Tics

Tics are rapid and repeated involuntary movements. Children who experience them may be embarrassed and teased by their peers. Tics usually affect the face and neck and take the form of eye blinking, shoulder shrugging, facial grimacing, neck twisting, throat clearing, sniffing and dry coughs. Sometimes these movements occur frequently throughout the day; at other times, they occur only occasionally.

Tics occur in about 20 percent of school-age children, beginning most often between ages 7 and 9, although they sometimes start as early as age 2 or 3. Tics are irregular in their pattern, but they often appear suddenly after some type of physical or social stress, and they tend to increase when a child is tense, anxious, tired or idle. Tics become less frequent when a child is able to relax and are never present during sleep.

Many parents find tics extremely irritating. They may urge their child to stop them, forgetting or unaware that the mannerisms are not totally under the child's conscious control. Sometimes they may feel that the child is purposely defying them as the tics continue.

Researchers are investigating the biological basis of tics. Since they are common in school-age children-whose brains are still developing and are not yet mature - tics may be a transient phenomenon of normal brain development and organization. Tics also seem to run in families, suggesting that they have a genetic component. The physical, organic origin of tics is just beginning to be understood.

Fortunately, most tics disappear on their own within several months. They may last longer when parents create stress for the child by pressuring him to stop the repetitive movements.

Types of tic disorders

Simple tics are single facial twitches that are persistent but do not change in character. By contrast, multiple motor tic disorders have ever-changing patterns of different visible physical tics.

The most severe tic disorder is Tourette's syndrome, which is characterized by multiple motor and vocal tics. The motor tics begin in the face but later involve all parts of the body. The vocal tics are vocalizations like snorts, coughs or hiccups. This syndrome is often associated with learning disabilities, obsessive thoughts, hyperactivity and attention deficit hyperactivity disorder. The frequency of tics in this syndrome varies: Sometimes they can be relieved with the use of medications.

Management of simple tics

Scolding your child or calling attention to her unusual mannerism is not helpful, and usually makes it worse. Since the more attention is called to the tics, the worse they are likely to become, tics are best ignored.

On the other hand, since your child is likely to have questions about why her body is acting this peculiar way, silence about them might increase her anxiety. It is best to talk with her sensitively and supportively, letting her know there is nothing wrong with her and there is no reason to feel ashamed. Help her develop strategies for explaining the tics to friends who may ask about them.

Seek ways to decrease any stress and conflict in your child's life. If she feels pressured and overscheduled, lighten her commitments. Discuss with her other sources of stress and worry, and together find ways to deal with them. Sometimes tics may have started under times of stress or conflict but persist long after those situations seem to have passed.

In some situations, you and your child may benefit from some outside help or advice. Talk with your pediatrician in the following situations:

The tics interfere with schoolwork or friendships and cause your child embarrassment, anxiety or emotional problems.
There are multiple tics or vocalizations, such as sniffs, snorts, throat clearing, chewing and tongue thrusting. These may indicate the condition called Tourette's syndrome.
The tics are intense and frequent.
The symptoms are present for longer than a year.
There is a strong family history of tic disorders, including Tourette's syndrome.
Your child is on medication for attention deficit hyperactivity disorder (ADHD).
Your efforts to identify the source of your child's tension or your efforts to help her reduce the stress are unsuccessful.