or a psychiatrist or a clinical psychologist to ensure that what you’re witnessing is a tic. However, in the vast majority of situations, parents will be advised to merely observe and wait before considering any additional intervention. Treatment is only required when tics become persistent and incapacitating.

Causes of Tics:

The absolute cause of tics is unkown to the scientific world. However, it is postulated that the changes in the areas of the brain that control movement are thought to be the cause. They can run in families, and in many cases, there is a hereditary cause. They frequently occur in conjunction with other conditions, such as hyperactivity-hyperactivity disorder (ADHD), Obsessive-compulsive disorder (OCD) etc.

Tics can also be triggered by illegal drugs like cocaine or amphetamines, and they can also be triggered by more serious health issues like cerebral palsy or Huntington’s disease.

Types of Tics:

Tics are of a variety of types. Some have an effect on body movement (motor tics), while others result in a sound (vocal or phonic tics).

Tics include excessive blinking, wrinkling the nose, or grimacing, jerking or slamming the head, clicking the fingers, coughing, grunting, or sniffing repeating a sound or phrase — this may be something vulgar or objectionable in a limited percentage of cases.

Patients experience an inner drive or a local premonitory sensation that is eased when the tic is performed. Tics can occur at any time and are often associated with stress, anxiety, exhaustion, enthusiasm, or happiness. They tend to worsen when they’re discussed or concentrated on. Tic disorders can be either primary (inherited) or secondary (caused by other illnesses) (e.g., head trauma, encephalitis).

What should you do if your Child or a family member is Diagnosed with Tic disorder?

Taking an active role in your kid’s care, learning about tics, and understanding treatment and symptom management can all help you make the best decisions for your child and family.

The majority of children with tics usually have at least one additional mental, behavioural, or developmental problem, which can add to stress and make managing tics more challenging. Work with a mental health professional (Psychiatrist/Clinical psychologist) to deal with all the issues including tics.

Anxiety among parents about their children’s tics may have the unintended consequence of exacerbating them. Parents can inadvertently make a child feel self-conscious and concerned by drawing attention to a tic that he isn’t worried about, which can aggravate the tic. The best thing you can do for your child is to remain calm and avoid drawing attention to the tic. A big part of helping your child and yourself is managing your own anxiety.

How is chronic motor or vocal tic disorder treated?

Treatment is not necessarily required if a tic is moderate in severity and not producing any other issues. Self-help advice, such as avoiding stress or exhaustion, is frequently highly beneficial to the majority of individuals in managing their tics.

Some of the self help tips to reduce the occurrence of tics are as follows:

1. Manage stress, anxiety, and boredom by finding a calming and enjoyable activity to do, (such as a sport or a hobby). Read more about stress reduction, and how to help an anxious youngster avoid becoming overstressed.
2. Get a good night’s sleep whenever possible. Read to know more about sleep hygiene and techniques to combat exhaustion.
3. Avoid calling attention to your child’s tic by ignoring it and not talking about it too much.
4. f your child happens to have a tic, do not chastise them.
5. Assure your youngster that everything is fine and that they have no reason to be embarrassed.
6. Inform others with whom you have regular contact about your tics so that they are aware of them and know not to react when they occur.
7. If your child is having trouble in school, talk to their teacher about how to help them. If their tics are extremely bad, kids may benefit from being allowed to leave the classroom. Arrangements with school staff may be made for the child to take exams separately from the rest of the class, especially if the youngster has vocal tics. When marking the child’s oral, written, and practical work, the degree to which the tics interfere with exam performance should be taken into account. Exam time pressure should be reduced, and students should be allowed to take periodic breaks throughout tests to lessen the frequency of tics.

If a tic is more severe and interfering with daily activities, therapies (psychotherapy and/or pharmacotherapy) aimed at reducing the frequency of tics may be prescribed.

The following are the most common tic treatments:

Habit reversal therapy seeks to teach you or your child intentional movements that “compete” with tics so that the tic cannot occur at the same moment.

Habit reversal therapy entails:

Teaching the child to recognise the sensation that precedes a tic.

Assisting the child in understanding what triggers their tics.

Training them to do something different when they feel they’ll have a tic. The behaviors they perform will be such that it will not be noticeable to others. A child with a sniffing tic, for example, can learn to practice a breathing exercise instead.

CBiT (comprehensive behavioral intervention for tics) is a series of behavioral approaches that can assist people learn how to control their tics. It incorporates CBT strategies such as habit reversal technique (discussed above), psychoeducation about tics, and relaxation techniques.

Exposure with response prevention (ERP) seeks to assist you or your child become accustomed to the unpleasant sensations that occur frequently shortly before a tic, with the goal of preventing the tic from developing.

If the above psychotherapeutic procedures do not help much, pharmacotherapy (use of medicines) in combination with psychotherapy should be a good option.

They are usually prescribed by either a paediatrician or a psychiatrist and can be used in conjunction with psychological therapies or after unsuccessful attempts at these therapies.

Children who have tics and who are struggling in school should be evaluated for learning disorders and provided with support if needed.

• The author is a licensed clinical psychologist (an alumni of Govt. Medical College Srinagar) and is currently working as a child and adolescent mental health therapist at Child Guidance and Well-Being Centre at Institute of Mental Health And Neurosciences-Kashmir (IMHANS). Reachout at [email protected]

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