Tics

What are tics?

A tic is a sudden repetitive movement or sound that the person didn't intend to make. Although kids may be able to control their tics briefly, it's difficult – like trying to suppress a hiccup or sneeze.

Tics are divided into two categories:

• Motor tics. These are involuntary body movements, such as rapid blinking or kicking.
• Vocal tics. Also called phonic tics, these are involuntary noises, such as throat clearing or repeating words.

Tics may occur many times a day or only occasionally. They often begin in childhood, get worse in the preteen or early teen years, and improve or disappear by adulthood.

Fortunately, many cases are mild and don't require treatment. However, treatments are available if a tic is affecting your child's quality of life, such as by interfering with friendships and schoolwork.

Children can't control tics, so shaming or punishing them won't help and may make the tic worse. At UCSF Benioff Children's Hospitals, our team of highly trained, compassionate specialists is dedicated to helping kids with tics.

Risk factors for tics

Experts don't know the exact cause of tics. We do know that they're more common in boys than in girls.

Many children with tics also have other conditions, such as attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, depression, sleep disorders, and learning or behavioral problems.

Symptoms of tics

Motor tics

When motor tics involve just a few muscle groups, they're called simple tics. Simple motor tics are brief and may include:

• Eye blinking
• Facial grimacing
• Head or shoulder jerking
• Nose twitching
• Shoulder shrugging

Complex motor tics usually involve several muscle groups. To observers, it can look as though the person is doing the movement on purpose. Examples include:

• Hopping or jumping
• Twisting
• Bending
• Kicking
• Smelling or touching an object

Vocal tics

Vocal tics can also be simple or complex. Simple vocal tics include:

• Grunting
• Sniffing
• Throat clearing

Complex vocal tics include:

• Repeating words or phrases (either the child's own or someone else's)
• Swearing or using obscene language

Tics usually worsen when the child is stressed, angry, excited or tired. They may lessen when the child is calm and focused on something else.

Diagnosis of tics

There are no specific tests to diagnose tics. However, your child's doctor may order tests – such as a blood test or imaging exam – to rule out other conditions that could be causing your child's symptoms.

Types of tic disorders

There are several tic disorders, including:

• Provisional tic disorder. Children with provisional tic disorder have motor or vocal tics (or both) that have been happening for less than a year. Previously called transient tic disorder, this is the most common tic disorder.
• Chronic (or persistent) tic disorder. Children with this type have had either motor or vocal tics (but not both) for more than a year. The tics may occur many times a day or on and off.
• Tourette syndrome. Children with Tourette syndrome have two or more motor tics and at least one vocal tic that have lasted at least a year. The tics may occur many times a day or on and off.

Treatment of tics

Many kids with tic disorders don't need to be treated. But if your child's tics distress them and interfere with daily life, treatments are available.

Behavioral therapy is often the first treatment recommended for tics. Although it's not a cure, it can reduce the number and severity of someone's tics. Behavioral therapy options include:

• Habit reversal training. The child learns to be more aware of the tic and to perform a replacement behavior that makes it impossible for their tic to occur.
• Comprehensive behavioral intervention for tics (CBIT). CBIT includes habit reversal training along with other strategies, such as relaxation techniques.

Medication can also play a role in managing tics. Your child's doctor will determine the best medication options based on your child's age and any other conditions they have, such as ADHD, OCD or depression.