Tic Disorders And Twitches In Kids And Adolescents: How To Notice Them And When To See A Specialist

The year I started high school, there was a girl with Tourette's Syndrome in my class. I distinctly remember wondering just how uncomfortable it must have been for her that a teacher asked her to get up in front of everyone to explained what that meant on the very first day — and somehow even worse, she was standing right next to me as a whole group of parents discussed this "strange disorder" among themselves during a "get to know each other" type of event. 

The tic disorder was a novelty that soon wore off — my classmate's persistent swallowing sounds, the ticking of her pen against a window, the occasional verbal tics... all these things simply blended into the rowdy school environment, as we simply accepted that her tics were a part of her. The fact remains, however, that neither us kids nor the parents knew what Tourette's was at the time. 

Thanks to the internet, more open discussions about health, and shows like I swear I can't help it, that's probably no longer the case. That greater awareness may, in turn, mean faster diagnosis — a good thing, considering that as many as one in every five kids and adolescents are now believed to experience transient tics. 

A quick overview: What kinds of tic disorders exist?

Tics disorders are neurodevelopmental conditions — meaning they affect the way in which the brain works — that cause sudden, fast, and frequently repetitive twitches, movements, or sounds. Tics can vary greatly in intensity and frequency, as well as in nature. These sorts of conditions are covered in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This "psychiatry bible" covers not just mental health disorders such as depression and anxiety, but also lifelong learning differences and neurodevelopmental conditions such as dyslexia. 

There are three possible tic disorders, as identified at the moment, and they are:

• Tourette's Syndrome. People with Tourette's have two or more motor tics — meaning tics that cause movements, such as repeated twitching of the hands or compulsive blinking — as well as a minimum of one vocal tic. Vocal tics can manifest as a wide variety of whole words and phrases, but can also consist of more subtle sounds such as clearing the throat or a burst of air. These tics begin before age 18, must last at least a year, and occur on most days, sometimes very frequently
• Persistent (Chronic) Motor or Vocal Tic Disorder features at least one motor or vocal tic, and maybe more. People with this tic disorder only have either vocal or motor tics, however.
• Someone may be diagnosed with Provisional Tic Disorder if they have had motor or vocal tics for less than a year, and other diagnoses are still being considered. 

In all these cases, other causes — such as epilepsy, drug use, or other neurodevelopmental disorders — must be ruled out first. Some physical medical conditions, such as postviral encephalitis, can also cause tics.

What else can cause tic-like movements and sounds in children and teens?

Not all repetitive twitches, motor movements, and sounds are tics — and parents shouldn't be quick to conclude that something that looks like a tic is, in fact, a tic or a tic disorder. Other possible causes of tic-like movements and sounds in children and teenagers (as well as adults) certainly exist. ADHD (attention deficit/hyperactivity disorder), often features sudden bursts of physical activity or sounds that can look a lot like tics to the untrained eye, for example, and autistic people, too, often "stim", meaning they make repetitive movements or sounds to help regulate emotions. In obsessive compulsive disorder, tic-like behaviors may be a part of the rituals (compulsions) the person carries out.

It is, therefore, not that simple to make a diagnosis!

Tics disorders in kids and adolescents: What should parents look out for?

Tic disorders generally begin showing symptoms before puberty, with ages four to six being the most common time period during which tics become apparent. Tics begin during adolescence occasionally but not very often, and if they do, they are more likely to have an underlying physical cause. It's even rarer for tics to suddenly show up during adulthood. 

Tics can be simple and short — a barely-there shrug of the shoulder that the person felt compelled to complete. They may also be complex, combining phrases, humming, or yelling with multiple motor movements. People who experience tics may be able to repress them for a time, but in that case, the tics are likely to get worse for a time once they finally give into the urge. A tic is, ultimately, beyond a person's control even though they may have some say in the timing. Times of stress or excitement may make tics more frequent.

Parents can always see their family doctor or pediatrician if they are concerned that their child is experiencing tics, but they should also be aware that tics can sometimes be so transient in nature that they'll have stopped by the time of the appointment. You should, however, seek medical attention and get the ball rolling to see a specialist if:

• The tics are causing social problems for the child. 
• The tics are interfering with the child's everyday life. 
• The child hurts themselves because of the tics — some tics involve slapping yourself, for example, while others cause wild swinging of the limbs that lead to inadvertent injuries. 
• The child experiences mental distress because of the tics. 

Getting your child's take on the situation will help you figure out what could be going on. After that, you can make an appointment and pick your doctor's brain.