Provisional Tic Disorder
Tics take the form of abnormal, repetitive, and unintentional movements or vocalizations that do not follow any rhythm or pattern.
Provisional tic disorder, previously known as transient tic disorder, is a motor disorder in which the person experiences seemingly involuntary motor and/or verbal tics for under 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, and symptoms usually begin before a child reaches puberty, with an average onset between the ages of 4 and 7. Symptoms tend to be most severe between the ages of 10 and 12 and improve as the child moves into adolescence. Tic disorders are at least twice as common in boys as in girls.
In recent years, a significant uptick of teenagers has experienced something like provisional tic disorder. Some researchers believe this is due to the consuming and sharing of videos of people with tics, particularly on the platform TikTok, and so has been dubbed by some the "TikTok Tics."
To be diagnosed with provisional tic disorder, a person must have at least one motor or vocal tic that has been present for less than a year. The behavior also must have emerged before age 18 and not be attributable to Tourette's disorder, persistent (chronic) motor or vocal tic disorder, substance use disorder, or another medical condition.
Tics can be either simple or complex. Simple motor tics are quick (milliseconds) and can include:
- Eye blinking
- Facial grimaces
- Shoulder shrugging
- Repetitive touching
- Straightening of the arms or legs
Simple vocal tics include:
- Throat clearing
Complex tics often involve a combination of simple tics, such as simultaneous eye blinking and head-turning. They tend to last for a longer period of multiple seconds. Tics can worsen when a person is anxious, excited, or exhausted. Similarly, they may diminish when a person is calm and focused on a particular activity, such as schoolwork.
In most cases, tics last only a few months before resolving on their own. Provisional tic disorder, by definition, lasts for at most a year. If tics continue past a year, then a diagnosis of persistent motor or vocal tic disorder or Tourette’s syndrome may be applicable.
With Tourette’s disorder, or Tourette’s syndrome, tics occur for more than one year and a patient must experience both multiple motor and one or more vocal tics. In contrast, those with provisional tic disorder have experienced symptoms for less than a year and symptoms may only include single vocal or motor tics, though they may experience multiple versions of each, as well. If the tics continue, provisional tic disorder may be reassessed and the patient may be diagnosed with Tourette’s syndrome or persistent motor or vocal tic disorder.
The most common tics include repeated eye-blinking, head-jerking, shoulder-shrugging, throat-clearing, shoulder-shrugging, grunting, and making inadvertent sounds, including animal or bird sounds.
Tics are common enough in children that some experts consider having a temporary tic to just be a part of growing up. The consensus estimate is that about 20 percent of children will experience an involuntary tic at some point in their childhood. Though tics can be startling and potentially embarrassing, they are often harmless and tend to fade or disappear altogether with time.
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 and a person’s environment. Tic disorders can run in families and may also be caused or worsened by environmental factors such as older paternal age and maternal smoking during pregnancy. Anxiety, stress, and exhaustion can exacerbate symptoms.
There is no evidence that tics are caused by anxiety but there is evidence that anxiety can exacerbate tic symptoms. It is common for tics to become more intense or frequent when children are anxious, nervous, or excited.
The number of parents seeking medical help for their children’s tics increased significantly during the coronavirus pandemic. It is unclear why this happened, and research is needed to explain the change, although there are several hypotheses that are being taken seriously.
One idea is that the disruption of normal routines during the pandemic facilitated the increase in the presentation of patients with tics. The additional stress that much of the population experienced during the disruption to normal life brought on by the pandemic could be another mitigating factor.
There are some very important distinctions, however, between the presentation of tics during the pandemic and those seen previously. For one, the surge in tics has come largely from a population that previously did not experience tics in high numbers: teenagers, and, specifically, teenage girls.
Typically, the onset of tics begins between ages 4 and 7, and are most pronounced in the period before puberty, at around 10 to 12. Additionally, tics have previously been diagnosed among boys at a rate two to four times as often as in girls.
The types of tics this new cohort of patients experience are often unlike tics seen previously, with some researchers calling them “bizarre in nature.” They can include explosive, tic-like motions, as well as complex motor or vocal tics previously noted by doctors. Some medical experts refer to such expressions of symptoms as “functional tic-like movements.” The term “functional” is used in medicine when there is no known cause for a symptom, and no available explanation.
Some believe these patients and their symptoms could represent a completely new tic-related condition.
Others offer a different explanation, pointing to social media and suggesting a psychogenic, or contagion effect. Views of videos on TikTok with the #tourettes hashtag doubled in just the month between January and February of 2021, and have been viewed more than 2.5 billion times. Some teenage girls reported watching these videos prior to the onset of their symptoms and others reported posting videos of, or about, their tics on TikTok or other social media platforms. Some of the teenagers reported that they had gained peer support for their condition and felt a sense of belonging from the exposure they received. This has led some to refer to the phenomenon as the “TikTok Tics.” Many researchers believe that these are not symptoms of provisional tic disorder, or an as-yet-unnamed new tic disorder, but rather a kind of fad, spread rapidly over social media, with other psychological factors at play.
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 might experience as a result of their tics. Additionally, relaxation techniques can help decrease the frequency of tics.
In most cases, a tic appears, lasts for a few months, and then goes away on its own. Some experts recommend going to a doctor only if the tic becomes a hindrance to the child’s life.
Parents or caregivers can share any concerns about their child’s motor or vocal tics with their pediatrician. They will be asked questions about what the tic or tics look like, when the symptoms started, and how often they occur. The patient may be referred to a neurologist to rule out any medical conditions that could be causing or contributing to their child’s tics. If a tic disorder is diagnosed, the provider can help the family determine the best course of treatment.
A supportive family can significantly and positively impact a child coping with a tic disorder, in part by limiting the attention focused on the symptoms. It’s important to remember that no one, including the child, has done anything to cause the tic. Providing a calm environment is an important way a parent can help. Tics sometimes wane in intensity when a child feels calmer and more relaxed. To this end, meditation or breathing practices and exercise can be useful.
Medication is not typically prescribed to patients with provisional tic disorder, as it most often resolves on its own with time.
For tics that cause a child distress, one type of behavioral therapy many people find helpful, and recommended by the American Academy of Neurology, is called Comprehensive Behavioral Intervention of Tics, or CBIT. This therapy attempts to help a child replace a tic with a less intrusive action. A child might learn to breathe deeply when they feel the urge to engage in a tic, for instance. The goal is to weaken the connection between the urge to engage in a tic and the reward gained from it. When the therapy works, the child learns that there are ways to soothe their urge other than the disruptive tic.