“Tics wax and wane. It’s just the nature of the beast.”
Or is it? Some experts are beginning to believe that the waxing and waning effect is not random but is instead related to environmental factors—many of which we have control over.
Although there are no controlled trials studying triggers, surveys from parents and treatment centers that see large populations of children with tics reveal certain environmental factors that appear to make tics worse. And while some are universal (like video games or computer use), others might apply only to certain individuals (like a food allergy).
Here are some common triggers. Try eliminating each one for two to three weeks to see if it makes a difference.
1. Electronic screen media—since video games and computer use increases dopamine and tics are dopamine-related, it’s understandable that electronic media worsens tics. For bothersome tics, I recommend a three week “electronic fast” to normalize brain chemistry and improve sleep (restful sleep improves tics in and of itself).
2. Food, chemical, and seasonal allergies or sensitivities—there are two ways to assess for sensitivities. Testing, and systematic elimination. Testing can increase compliance, but sometimes an individual will test negative for a particular offender but nevertheless see improvement with the offender removed. By the way, your doctor needs to test for IgG for sensitivities, which are delayed reactions, not just IgE, which are immediate reactions. Labs like Metametrix specialize in this kind of testing at a reasonable cost. Here are some common sensitivities:
3. ADHD medications—stimulants, Strattera, and Wellbutrin can all worsen tics—but not in every case. Unfortunately many children with tics also have ADHD, rendering the ADHD difficult to treat. However, removing offenders outlined in this article can help both conditions.
4. Fluorescent lights—as incandescent lights are phased out and replaced with energy saving fluorescents, this may be one reason that tics are on the rise. Flourescent lights flicker (yes, even the “non-flicker” kind still flicker) and emit more radiation—both of which irritate the nervous system. Stock up on regular old incandescents if you can; halogen incandescents are second-best. LEDs are less irritating than CFLs but still worse than halogens.
5. Streptococcal infections (PANDAS)-Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococci are a group of disorders in which the antibody created against Strep bacteria cross-reacts with the basal ganglia in the brain--causing tics, movement disorders, and/or OCD. Since PANDAS-related tics may respond to antibiotics or tonsillectomy, it’s worth checking testing for.
For more on the influence of screen-time and lighting on tics, see Reset Your Child's Brain: A Four Week Plan to End Meltdowns, Raise Grades and Boost Social Skills by Reversing the Effects of Electronic Screen Time.