Tics Are for Kids
Childhood tics often alarm parents, but for many they are benign and transient.
Posted May 09, 2015
Tics. We all know children and adults who have them, though unless it pertains to us, we tend not to pay too much attention. Nose wrinkling, shoulder shrugging, eyebrow-raising, sniffing, throat-clearing, the list goes on; yet even though there are a variety of tics, there seem (oddly) to be actual limits to the repertoire.
The vast majority of tics occur near the head and shoulders and in some way partake of the five senses: the eyes blink and roll; the eyebrows elevate; the nose wrinkles and sniffs; the hands touch, tap, or align; the lips purse and twitch; the tongue protrudes or licks, and the mouth makes all manner of sounds that the ears can hear.
What are these strange phenomena? At best, they are nuisances, at worst they can be stigmatizing and for a much smaller number of young people and adults, even disabling. Unless you have a child with tics or you are a teacher or therapist, tics typically float under the radar. “Oh yeah, I guess he or she does do those funny things, but come to think of it I never really noticed until you mentioned it.”
From a neuropsychiatric point of view, tics represent motor disinhibition, a way that the more primitive part of the brain suddenly breaks through and hijacks the more demure higher cortical functions. Though many people with tics have other co-morbidities or other conditions that are often seen in tandem with tics such as ADD or OCD, tics are all about wayward impulses and actions.
Tics are, in fact, surprisingly common, at least transiently occurring in more than 15 percent of children at some point during childhood. They are more common in boys than in girls. There is a genetic component to tics, tending to run in families. Tics by their nature characteristically wax and wane and do not necessarily persist continuously. They come in bouts and flurries and they morph over time. A child who is shrugging her shoulders may stop doing so then suddenly start rolling her eyes. A parent may think a child’s tics are gone, only to see them reincarnated in some other form months afterward. The waxing and waning are characteristic, and therefore physicians cannot diagnose a tic disorder until a child’s tics have ebbed and flowed for at least a year.
Are they involuntary? Some say they are un-voluntary, in that they can be momentarily suppressed, like not scratching an itch or not coughing when there is a tickle in the throat. Eventually, they need to be expressed, as the consummation of a peremptory urge, a motor arc requires completion. There is a sensation of not feeling quite right until something is done to correct it: thus the eye blink provides a little visual clarity, the shoulder shrug relieves tension, tapping achieves a feeling of symmetry, knuckle-cracking a physical release and so on. Tics provide immediate relief for a vexing physical sensation.
Many parents are very alarmed when their child’s tics start to declare themselves. The onset may be sudden and dramatic or insidious and confusing. Tics, once they set in, have an uncanny and unbidden flavor. A child may even look as if he or she has a serious neurological affliction. And though tics are certainly a neurologically mediated phenomenon, they do not tend to be particularly serious, and unless they are interfering with a child’s everyday life, they do not merit a great deal in the way of intervention.
Seasoned psychologists, psychiatrists, and neurologists are not unduly concerned unless the tic is interfering with a child’s social and emotional functioning. In most instances, tics will eventually lessen and recede and in almost three-quarters of the cases, will be gone by the time a child is ready for college. Nonetheless, they remain mysterious and complex, perhaps they are a link between the psychological and the physical.
Interestingly, clinicians who work with children with tics may often not even see the tics in question when the child comes for a consultation. A rule of thumb is to follow the child to the waiting area, where one will see a flurry of tics, finally being released after they had been effortfully suppressed during the course of the visit.
The majority of tics fly under the radar, and often do not even get noticed by teachers, parents, relatives, and friends. Many tics tend to be mild and transient, with a now you see it, now you don’t quality. If a child develops a tic during the elementary years, parents need not rush off to the pediatrician or neurologist. Most people who work with children have seen tics come and go with little collateral damage. If you know a child who has any of the symptoms described above, there is ample reason to feel confident that everything will turn out fine.
Unless or if development is derailed by the tic, a relaxed approach is merited. And further, the more attention that is paid to a tic, the greater the likelihood that such focus will exacerbate not ameliorate it. Asking a child to stop or expecting that a child can stop is off-base and can make things worse, not better. And attributing deep meaning to a tic or assuming that it indicates a child is under severe stress is simply incorrect. It might, but then again, it might not.
Tics can occur under a variety of circumstances including stress, but there are many others: boredom, excitement, inactivity, concentration, being over-heated, illnesses. There is no smoking gun. Parents are often relieved to learn that there is no need to panic. The first strategy is simply to calm down, sit back, observe, and take a wait-and-see approach. There is little downside to that attitude because it removes the added factor of parental anxiety.