Tics (nervous tics)
A tic is a short movement or sound that comes out on its own: a child blinks over and over, jerks a shoulder, wrinkles their nose, clears their throat without…
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Medicines commonly prescribed for Tics (nervous tics)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 1 mgActive substance: risperidoneManufacturer: Neuraxpharm Spain S.L.Prescription requiredDosage form: TABLET, 1 mgActive substance: risperidoneManufacturer: Aurovitas Spain, S.A.U.Prescription requiredDosage form: TABLET, 0.5 mgActive substance: risperidoneManufacturer: Laboratorio Stada S.L.Prescription required
A tic is a short movement or sound that comes out on its own: a child blinks over and over, jerks a shoulder, wrinkles their nose, clears their throat without having a cold. From the outside it looks like a bad habit or like play-acting, which is why tics attract more telling-off than almost any other childhood condition. In fact holding a tic in is about as hard as holding in a sneeze. Tics are common — a sizeable share of school-age children go through them — they usually appear at around five to seven years of age, and in most cases they fade away on their own with no treatment at all. They are not the result of poor parenting, they are not caused by a fright, and they are not something a family failed to prevent.
What they look like
Tics come in two groups. Motor tics are movements: blinking, screwing up the eyes, jerking the head, hitching a shoulder, grimacing, flinging out an arm, sometimes whole sequences such as turning round and touching an object. Vocal tics are sounds made on the out-breath: throat-clearing, sniffing, grunting, whistling and, less often, repeating a word or a scrap of a phrase.
A few features make a tic recognisable almost every time:
- it comes in bouts: several jerks in a row, then a pause;
- in older children it is preceded by a build-up of an unpleasant sensation — an itch in the eyelid, a lump in the throat, tightness in the shoulder — which the tic releases; children describe it as "I have to do it or it won't let go";
- it changes over time: the blinking stops, sniffing takes its place, and six months later it is a shoulder jerk;
- it comes in waves: barely noticeable one week, glaringly obvious the next month, and that does not mean anything has got worse;
- during sleep there are usually no tics.
Young children often do not notice their own tics at all and are surprised when someone points them out. Awareness of the tic, and of the urge that comes before it, tends to arrive at around ten.
Why they flare up and settle down
Tics are very sensitive to the state a person is in. They get stronger with tiredness and short sleep, with excitement — happy excitement included, so there are more of them before a birthday and after a party than on an ordinary Tuesday — with stress, during a feverish illness, and when a child has nothing to do. And there is one amplifier of its own, the most unfair of the lot: talking about the tics. The more often they are mentioned, the more of them there are.
They ease off when a person is absorbed in something: playing an instrument, reading, building with bricks, deep in a game, talking about something that interests them. That is one reason teachers sometimes do not believe parents — in a lesson where the child is concentrating there may be no tics at all.
And here is the part that matters most for everyone around. A tic can be held back for a while — a minute, sometimes a few. That is exactly why adults draw the wrong conclusion: "So he can stop when he wants to." He can, but at a price. For all that time the person is occupied with nothing but holding on and cannot concentrate on anything else, and the moment the effort lets go the tics come out in a burst, more of them than usual for a while. The child who "behaved beautifully at the doctor's" gets home and discharges the whole lot in the hallway. That is not an act and not revenge on the parents; it is the direct consequence of an hour of self-restraint.
Where they come from
Tics are linked to the workings of the parts of the brain that start and stop movements. Nothing in the brain is being damaged, and tics on their own do not affect a child's development.
Heredity counts for a great deal: ask around and a relative usually turns up with a similar childhood history the family never talked about. Tics often travel alongside attention deficit hyperactivity disorder or obsessive thoughts and rituals, and sometimes those companions bother the child considerably more than the tics themselves.
What is not on the list of causes: upbringing, screens, sugar and "a tense atmosphere at home". Stress makes existing tics more visible, but it does not create them out of nothing. Less commonly tics are a side effect of stimulant medicines or a consequence of drug use; and very rarely the jerks are a sign of another condition of the nervous system — and that is precisely the situation in which a doctor is needed.
How long it lasts, and where Tourette's fits in
The usual course is that tics last a few months and go. If they persist for more than a year and there are both motor and vocal tics, the picture is called Tourette's syndrome. The name sounds heavy, and films tend to portray it as someone shouting obscenities, when in reality that affects a minority of people with the diagnosis. The word "Tourette's" by itself does not mean a severe course or a special outlook: it simply records that the tics are not a passing month but a persistent pattern.
The peak runs from about eight years of age to the middle of the teens. After that, in most people, tics weaken or disappear: by adulthood some are left with nothing and some with slight jerks that nobody but they themselves notice. You cannot predict from the strength of the tics at seven what things will look like at seventeen, and the reassuring part is that the direction of travel is usually good.
How to behave around a tic
There is one main rule: do not draw attention to the tic. It sounds simple and it is hard to keep, because a tic all but asks to be reacted to.
- Do not comment and do not say "stop that" or "keep still". It never helps, and after such a request there are more tics, not fewer.
- Do not punish and do not shame. The child is not to blame, and needs to hear that from you in words.
- Do not discuss the tics in front of the child with grandparents, neighbours and doctors as though they were not in the room.
- Do not make a child "show the tic" and do not film it without asking. If a doctor has asked for a video, record it in passing, without announcing it.
- Explain calmly what is happening: it happens to plenty of people, the body sometimes makes extra movements, it will pass, there is nothing to be frightened of. Not knowing frightens children more than the tics do.
- Tell the teacher and the sports coach, and ask them not to pull the child up on it. It helps if the child is allowed to step out of the classroom for a minute when it gets bad: the permission is used less often than parents fear, but it takes a lot of pressure off.
- Protect sleep and keep the day from being overloaded: too little sleep is the most predictable amplifier of tics.
- Watch for bullying separately. It is far more dangerous than the tics and needs adults to step in, not a "take no notice of them".
When a tic needs a doctor
Most children with tics need a doctor once: to confirm that these really are tics and to be told that nothing needs doing. But there are situations where an appointment is not optional:
- the tic hurts or causes injury — violent head jerks, hitting oneself with a hand, biting the lip, movements that leave the neck aching;
- tics appearing for the first time in an adult. Tics begin in childhood; jerky movements that start for the first time in adult life more often turn out to be a different movement disorder, and that has to be sorted out;
- other neurological symptoms alongside the jerks: weakness in an arm or leg, unsteadiness, a change in handwriting, loss of skills already mastered, slowness, altered speech;
- a sharp deterioration — tics that within a few days have become far stronger or changed beyond recognition, especially after a head injury, after an illness or on starting a new medicine;
- the tics interfere with eating, sleeping, writing, school or work;
- the child is suffering because of them: embarrassed, afraid to go to school, withdrawing, speaking badly of themselves;
- low mood, anxiety, outbursts of anger or thoughts of self-harm have appeared alongside the tics.
Adults deserve a paragraph of their own, because something rare but important hides there. Among the causes of new movements in a young adult is Wilson's disease, a disorder of copper handling that strikes the liver and the nervous system at the same time. It is uncommon, but ordinary blood tests pick it up and it can be treated, and the earlier that starts the better the outcome. Findings like that are the reason new jerky movements in an adult are never left unexamined.
There is no test "for tics": the diagnosis rests on the account and on what the doctor sees. Investigations are not for everyone, only for those whose picture falls outside the usual.
What helps when tics get in the way
Start with the honest part: if the tics are mild and are not spoiling anyone's life, they do not need treating. The aim of treatment is not to abolish tics but to give the person back a life that is not organised around them.
The first thing offered is behavioural therapy, and it is not a series of chats about coping but the teaching of a specific skill. The person learns to notice the urge that comes before a tic and, at that moment, to make a different movement that cannot happen at the same time: for a shoulder tic, for instance, gently stretching the arm until the urge dies down. There is also a version in which, the other way round, you learn to sit with the urge without answering it. It takes several sessions, it suits children from about eight or nine and adults, and the gains hold if the techniques carry on being used after the course ends.
Medicines are needed by a minority — those whose tics are severe, painful or plainly disabling. Drugs acting on dopamine transmission are used, as are alpha-2 agonists, which have the advantage of helping with associated attention problems; for a single stubborn tic in one muscle, botulinum toxin injections are sometimes given. All of them carry side effects, from drowsiness and weight gain to movement problems, so this treatment is chosen by a doctor rather than over a pharmacy counter.
And often the thing to work on is not the tics at all: if a child has attention problems or obsessions, dealing with those makes life easier than any intervention aimed at the jerks.
What does not work, however keenly it is offered: special diets, vitamins and supplements "for the nervous system", nootropics, homoeopathy. There is no evidence of benefit in tics, and time and hope go into them.
Online consultation
A remote appointment suits the first conversation about tics very well. The doctor will ask how it all started, what exactly happens and in what circumstances it worsens, will look at a short video if you have one, and in most cases will already be able to say the main things: whether this looks like ordinary childhood tics, whether anything needs doing now and what to keep an eye on. The practical side gets covered too — how to answer classmates' questions, what to tell the teacher, how to rearrange the day so the child gets enough sleep. Online is also a convenient place to weigh up whether it is worth looking for behavioural therapy, and to come back later when the picture changes. Jerky movements appearing for the first time in an adult, other neurological symptoms or a sharp deterioration, on the other hand, call for a face-to-face neurological examination: video is no substitute for it.
This material is for information only and does not replace medical advice.
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