Persistent (Chronic) Motor or Vocal Tic Disorder
Tics are sudden, uncontrollable, spastic movements or verbal outbursts. These movements or vocalizations are repetitive, do not follow a rhythm, and are generally involuntary. Persistent motor or vocal tic disorder is a condition in which a person experiences single or multiple occurrences of either motor or verbal tics, but not both, for a period lasting more than one year. If a person experiences both motor and vocal tics for more than one year, the diagnosis would likely be Tourette’s disorder, or Tourette's syndrome, instead. However, persistent (chronic) motor or vocal tic disorder is more common than Tourette's disorder.
For a person to be diagnosed with persistent (chronic) motor or vocal tic disorder, the tics must have started before age 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 4 and 6. Symptoms tend to be at their most severe between the ages of 10 and 12 and may improve as the child moves into adolescence.
Tics are often preceded by a premonitory urge, described as a strong, uncomfortable, and seemingly uncontrollable drive to move, followed by a release of tension once the tic has occurred. Some children also feel that their tic must be done in a certain way, and they will repeat the tic until it has been done “just right.” But not everyone who suffers experiences these urges and needs.
Tics can be either simple or complex. Simple motor tics are quick (milliseconds) and can include:
- Eye blinking
- Facial grimaces
- Repetitive and rapid shoulder shrugging
- Repetitive touching
- Straightening the arms or legs
Simple vocal tics include:
- Throat clearing
Complex tics last for a longer period (seconds) and may include a combination of simple tics, such as simultaneous head-turning and eye-blinking. Complex tics may also include repeating specific words or phrases.
Tics tend to worsen when a person feels 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 during the suppression of a tic can only be relieved by allowing the tic to occur.
The DSM recognizes several major tic disorders that differ mostly in the types of tics and length of time they have existed. For instance, with persistent (chronic) motor or vocal tic disorder, someone can have either motor tics or verbal ticks that persist beyond a year. Tourette’s disorder, or Tourette’s syndrome, involves both motor and verbal ticks lasting more than a year. With provisional tic disorder, the tics have been present for less than a year.
Tics are normal—so much so that some experts consider having a temporary tic to be just part of growing up. It is estimated that about 20 percent of children will experience an involuntary tic at some point in their childhood. Though tics can be embarrassing (and occasionally annoying to parents), they are generally harmless and tend to fade or even disappear altogether with time.
Mild to moderate tics may be easier to manage and may not impede much on an individual’s daily life. However, when, a tic is severe enough to impact functioning, as can happen with some cases of persistent (chronic) motor or vocal tic disorder, it can lower a person’s quality of life, making it difficult to go to school or work like usual. People with tics may feel socially isolated, experience more conflict with others, or even get bullied by their peers, leading to great distress.
Genetic factors are believed to play a role in the presence and severity of tics. Tic disorders seem to run in families (e.g., a certain allele can increase someone’s risk of developing Tourette’s disorder). Persistent (chronic) motor or vocal tic disorder can also be caused or worsened by environmental factors, such as lower birth weight and maternal smoking during pregnancy. Stress and lack of sleep can exacerbate symptoms.
The exact cause of persistent (chronic) motor or vocal tic disorder, along with other tic disorders, has not yet been determined. However, this condition often presents with co-occurring medical and psychiatric issues, including but not limited to ADHD, OCD, bipolar, depression, and possibly substance use problems.
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 cognitive-behavioral therapy (CBT) to reduce the presence and severity of symptoms as well as improve the distress a person experiences as a result of the tics. In particular, a form of CBT known as habit reversal training can help the child learn to identify situations that trigger their tics and methods to counter a premonitory urge. Practicing relaxation techniques can also help reduce the frequency of tics.
Parents/caregivers can share any concerns about their child’s motor or vocal tic(s) with their primary care provider. They will be asked questions about what the tic(s) look like, when they started, and how often they occur. They may be referred to a neurologist to rule out any medical conditions that could be causing or contributing to their child’s tic(s). Once a tic disorder has been diagnosed, the provider can help the family determine the best course of treatment.
A supportive family can make a world of difference to a child who is coping with a tic disorder. It’s important to remember that no one, including the child, has done anything to cause the tic. If you find yourself getting stressed or angry, take a break; try some relaxation techniques or take a walk. Breathing and meditation practices can help a child calm down and reduce or even stop their tic—not to mention providing relief for you.
Parents of a child with a tic can sometimes feel like they are trying to control the uncontrollable. While it is not a cure, many people have found that Comprehensive Behavioral Intervention for Tics (CBIT) can help provide relief. CBIT works by getting the child to become aware of an impending tic and replace the desired movement with something different, thus breaking the negative cycle between the spontaneous urge and the tic instead of reinforcing it.