Tics in childhood

What is it about ?

A tic is a brief and sudden movement or sound which has the characteristic that it is not rhythmic and that it is recurrent. The tic does not have a precise objective, it brings an (emotional) discharge. Tics can be of several kinds: transient tics, chronic tics and Gilles de la Tourette syndrome. These last two groups probably have the same cause and the same differences in severity of tics. To talk about chronic tics or Gilles de la Tourette syndrome, complaints must appear before the age of 21.

The cause of tics is not very clear, but it is believed that they are largely genetically determined and associated with certain environmental factors, such asanxiety, emotional stress and fatigue.

What is their frequency?

Transient tics are frequent, they occur in 2 in 10 children. Chronic tics affect less than 2 in 100 people. Gilles de la Tourette syndrome affects less than 1 in 100 children or adolescents.
Tics most often start between the ages of 4 and 6.

How to recognize them?

Tics can affect any part of the body, most often in the head and upper body. The most common tics are blinking, shaking the head, grimacing, raising the eyebrows, squinting the nose, moving the corners of the mouth, raising the shoulders and flexing the limbs. Vocal tics are sighs, yawns, coughs, sniffles, growls, and barks.

More complex tics are possible, such as sudden outbursts of insults or swear words: 30% of people with Gilles de la Tourette syndrome suffer from it.

Tics are often preceded by unpleasant bodily sensations (pain, itching, or a feeling of pressure in the muscle about to be affected by a tic).

Tics are often associated with other behavioral or emotional conditions, such as attention disorders, learning disabilities, stuttering, panic attacks, anxiety, the Depression, obsessive-compulsive disorder, etc.

How is the diagnosis made?

If the tics persist for more than two months, the general practitioner will refer the child to a psychiatrist specializing in children (child psychiatrist) or a doctor specializing in both pediatrics and neurology (pediatric neurologist) for additional examinations based on questionnaires and of an observation. The doctor can start treatment if necessary.

What can the doctor do?

For a child with mild tics, it can take several months to see if things improve spontaneously. It is possible that the tic will go away completely, but it can just as easily turn into another tic. During this time, it is especially important to reassure the child, the family and those around him. Depending on the severity and duration of the tic, the doctor will send the child to a child psychiatrist or a pediatric neurologist.

The treatment is aimed at relieving complaints, to avoid a negative influence on the physical and emotional functioning of the child. In addition to full explanations, the behavior therapy can be useful. In the absence of improvement only and despite general advice and psychotherapy, a specialist can start treatment with drugs. The general practitioner will also take care of the follow-up of the child.

Want to know more?

• Childhood tics – being born and growing up

Are you looking for more specialized help?

• Mental Health Services – The Social Guide
• PMS Center – Wallonia-Brussels Federation
• Find a therapist – AEMTC – Association for the Study, Modification and Therapy of Behavior
• Find a psychologist – Commission des psychologues
• The LUSS – A federation of associations of patients and relatives

Source

Foreign clinical practice guide ‘Tics in childhood’ (2000), updated on 28.10.2019 and adapted to the Belgian context on 22.06.2019 – ebpracticenet