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Vocal and Motor Tics in Children

Young child scrunching up their face.
Anna Kroncke
Anna Kroncke
Ph.D., NCSP
Last modified 25 Oct 2022
Published 22 Apr 2022

What are Tics in Childhood?

Tics in childhood are uncontrolled movements that show up as motor or vocal repetitive motions. Tics include throat clearing, head shaking, grunting, and excessive blinking. These repetitive motions are often called movement disorders. The most common tic disorder is Tourette Syndrome. 

A tic is defined as a “sudden, non-voluntary reflexive action” [1]. 

Often people think Tourette’s is associated with verbal outbursts like when a child yells or curses in class involuntarily. This tic is actually fairly uncommon. A more typical example of a vocal tic would be grunting or saying a random word like ‘coffee’ completely out of context.

Typical tics are sniffing, throat clearing and subtle head shaking. These can still be very embarrassing and stress producing for a child, making them unable to concentrate on anything other than suppressing tics. 

The difference between a tic and a repetitive behavior is an important distinction. Tics are less voluntary. They are sudden and arrhythmic. Repetitive behaviors may show excitement while tics do not serve that function. Most people describe their tics as anxiety relieving but not deliberate. They admit they feel better after ‘ticking’ and have some momentary relief from the need to tic more. 

Tics are neurological and commonly co-occur with diagnoses like ADHD. Tics are more common if there is a family history of a tic disorder. They do often go away and tend to be much less common in early adulthood with a peak in late elementary to early teen years. 

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Types of Tics in Childhood

Tics are moderated by the basal ganglia in your child’s brain, which is where motor movements are controlled. The two types of tics are: motor tics and vocal tics.

Motor tics are movements that appear to be somewhat involuntary and are non-functional. For example, a frequent head nod that does not appear to be in response to a question.

 Another example would be eye blinking. One eye blink would be expected, but your child may have exaggerated blinks that are far too frequent to serve a purpose.

Vocal tics are noises such as clicking, grunting, repeating words, clearing throat, or growling.

Often, the behavior may show up in elementary or middle school perhaps between the ages of 4 and 6 with symptoms peaking by age 12. These movements seem to serve no function to your child. Your child may notice that tics are more frequent when they are tired, nervous or excited. They can be a source of great social stress.

Your child may start shaking her head or blinking her eyes frequently. He may shrug his shoulders or show a repetitive smile for no apparent reason. 

It may be that your child does the odd movement and then appears to be calmer as a result. 

Most children will deny that they are doing tics or will say that they ‘can’t help it.’ With repetitive behavior there tends to be more awareness though it can be challenging for a child to abstain from a repetitive behavior like hand flapping or hair twirling also. These repetitive behaviors or motor stereotypies in autism may also be more rhythmic than a tic. 

It is also challenging to suppress a tic. Your child may be able to do this but it tends to be exhausting.

In order to understand what tics feel like, here is a statement from a child who experiences them. He describes,

“People don’t understand what tics feel like. You get this feeling in the place where the tic is. You know the only way to make that feeling go away is to do the tic. It’s like your brain is in the habit of doing tics. You can stop it. You can, but you have to fight your brain so hard!” – 5th grade Gifted student

Some good news about tics:

  1. The first piece of somewhat good news is that many tics are temporary. These tics are sometimes referred to as transient tics. A child can have a tic disorder without having Tourette’s syndrome. This diagnosis would be the case if your child has only motor tics (no vocal tics) or if the tics come and go, rather than persisting for more than 6 months.
  2. The second piece of good news is that tics, although not entirely voluntary, are controllable. That is, children can stop themselves from doing a tic.

Although this analogy is not perfect, some liken tics to a sneeze. Although it may be very hard to prevent a sneeze, and a sneeze provides a great deal of relief, it is possible to stop oneself from sneezing.

For example, if you were in a quiet meeting or a ballet and it was vital that you do not sneeze, you could probably prevent yourself from sneezing.

With tics, although it takes effort and sometimes intensive therapy, many children can learn to stop. Most children will not necessarily admit that they are displaying tics and generally do not realize they have control.

Symptoms of Tics in Childhood

  • Moving in a repetitive manner: you notice your child making noise or moving in a repetitive manner such as shaking their head, raising their eyebrows, smiling, or grimacing
  • Flicks fingers: you notice your child making repetitive finger movements
  • Shrugging shoulders: you notice your child making repetitive shoulder movements
  • Nodding head or shaking head as if to say ‘yes’ or ‘no’: you notice your child making involuntary head movements 
  • Clears throat often: you notice your child making repetitive throat clearing sounds
  • Makes clicking sounds with fingers or tongue: you notice your child making repetitive sounds such as making noise by clicking their tongue against the roof of their mouth
  • Says the same word over and over again: you notice your child repeating one or two words again and again
  • Involuntary verbal outbursts: you notice your child interjects words or phrases without really meaning to, feeling like they cannot stop the words. Although the child may use swear words, this is uncommon. Most often the words are more random such as ‘coffee’ and ‘metal’. These are normal words to use but they are used out of context

Causes of Tics in Childhood

Your child may somewhat suddenly start showing a pattern of involuntary repetitive noises or movements. There is typically a neurological cause for tics. 

Neurological brain chemistry: there are genetic factors and differences in brain chemistry that lead to tics

Environmental influences can combine with brain chemistry: environmental factors like stress and lack of sleep can bring on or influence the severity of tics

Giftedness: although research is scant on this topic, many gifted kids experience transient tics. So common, in fact, many gifted conferences include sessions on tics. Generally with a gifted kid, the tics will come and go and may not have a significant impact on their social life. Many gifted kids are highly sensitive from a sensory standpoint and can ‘run a bit anxious’. This combination of features may be a factor in the development of tics during childhood in this population.

Tics may co-occur with a few other mental health or neurological conditions:

ADHD: In children often those with tics are more likely to have another neurological disorder like Attention Deficit Hyperactivity Disorder

OCD: Children Obsessive Compulsive Disorder and tics commonly co-occur

Depression: For older teens it is more common to have tics and depression. Tics could be brought on by stress or anxiety. Some children who are anxious for a long time will eventually become depressed. The tics may remain present throughout periods of anxiety or depression or both.

Bipolar disorder: Children and teens may experience tics along with symptoms of bipolar disorder. The tics may accompany periods of depression and mania

What to Do About Tics in Childhood

For temporary tics (lasting less than 6 months): there is not necessarily a reason to be concerned. As a parent, it may be important to evaluate what may have changed that could be causing your child anxiety. [2]

Let your child know they can have control of their tics: although you do not want to shame your child or make your child feel self-conscious, it is worthwhile to let your child know that he or she can stop the tics with effort and focus

  1. First, pay attention to when the tics are happening: observe your child. When do you notice that your child starts to have tics? Is it after someone in the home has an argument? Does your child tic more when under academic stress? Keep track of when the tics are happening. 
  2. Second, help your child become aware of the times he has a tic: often, your child will not be aware that they have tics. The first step is to help your child recognize when it is happening. You want to do this in a kind, gentle way. You can say, “I noticed you shake your head when you are nervous. Do you feel yourself doing that?”
  3. Third, provide another strategy in lieu of the tic: Instead of clicking, your child might be able to chew gum. Instead of finger flicking, your child may be able to rub a piece of fabric in his pocket or to stroke a rabbit’s foot.

Instead of a head shake, your child may be able to run her fingers through her hair or gently flip her hair. Although the tic is not completely gone, your child has successfully changed the movement to a more ‘adaptive’ or socially acceptable behavior.

Tics in the gifted child: If your child is Gifted (very high IQ), tics are somewhat common and tend to be temporary. These tics may fade out or go away over time without treatment. 

If your child is diagnosed with Tourette’s Syndrome: Find someone skilled in ‘habit reversal.’ This evidence-based treatment has the best efficacy for Tourette’s syndrome. 

This treatment uses a long-standing cognitive behavioral approach whereby your child learns to calm him or herself when faced with distressing stimuli, without doing the tic.

For example, for a child who is nervous in a crowded room, the therapist may show your child a video of a noisy, crowded room. Your child would then practice using calming techniques and resisting the urge to do the tic. 

Sometimes, the therapist may use biofeedback to help your child assess his or her level of anxiety before and after using the calming strategies.

Then, some sort of tracking system will be set up with the parent or teacher to observe your child and the frequency of tics. Every time your child’s tics are reduced by 5% or more, your child earns a prize.

Although it may be the case that total remediation of tics is impossible, many individuals who were treated  with habit reversal reduced their tics by over 90%. 

This reduction often means that your child only tics at home or in the bathroom and is able to get through the school day, free of tics. This progress can be substantial and may be the difference between a debilitating, socially isolating syndrome and a manageable, quirky behavior.

When to Seek Help for Tics in Childhood

For pervasive tics (lasting more than 6 months); tics that appear to be ‘setting in’ and are beginning to cause distress are worth evaluation and treatment. If your child has a motor tic that lasts more than 6 months, with at least one vocal tic, Tourette’s syndrome should be evaluated. [2]

Professional Resources for Tics in Childhood

  • Psychologist: to consider symptoms in a mental health context. Can diagnose related disabilities, such as Anxiety or ADHD
  • Neuropsychologist: to provide expertise and assessment of executive functions and potential neurological disorders
  • Neurologist: to provide a diagnosis, additional neurological tests and to rule out or diagnose Tourette’s syndrome
  • Movement disorder therapist: to look at what is happening in your child’s sensorimotor system. A motor therapist can be found in a hospital setting or special program often associated with neurology. 
  • Psychotherapist trained in habit reversal: to treat tics directly and either reduce or alleviate tic behaviors. Tics may be treated with cognitive behavioral therapy including relaxation techniques.  Habit reversal therapy is an extremely effective therapy for tics. This is a method that some cognitive behavioral therapy some psychologists or therapists are trained to do. 

Similar Conditions to Tics in Childhood

  • General anxiety: some tics serve to alleviate anxiety so most kids with tic issues have some level of anxiety
  • Rigid behavior: children who are inherently ‘set in their ways’ or who are very Inflexible, or become quite nervous with changes in routine, and may have tics that result from anxiety 
  • High intelligence (gifted): the intensity and hyper-sensitivity of many gifted children may be accompanied by tics
  • Executive functioning challenges: pervasive tic disorders tend to be associated with weaknesses in executive functions, such as working memory, task initiation, planning, and self-monitoring.
  • Memory challenges: although the tics do not directly cause memory problems, many children with tics become very nervous and embarrassed, and they may exert a great deal of energy to stop tics. In so doing, they ‘freeze’ up and may not hear (that is, ‘encode’) information coming into their ears, resulting in poor recall later
  • Social challenges: many children with tics feel embarrassed and socially isolated because of tics. If your child’s tics are truly getting in the way, it may be worthwhile for him or her to talk to peers about tics. Your child may say, “I do these tics so that I can feel less nervous; it makes me feel relieved afterwards.” Often, peers have more compassion and patience when they understand

References on Tics in Childhood

[1] Helena Huckabee, Ph.D., BCBA-D, Neuropsychologist, personal communications.

[2] Tourette Association of America

42-40 Bell Boulevard

Suite 205

Bayside, NY  11361-2820

Email: ts@tsa-usa.org

http://www.tsa-usa.org 

Eide & Eide (2006) The mislabeled child: Looking beyond behavior to find the true sources—and solutions—for children’s learning challenges. Hyperion, NY

 

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