What Causes Tics?
Tics can be hard to understand, because our body and our voices are often something that we feel like we can control. Researchers also don’t know the exact reason or cause for tics, but many do believe that tics are a result of changes in the part of the brain that controls movement. Tics have also been linked to presence in biological family lines, indicating that they could have a genetic basis. Tic disorders are commonly found alongside other conditions including Attention-deficit/hyperactivity disorder (ADHD) and Obsessive Compulsive Disorder (OCD). Tics often become present in early childhood, with most common diagnoses between the ages of five and ten, and more frequently impacting biologically male children.
Tic disorders are a neurological condition because research has led us to believe that tics may be in part a result of dysfunctional basal ganglia pathways. An excess of dopamine is thought to be the cause of tics, and this excess dopamine production can often be triggered by external stressors. Both ADHD and OCD are thought to involve the same pathways in the brain, and dopamine plays an important role in these disorders, which can explain the overlap between these disorders and tic presentation. Research has also identified that there is likely an emotional component to tic disorders, as experiences of stress, frustration, and anxiety have been linked to ticking behaviors.
How Can Tics Be Treated?
Whether or not tics require treatment depends on their severity and the impairment or distress that they introduce to a child’s life. If a child’s tics are mild, they may not need any treatment, and the tics may resolve on their own. For these children, learning how to manage stress and get good sleep can be a helpful way to reduce tic experiences. For kids with more severe or frequent tics, you may consider engaging with behavioral therapy.
One behavioral therapy is called Habit Reversal Training (HRT). Through HRT, the goal is to help your child learn skills to manage their symptoms and replace the ticking behaviors with other, more appropriate and less interfering behaviors. This involves helping the child recognize the urge or feeling that comes before a tic and then substitute a competing response to prevent or replace it. This replacement behavior should be something that cannot be completed at the same time as the original tic. For example, if a child has a simple vocal tic, the clinician may suggest that the child takes a deep breath after feeling the urge so that the child cannot engage with the vocal tic. HRT involves caregivers and family to support the child in recognizing the urges and practice using the competing response at home and in real-life.
Another treatment option is Comprehensive Behavioral Intervention for Tics (CBIT), which uses the same components and skills as HRT, but also includes psychoeducation about tics and how stressors can impact tics, as well as function-based environmental intervention. This means that the course of treatment addresses more directly the factors in a child’s daily life that may worsen tics like stress, fatigue, or difficult emotions.
What Can I Do To Help My Child?
As caregivers, you can play an important role in helping a child learn about and manage their tics. Teaching and modeling self-care can be a great way to reduce stress for a child, which can in turn help with the severity of tics. Engaging with fun activities, practicing relaxation techniques like deep breathing, and ensuring that they get a good night’s sleep can have a bigger impact than you may think. In addition, research has found that drawing attention to a child’s tics can make them worse. Speaking about the tics in a way that is unsupportive or stressful for the child can increase the frequency or severity of tics, creating the opposite result from what you may desire. The child cannot control their tics, so disciplining them for performing the tics will not reduce them. It may actually increase them. You can also act as an advocate for your child. Reassure them that they do not need to be embarrassed by their tics and teach them about what they are and why they might happen. In the same way, discuss your child’s tics with their schoolteachers and other providers to ensure that they respond to your child in a supportive and helpful manner, instead of disciplining them for something that they cannot control.
If you are concerned that your child may have a tic disorder that could benefit from treatment, begin by talking to your child’s health care provider and describing the type, frequency, and severity of tic behaviors. Then, the provider may recommend engaging with a more thorough assessment and behavioral therapy if indicated.