Tics are sudden twitches of whole muscle groups, most often affecting the eyes, mouth, shoulders, or neck. A tic can manifest as movement — like rapid uncontrolled blinking of the eyes — or as sounds, like throat clearing or making grunting noises.
Everyone experiences tics from time to time — a persistent eyelid twitch is not uncommon when a person has not slept well or is experiencing stress, for example. Similarly, a sudden muscle spasm can cause a violent twitch that surprises or embarrasses the person who experienced it. In most cases, though, these one-off tics are harmless and temporary. When the tics become regular and prolonged, however, they may point to a tic disorder.
Tic disorders — including Tourette Syndrome, the most well-known of the group — rarely travel alone. They’re most commonly seen with ADHD, obsessive-compulsive disorder, and major depressive disorder. In fact, studies suggest that up to 60 percent of children with Tourette Syndrome also have ADHD.
Tic disorders are more common among men than women, and they show up more often in children — some studies estimate that as many as 20 percent of children have experienced a tic. As children age, this percentage falls — by adulthood, only about 1 in 100 people has a tic disorder.
Where do tics come from? The research is inconclusive. Some genetic element seems to exist, as tic disorders tend to run in families. Stress and lack of sleep seem to make tics worse, but there’s no evidence that they cause tics to develop.
For years, experts worried that the stimulant medications commonly used to treat ADHD caused tic disorders, but more recent research indicates otherwise. Instead, it seems that, while stimulant medications do not cause tics, they may bring them out in individuals who are genetically predisposed to them. For this reason, doctors may be reluctant to start stimulant medication with patients who report a family history of tics. In most instances, the tics go away once the medication is discontinued with these patients.
Symptoms of Tic Disorders
Tics manifest in two forms — motor tics and vocal tics — that are further delineated into two categories: simple and complex.
Simple motor tics:
- Eye blink, eye roll
- Neck jerk, jaw thrust
- Nose twitching, face grimacing, head jerking
- Arm or leg thrusting
- Muscle tightening (commonly the buttocks or abdomen)
Complex motor tics:
- Series of movements performed in the same order
- Mimicking movements of others
- Vulgar movements (giving “the finger,” or sexual motions)
- Friendly gestures (waving, thumbs up, etc.)
- Frozen posture (“statue-like”)
Simple vocal tics:
Note: Simple vocal tics often occur in repeated bouts, and don’t seem to mimic real words or any form of spoken language.
Complex vocal tics:
- Mimicking words said by others
- Repeating phonemes
- Unintentional obscene words or statements
- Random words, blurted without intention to communicate
Tics aren’t classified as involuntary movements — rather, experts have deemed them “unvoluntary,” meaning that most patients can suppress them with focus. However, this suppression is often uncomfortable, and the patient usually relieves this discomfort only by performing the tic.
Types of Tic Disorders
Tic disorders fall into four categories, according to The American Psychiatric Association (APA)’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V):
1. Transient tic disorders: Multiple tics, lasting more than 4 weeks but less than 12 months. This is the most common tic disorder diagnosis, and is thought to affect anywhere between 5 and 25 percent of school children at any given time. In some cases, patients experience multiple episodes of transient tic disorder, with tic-free periods in between.
2. Chronic tic disorder: Either a single tic or multiple motor or vocal tics (not both), which have been present for more than a year. For a diagnosis of chronic tic disorder, the symptoms must appear before age 18.
3. Tourette Syndrome: Multiple motor tics and multiple vocal tics that have been present for more than a year. This is the most severe form of tic disorder, and is typically diagnosed between the ages of 5 and 18. Around 200,000 people in the United States live with Tourette Syndrome.
4. Tic Disorder NOS: Tics are present, but meet none of the categories listed above. This category mostly applies to adults, since the other tic disorders are primarily diagnosed in childhood.
Understanding Tourette Syndrome
When most people think of tics, they think of Tourette Syndrome — or rather, they think of the Tourette stereotype: an angry individual yelling swear words or jerking uncontrollably. This is far from accurate. While Tourette Syndrome is the most severe type of tic disorder, affecting between 0.4 and 3.8 percent of children nationwide, it is not often portrayed accurately on TV and in films.
Thanks to over-exaggerated stereotypes, it’s a common misconception that Tourette Syndrome patients shout profanities without warning. The truth is that coprolalia — or unintended swearing — only affects about 10 to 15 percent of people with Tourette Syndrome.
Likewise, sudden explosive outbursts are not commonplace. About 25 percent of children with Tourette Syndrome do experience these outbursts, but experts theorize that these are mostly uncontrollable and not a manifestation of real anger. Most children feel intense shame and remorse after a “rage attack,” and in general are no angrier than their peers. In the rare cases where anger is a problem, antipsychotic medications have been shown to be effective forms of treatment.
In fact, Tourette is largely manageable with proper treatment, and even those with severe vocal and motor tics can realize symptom improvement and live fulfilling lives. Tourette is mainly a childhood disorder; most patients see their worst symptoms between the ages of 8 and 12. By the time adulthood rolls around, severe cases of Tourette Syndrome are extremely rare.
Tourette Syndrome, like other tic disorders, has no link to low intelligence or a reduced lifespan — other common misconceptions.
Diagnosing Tic Disorders
There’s currently no brain scan or other neurological test designed to diagnose tic disorders — meaning your doctor will rely mainly on a clinical interview and observation to diagnose a tic disorder in you or your child. To do this, he or she will ask you to carefully track when the tics started, how long they’ve lasted, and what they look like.
Children and adults alike may not notice their tics, so many doctors recommend asking a loved one and even a teacher to observe and record the frequency, triggers, and severity of various tics. In some cases, children purposely suppress tics while in the doctor’s office, so it may be necessary to observe them in situations where they don’t think they’re being watched.
A thorough evaluation will also assess for co-existing conditions — particularly autism, ADHD, depression, or OCD. Overlapping or lookalike symptoms are often present, potentially complicating the diagnosis and subsequent treatment plan.
Treatment Options for Tic Disorders
Since the majority of tics stop on their own without treatment, many experts recommend a “wait and see” approach for tic disorders in children, especially if they cause the individual minimal embarrassment. If the tics persist — or cause great distress — stress-reduction techniques, habit-reversal therapy, and behavioral therapy have been shown to work wonders, for both children and adults with tic disorders. If no other options prove effective, some medications can be used to help suppress tics.