Tourette Syndrome and Other Tic Disorders in Children and Adolescents

There are three major types of tic disorder:

Typically, children begin with provisional tic disorder and sometimes go on to develop persistent tic disorder or Tourette syndrome.

The cause of tic disorders is not known, but tic disorders often run in families, so doctors think heredity plays a part.

Sometimes people who have another disorder, such as Huntington disease Huntington Disease Huntington disease is a hereditary disease that begins with occasional involuntary jerking or spasms, then progresses to more pronounced involuntary movements (chorea and athetosis), mental... read more or a brain infection (encephalitis Encephalitis Encephalitis is inflammation of the brain that occurs when a virus directly infects the brain or when a virus, vaccine, or something else triggers inflammation. The spinal cord may also be involved... read more ), develop tics. Tics can also result from use of certain drugs, such as cocaine or amphetamines. However, tics caused by other disorders or by drugs are not considered a tic disorder.

In children who have or have had a streptococcal (strep) infection Streptococcal Infections Streptococcal infections are caused by any one of several species of Streptococcus. These gram-positive, sphere-shaped (coccal) bacteria (see figure ) cause many disorders, including... read more , tics and/or symptoms of OCD sometimes start suddenly or become dramatically worse within a day. Such cases are called pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS). Some investigators think that antibodies produced by the body to fight the streptococcal bacteria may cause tics (or OCD) or make tics worse. However, most investigators think that the proof of this connection is lacking.

Before a tic occurs, an urge to do the tic may be felt. This urge is similar to the need to sneeze or scratch an itch. Tension builds up, usually in the affected body part. Giving in to the tic provides brief relief.

The tic can sometimes be postponed for seconds to minutes but only with conscious effort and difficulty. Usually, the urge to do the tic eventually becomes irresistible. Trying to control tics is usually difficult, especially during times of emotional stress. Stress and fatigue can make tics worse. However, tics often also become worse when the body is relaxed, as when watching TV. Calling attention to a tic, particularly in children, may make the tic worse. Typically, tics do not occur during sleep, and they rarely interfere with coordination. Tics may lessen when people are concentrating on a task such as school or work activities or when people are in an unfamiliar place.

People with severe tics, particularly Tourette syndrome, may have difficulty functioning and experience considerable anxiety in social situations. In the past, they were shunned, isolated, or even thought to be possessed by the devil. They may become impulsive and aggressive and behave in self-destructive ways.

Children with a severe tic disorder or Tourette syndrome are more likely to have another disorder, such as OCD, ADHD, and/or learning disorders. These problems seem to result from the brain abnormalities that cause tics and Tourette syndrome. However, when a tic disorder is severe, the extraordinary stresses of living with the disorder may make these problems worse.

Tics tend to be similar at any given time, but they vary in type, intensity, and frequency over a period of time. Sometimes they start suddenly and dramatically. They may occur several times an hour, then almost disappear for many months.

Early diagnosis of a tic disorder can help parents understand that the tics their children have are not intentional and that punishment cannot stop the tics and may even make them worse.

The diagnosis is based on the symptoms and their duration.

To distinguish Tourette syndrome from other tic disorders, doctors may have to evaluate children periodically over time.

Doctors also check children for disorders that often accompany tics, such as ADHD and OCD.

If symptoms are mild, reassurance is often best, with as little attention paid to the tic as possible until it disappears on its own. Treatment can often be avoided if the family understands the disorder and if the disorder is explained to and understood by the child's teachers and schoolmates.