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Tics and Tourette Syndrome in Children
By Riikka Melartin, Psy.D.
Tics, or repetitive involuntary movements or sounds such as blinking, head rolling, sniffing, and throat clearing, are fairly common among young children. I’ve read estimates that vary between 10 to 25% percent, although they are more common in boys than girls. In my professional and personal life, I have observed dozens of small children with tics, many of them in the 6 to 9-year old range. Tics are generally normal behaviors that don’t necessarily call attention to themselves, so they may even go unnoticed. Sometimes the movements or sounds make adults think that the child is fidgeting because they’re nervous or have Attention Deficit/Hyperactivity Disorder. Most childhood tics are transient – they may be present for a year or less.
If you notice tics in your child you should mention them to your pediatrician, but in most cases, in the absence of other difficulties or symptoms, no intervention will be necessary as they will pass over time. Sometimes people are unclear on how tics are different from the repetitive behaviors that are common with Obsessive Compulsive Disorder, which will be covered in a future article. OCD rituals tend be more complex, such touching all the even numbered chairs.
In about one percent of the population, tics are chronic and are diagnosed as Tourette Syndrome, which is considered a neurological disorder with a genetic component. With Tourette’s, there are multiple motor and at least one vocal tic that persist over years. They can be minor or include more disruptive vocalizations (even phrases, sometimes offensive) or more complex movements such as repeatedly smelling an object. With Tourette’s, the child is more likely to suffer from teasing from classmates or unwitting scolding or punishment from parents or teachers. Unfortunately, this can create a secondary layer of anxiety, distress, and self-esteem difficulties.
It is extremely important to understand that while children and adults with tics or Tourette Syndrome can sometimes delay their movements or vocalizations, this is only temporary and takes a great deal of effort. For example, a child in class trying hard to not tic, will have difficulty fully focusing on a conversation or on her lessons. Often, children will eventually have to go to the restroom or somewhere else private to express their tics (this accommodation can even be written into a special education plan at school.) Ticking can wax and wane, with fatigue, stress, and other factors having an impact. This inconsistency unfortunately can also make adults erroneously think the child has control over them.
If your child is diagnosed with Tourette Syndrome, support, acceptance, and educating those around your child about the nature of the syndrome are of primary importance. Treatment for the tics themselves can include medications, specific types of behavioral therapy which involve replacement behaviors for the tics over time, as well as supportive counseling to help with coping and self-esteem.
Because of the relative rarity of Tourette Syndrome, you may need to go to a larger medical center to find diagnostic and treatment specialists. In that case, you may be able to get consultation and a treatment plan that can then be followed up by medical professionals closer to home. As noted above, because of the social cost of Tourette Syndrome, you will also want to make sure that your child’s school provides any recommended accommodations and support to minimize its emotional and social impact. Every new teacher, and the parent of every new playmate, should be told about your child’s tics so that they will not be shamed or punished for them. The good news is that Tourette’s symptoms not only can often be successfully treated but will often lessen by adulthood.
Riikka Melartin, Psy.D. is a licensed psychologist who provides individual therapy, counseling, and consultation for clients who are diverse in age, ethnicity, and sexual orientation. Until recently, she also worked as a school psychologist. Look for her monthly blog post about child & adolescent therapy on www.commpsych.com.
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