A “tic” is when a person experiences an involuntary movement or a semi-involuntary movement. Tics are typically sudden or rapid movements, such as a twitch, spasm or a sound, for example a blurted word or a throat clearing. Positively, most tics will pass on their own, but those that don’t or if they are impacting on daily living then they may need intervention. There are levels of severity when considering the intensity and duration of tics, they are considered provisional when they’ve lasted less than a year; chronic motor or vocal when ongoing for a prolonged period of time and would typically require intervention. Finally, Tourette’s syndrome being the most widely known due to media portrayals. Tourette’s disorder is when the child has multiple tics, including both motor and vocal, to be diagnosed the tics need to have been occurring for over 12 months. While a small percentage of individuals will have Coprolalia, which is cursing or to make socially inappropriate remarks. While there is some suggestion that tics are hereditary, they can also be caused by the environment that being the result of sickness, poor sleep, or stress. In particular, when diagnosed with Tourette’s syndrome there is a high rate of comorbidity with both anxiety disorders and neurodiversity. All of which need be considered as part of broader treatment planning.
Common motor tics include shrugging, head movements or blinking, whereas common vocal tics include sniffing or throat clearing. While the movements themselves are said to be “uncontrollable”, but with help children can learn how to control their tics. A common form of therapy is called Habit Reversal Training, which is a form of Cognitive Behavioural Therapy. Habit Reversal Therapy is an evidenced-based intervention that seeks to empower people with tic disorders to overcome the urge.
Treatment:
The word semi (as in semi-involuntary movement) is an important distinction, as the individual (even a child) experiences a feeling that precedes the tic (sound or movement). It is those “premotionary experiences” that are important to learn. For children even as young as 9 years of age, they are often able to describe these feelings or experiences. Quite often, the preceding feeling isn’t related to the tic, while a child may have a head, arm or back tic but the preceding experience is described as a hot flush or a tingle in a connected part of their body.
Understanding the preceding physical experience is an important part of the behavioural intervention. By first being able to understand the preceding experience, the individual gains insight as to when their tic is going to occur. The next step is then being taught a “competing response”. Increasing awareness of the
sensation and then engaging in a competing response is the essence of habit reversal therapy. An example of this may be a child who would engage in a backward bend, when they notice the body clue of a tingle or hot flush in their shoulders (preceding experience), they engage in a forward bend. The brain is unable to focus on both movements, then overtime the tic movement becomes defused. The same interventions can be used for vocal tics. As a part of the intervention, a therapist will help the individual become aware of their triggers, relaxation techniques, and mindfulness to reduce the frequency of their tics.
What can parents do?
For parents, who are concerned about their child’s tic disorder, they would benefit from a paediatric review to rule out other possible causes including, a seizure disorder or following a severe infection. Quite often, the parents are more concerned about the tic than what the child is and if it is mild then usually parents are encouraged to watch and wait as many will pass on their own. If, however, a child is being teased about it or they are becoming embarrassed then treatment is often sought. Parents will often ask what may cause the tic to worsen, and parental anxiety is a major contributor. By drawing greater attention to a tic may inadvertently lead to self-consciousnesses and exacerbate the tic. Managing your own anxiety is an important part of assisting your child.
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