Tics: what are they?

Tics are sudden, repetitive and uncontrollable movements and sounds.

Tics can be simple or complex:

• Simple movement tics involve only one part of the body – for example, eye blinks, jaw movements, head jerks, shoulder shrugs, arm movements and leg movements.
• Simple sound tics are fast or meaningless sounds – for example, sniffs, throat noises, squeaks, grunts and barks.
• Complex movement tics involve several body parts – for example, tummy movements, jumping, touching, tapping, twirling or gestures.
• Complex sound tics are when a child repeats whole words or phrases.

Tics usually start for no obvious reason. They’re very common – 1 in 8 children has tics at some point. They usually aren’t a sign of something more serious. And they usually don’t cause harm.

Tourette disorder and other tic disorders

In many children, tics go away after a short time. When children have tics for less than a year, this is called provisional tic disorder.

For a small number of children, tics can last longer:

• Chronic motor or vocal tic disorder – this is when children have movement tics or sound tics (but not both) for longer than a year.
• Tourette disorder – this is when children have both movement tics and sound tics for longer than a year.

Provisional tic disorder, chronic motor or vocal tic disorder and Tourette disorder are all called primary tic disorders. This means the tics aren’t caused by another medical condition or by a medicine.

Tics and tics disorders usually start as simple tics. Children whose tics don’t go away quickly tend to get complex tics years later.

When tics start and how they change over time

The most common time for tics to start is the early primary school years, but they sometimes start earlier or later. This includes Tourette disorder and chronic tic disorders, which are often most severe at 8-12 years of age.

Tics can come, go and change over time. In many children, tics start and then quickly go away. About two-thirds of children with Tourette disorder or chronic tic disorder have very few or no tics by the time they’re young adults.

How often tics happen

Tics can happen several times an hour, once a day or every few days.

Your child’s tics might happen more when your child is nervous, worried, tired, unwell, stressed or excited. They might also happen more when your child thinks about them – for example, if you’re discussing the tics with them or in front of them or if someone asks them to stop.

Tics might happen less when your child is concentrating on something else. And they might not happen at all when your child is fully asleep.

Children might have one or more tics at a time, and the number and type of tics they have can change.

What tics feel like

If your child is younger, they might not be aware that their tics are happening.

If your child is older, they might tell you that they feel uncomfortable before a tic. It can feel like a build-up of inner tension, like when a sneeze is coming. This feeling goes away after the tic.

Your older child might be able to hold in a tic for a short time. This can be quite uncomfortable as the tension builds up.

Children usually aren’t bothered by their tics. But when tics are severe, they might interfere with children’s ability to do everyday things.

Things that affect tics

Children with tics often have one or more other conditions or difficulties. Children with these conditions can have more severe tics.

These conditions or difficulties include:

• poor concentration or attention deficit hyperactivity disorder
• angry outbursts
• sleep difficulties
• learning difficulties
• obsessive compulsive behaviour
• low mood, excessive worries or mental health problems like childhood anxiety, teenage anxiety, childhood depression and teenage depression.

Medical advice: when to get it for children and teenagers with tics

If your child isn’t bothered by their tics, they probably don’t need to see a doctor.

But in some situations, your child might need medical advice about their tics. For example:

• You’re worried about your child’s tics.
• Your child is worried or distressed by their tics.
• The tics are causing social problems for your child.
• The tics are affecting your child’s concentration, learning, or emotional and social wellbeing.
• The tics are physically painful for your child.
• Your child has tics, and you think they might also have one or more of the other conditions above.

You could start by seeing your GP. Your GP might refer your child to a paediatrician or a neurologist about the tics.

If you or the GP thinks that your child needs support for any of the mental health or learning difficulties above, the GP might refer you to a psychologist, psychiatrist, counsellor or other professional. Support for these conditions is as important as – or even more important than – support for the tics.

Diagnosing tics, tic disorders or Tourette disorder

The GP or specialist will ask about your child’s symptoms. They’ll also do a physical examination to check things like your child’s walking patterns, coordination, reflexes and eye movements.

If the doctor can see what your child’s tics look like, it can help with diagnosis. The doctor might ask you to video your child when the tics are happening. It’s best to let your child know about this beforehand and check that they’re OK with it.

If your doctor isn’t sure whether your child’s movements or sounds are tics, they might investigate further to rule out other conditions.

Treatment for tics, tic disorders or Tourette disorder

Usually, children with tics and their families need only education from their doctor. This is so they can understand the tics and learn strategies to manage them.

If your child is older and has tics that are severe, distressing or affecting their daily life, your doctor or psychologist might recommend specific behaviour therapies. These therapies can reduce tics to a level where they’re no longer causing problems. The therapies work best when children are motivated to practise them.

Doctors might prescribe medicines only if tics are quite severe or children have some of the difficulties above as well as tics. That’s because these medicines are only partly effective at reducing tics and often cause side effects.

If your child has mental health problems, poor concentration, learning difficulties or sleep difficulties as well as tics, your child needs support to manage these difficulties. Managing these difficulties can lead to fewer or less severe tics. Depending on your child’s difficulties, support might include behaviour or psychological therapies like cognitive behaviour therapy (CBT), counselling, relaxation techniques, behaviour support plans, specialised learning support or sleep strategies.

Supporting children with tics, tic disorders or Tourette disorder

If your child has tics, a tic disorder or Tourette disorder, the best thing you can do is actively ignore the tics. This means not pointing out or drawing attention to the tics and not asking your child to stop or reduce them. If your child is reminded about their tics, the tics might happen more often.

Here are other ways to support your child:

• Be calm and patient with your child. Your child can’t control their tics.
• Help your child find ways to explain their tics to others. For example, ‘I have tics. They are movements and sounds I make without thinking. Many children have them’.
• Focus on and celebrate your child’s strengths. When children feel good about themselves, they’re better able to cope if they feel embarrassed, upset or frustrated by their tics.
• Encourage your child to eat well, be physically active, get enough sleep and manage stress. Good health and wellbeing can reduce your child’s tics.
• Explain your child’s tics to family members and your child’s teachers and friends. Let people know that the best way to handle tics is to actively ignore them.

It’s safe for children with tics to do activities like bike riding, swimming or horse riding.

Causes of tics, tic disorders or Tourette disorder

We don’t fully understand what causes primary tics and tic disorders in children, but we know that there are genetic and environmental risk factors. For example, your child is more likely to have tics if another family member also has tics.

Tics are more common in autistic children and children with certain genetic and neurodevelopmental conditions.