A tic is an involuntary, recurring and stereotyped motor movement or vocalisation. Tics are more common in children than adults and usually present around 6-7 years of age. Although tics often resolve spontaneously, they can have a significant impact on a child’s self-esteem and social interactions and can be a significant source of concern for parents.
The most well known child tic disorder is Tourette’s Syndrome. Children with Tourette’s Syndrome experience both motor and vocal tics while children with other tic disorders may experience one or more motor (or vocal) tics. Tics can be variable or chronic in nature and are often preceded by a tension or sensation in the particular muscle group (a premonitory urge) and followed by a feeling of relief succeeding the expression of the tic. Although obscene gestures (Copropraxia) and words (Coprolalia) are commonly associated with Tourette’s Syndrome in the media, these tics are actually relatively uncommon.
Examples of motor tics
- Eye blinking
- Nose wrinkling
- Neck jerking
- Shoulder shrugging
- Facial grimacing
- Hand gestures
Examples of vocal tics include
- Throat clearing
- Spontaneous expression of single words or phrases
What does treatment for Child Tic Disorder Involve?
Although the tics in Tic Disorder have a neurological basis, environmental factors have been shown to interact with biological factors in influencing the variability of tics. Behavioural interventions, such as Habit Reversal Therapy (HRT) and Comprehensive Behavioural Intervention for Tics (CBIT), can assist children to manage the intensity, frequency and duration of tics and provide children with the confidence that they can cope effectively in situations when tics occur.
Main components of HRT and CBIT
This involves teaching the child to become more aware of the urges associated with tics and of how tics start and progress. The child then practices noticing the urge or beginning of the tic.
Competing Response Training
The child is assisted to select a behaviour that is physically incompatible with the tic and practices engaging in this behaviour when the urge or beginning of the tic is noticed, in order to break the link between the urge and the tic. For example, if the tic involves the child opening their mouth the competing response might be to practice clenching their teeth together.
An examination of possible factors in the environment that trigger and reinforce the child’s tics is undertaken. If triggers or reinforcing consequences are identified, a problem-solving approach is taken to identify strategies to manage these environmental factors.
A support person (usually a parent) is selected to provide praise for the correct implementation of the competing response and to prompt the initiation of the competing response if the child has not noticed that they are engaging in a tic.
Treatment for co-existing conditions
Children with tic disorders often experience a number of co-morbid conditions including anxiety, low self-esteem, feelings of shame, self-consciousness, social isolation/rejection and depression. Obsessions and compulsions are also common for children with tic disorders. Cognitive Behavioural Therapy can be used to teach children strategies to cope with and manage the symptoms of these co-occurring conditions. This is particularly important as internal states such as stress and anxiety are likely to influence tic frequency, intensity and duration and can often be a source of greater distress for children than the tics themselves.
If you would like to find out more about our treatment for child tic disorders, or to book an appointment with one of our child clinical psychologists who provides treatment in this area, please email or call the clinic on 02 9438 2511.