Provisional Tic Disorder

Definition

Tics take the form of abnormal, repetitive, unintentional movements or vocalizations that do not follow any rhythm or pattern. Provisional tic disorder, previously known as transient tic disorder, is a childhood motor disorder in which the child experiences seemingly involuntary motor and/or verbal tics for up to one year. Tics are often described as being preceded by a strong, uncontrollable urge to tic, followed by a release of tension. Some people also report feeling that their tic must be done in a certain way, and they will repeat the tic until it has been done “just right.” 

Tic disorders generally surface in childhood; to meet the criteria for a diagnosis of provisional tic disorder, tics must have started before the age of 18. Tics are at least twice as common in boys as in girls, and symptoms usually begin before a child reaches puberty, with an average onset between the ages of four and six. Symptoms tend to be most severe between the ages of 10 and 12 and improve as the child moves into adolescence. 

Symptoms

Tics can be either simple or complex. Simple motor tics are quick (milliseconds) and can include eye blinking, facial grimaces, shoulder shrugging, repetitive touching, or straightening the arms or legs. Simple vocal tics include throat clearing, sniffing, and grunting. Complex tics last for a longer period (seconds) and may include a combination of simple tics, such as simultaneous head turning and eye blinking. Tics tend to worsen when a person is anxious, excited, or exhausted. Similarly, tics may diminish when a person is calm and focused on a particular activity, such as schoolwork.

Tics may occur intermittently and change over time. Tic-free periods can last weeks or months. Those with mild or moderate tics often feel no distress or experience any impairment as a result of their tics. Although difficult to control, children are sometimes able to suppress tics for short periods of time. However, the tension and discomfort that builds up during the suppression of a tic can only be relieved by allowing the tic to occur. Symptoms of provisional tic disorder usually disappear when the child reaches the teen years but, in rare cases, may persist into adulthood.

Causes

The specific cause of provisional tic disorder is unknown; it is thought to be influenced by a combination of several factors, including genetic and brain abnormalities. Tic disorders can run in families and may also be caused or worsened by environmental factors, such as low birth weight and maternal smoking during pregnancy. Stress and lack of sleep can exacerbate symptoms.

Treatments

Treatment for a tic disorder is only necessary when the symptoms are severe enough to cause distress in a child or adolescent and interfere with their school functioning or social development. Treatment might include medication or behavioral therapy to reduce the presence and severity of symptoms as well as improve any distress a person experiences as a result of their tics. Additionally, relaxation techniques can help decrease the frequency of tics. 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edition). Arlington, VA: American Psychiatric Publishing.

Black, K. J., Black, E. R., Greene, D. J., & Schlaggar, B. L. (2016). Provisional Tic Disorder: What to tell parents when their child first starts ticcing. F1000Research, 5.

Last reviewed 03/05/2018