Tics

What are tics?

Tics are purposeless, rapid and repeated contractions of a group of muscles that result in movement (a motor tic) or the production of a sound (a vocal tic). Sometimes, a tic involves more complex behaviour.

Motor tics often involve the muscles of the face, head and neck, with movements such as blinking, lip smacking, facial twitching, grimacing and shrugging of the shoulders. Common vocal tics include coughing, grunting or clearing the throat.

The intensity of a tic can vary. Occasionally, tics are forceful, which can be frightening and uncomfortable.

Tics aren't voluntary movements - in other words, they can't be consciously controlled - although some people say they feel a strong urge to move, linked to stress. Some people are able to suppress their tics briefly, but this is said to be like holding back a sneeze and tension rises until the tic finally escapes.

Tics are usually divided into several categories, as described below.

Transient tic disorders

As many as one in ten children will develop a transient or simple tic at some point during their school years. Such tics usually occur in just one muscle group and don't last more than a few months, although a child may have a series of different transient tics over a period of years.

Transient motor tics may include blinking, squinting, snapping the fingers, jerking the head or wrinkling the nose. Occasionally, transient vocal tics such as gurgling or humming occur. The tic may even involve more bizarre behaviour, such as touching objects or licking.

Transient tics may become more prominent when a child is tired or excited, but they don't lead to harm and don't need treatment. They decrease or disappear when the child sleeps.

Chronic tic disorders

Not only do chronic tics persist, sometimes for years, but they change little in their character. While they don't usually need treatment, they can be disruptive, especially if a child realises others think them strange. Occasionally, a person has several tics and is said to have chronic multiple tics.

Tourette syndrome

Chronic tics are also a feature of Tourette syndrome. This neurological disorder causes multiple motor and vocal tics, which can be quite dramatic and frequently change in nature. Tourette syndrome usually begins in early childhood, varies in intensity and lasts more than a year.

Tourette can be particularly debilitating because the vocal tics can include the uncontrollable use of obscene language (known as coprolalia) and repetition of phrases the person hears others use (called echolalia).

Those with Tourette syndrome often have a variety of psychological problems too, such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and self-harm behaviour, although the link isn't clear.

Like other tics, the exact cause of Tourette syndrome isn't known, although genetics appear to play a part. It's likely that a particular gene makes a person more vulnerable than others to environmental factors that also contribute to the condition.

Treatment and recovery

Psychological support and counselling can be helpful for those with disruptive tics and cognitive behavioural therapy may help some people control their condition.

Medication is the most effective treatment in reducing the tic itself. However, the powerful drugs used (such as haloperidol, pimozide, fluphenazine and clonidine) tend to have unpleasant side-effects. So, while 70 per cent of those with Tourette have tried drugs, for example, many people prefer to manage without medication if possible.

• Don't panic if your child develops a tic - most are mild and transient
• Most tics don't interfere with life or school and don't require treatment
• People taking stimulant drugs (for ADHD, for example) may develop tics but these should cease when the drug is stopped
• Stress can aggravate symptoms or simply make life harder - relaxation and biofeedback techniques may help