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Tics

  • Tics are sudden and repetitive movements and/or sounds that people make involuntarily. Tics commonly affect school-aged children, often starting around early primary school age.

    One in eight school-aged children are affected by tics at some point for a short period of time (provisional tic disorder). Bouts of tics occurring longer than a year (chronic tic disorder) happen in about one in 100 children. In these children, tics tend to be more troublesome around 10 to 12 years old, but usually improve in later teenage years or early adulthood.

    About 50 per cent of young people with chronic tics will outgrow tics in adulthood, and most will experience them less frequently than in childhood.

    Signs and symptoms of tics

    Motor tics are movements that can affect any part of the body, but particularly the face, eyes, head and shoulders. Any movement can be a tic and the movement is made without a clear reason or purpose.

    Phonic tics, which make a sound, can include anything from throat clearing, sniffing, squeaking to words or even phrases. They can sound exaggerated and out of context.

    Tics will come and go and can change over time and one tic can stop as another starts. Tics tend to increase during strong feelings, like stress, nervousness, excitement, or tiredness. They are ‘suggestible’, which means that talking about tics and drawing attention to them will increase their occurrence. This can increase stress and frequency of tics for the young person.

    Some people can suppress their tics for short periods even though they are involuntary. This can be hard to do for a long time and more tics may appear afterwards. In general, tics are reduced at times of active and focused concentration.

    What causes tics?

    We do not fully understand the underlying cause of tics.  There are complex genetic and neurobiological factors, and it is more common if another family member also has tics. It is important to remember tics are not harmful.

    How are tics diagnosed?

    Tics are diagnosed by a paediatrician or neurologist. No tests are required to diagnose tics. Your paediatrician or neurologist may ask you to describe or imitate the movements that your child makes. They will ask your child about their experience of the tics. Home videos can also be helpful for diagnosis.

    Some children with tics experience extra problems like difficulty concentrating, fidgeting, impulsivity, and anxiety. Your paediatrician or neurologist will also ask about your child’s development, learning and focus.

    Management for tics

    One of the challenges with having tics is the response from family, friends or other people around your child. It is a good idea for these individuals to not make a fuss about tics when they notice them (active ignoring). Asking the young person to stop the behaviour, or punishing them for the tics can make tics worse as the young person is not intentionally doing them. It can be helpful to discuss this with school teachers privately, so everyone at home and at school responds to the tics in the same way.

    Some helpful general measures include:

    • Not drawing attention to the tics when they occur—Do not react, actively ignore them.
    • Ensuring the young person has adequate sleep and follows a regular sleep routine to prevent fatigue.
    • Agreeing on basic strategies for the young person to release the tics in a way that they are comfortable with:
      • identifying a quiet and safe place for them to go to when they feel the need to release tics 
      • taking quick short breaks from a stressful activity
      • Switching to a different activity when tics build up
    • Guiding the young person to build self-awareness of stress levels and use of mindfulness techniques. This may include deep breathing exercises, colouring in or listening to music.
    • Recognising and emphasising the young person’s strengths and building their self-confidence.

    Most people with tics do not require any specific treatment. This is particularly the case when tics are not interfering with the young person’s daily life. Where tics are disruptive, psychological treatments and medicines can be considered.

    Psychological treatments can be helpful in some well-motivated young persons, even though tics are not behavioural or voluntary. A psychologist can guide the young person to delay or change the tics if the young person can learn to recognise the urge leading to a tic. Effective treatments include habit reversal and comprehensive behavioural therapy for tics (CBIT). Relaxation training can also be helpful. These treatments require motivation and practice and can take some time, which is why they may not be suitable for all young people. Your child’s treating team will discuss if they believe this treatment will be suitable for your child.

    Medications can reduce severity and frequency of tics but cannot stop or cure the tics. They are not effective for everyone and there can be side effects.

    If your child has problems with difficulty concentrating, fidgeting, impulsivity or anxiety, discuss this with your paediatrician. These behaviours should be assessed and treated.  This is an important aspect in managing your child’s overall health and well-being and can be helpful in reducing tics.

    When to see a doctor

    You should visit your GP or paediatrican if you are worried about your child’s movements or their learning, concentration or development. Your child’s doctor can evaluate your child and provide helpful resources, provide further advice for managing tics, or refer your child to a specialist if required.

    Key points to remember

    • Tics are movements and sounds that people make involuntarily.
    • Tics are not harmful to your child, but some children with tics experience difficulty concentrating, fidgeting, impulsivity or anxiety.

    • Home videos can be helpful for diagnosis.
    • Active ignoring and not drawing attention to the movements are helpful strategies when tics do not bother your child.
    • Speak to your GP if you are worried about your child’s tics. 

    For more information

    Common questions our doctors are asked

    Are tics harmful? 

    No tics are not harmful, but some children with tics can experience difficulty with concentrating, fidgeting, impulsivity or anxiety. We encourage you to speak to your child’s GP if this is the case.

    What is the difference between tics and Tourette syndrome?

    Tics are the involuntary movements and sounds that are made. Tourette syndrome is the condition when you have recurrent tics for at least 12 months.

    Is there any treatment for tics? 

    One of the most effective ways to manage tics is for others to actively ignore them. If tics are severe and causing pain, sometimes medicines can help to reduce their severity. Psychological treatments can also be considered if the young person is motivated and interested in this treatment option and their doctor believes it will be beneficial. These options will be discussed with you. 

    Developed by The Royal Children's Neurology Department. We acknowledge the input of RCH consumers and carers.

    Reviewed August 2021.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.



Disclaimer  

This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.