Tics, Nervous Habits and Tourette’s Disorder
Tics are sudden, rapid, repetitive movements that often begin in childhood. Tics are frequently referred to as “nervous habits” and may involve motor movements such as eye blinking, squinting, shoulder shrugging, or vocalizations that include repeating a sound, grunting, coughing or sniffing. These behaviors are common in childhood, are usually short lived, and often change or occur intermittently. A child may be eye blinking for several weeks and then switch to sniffing or coughing. This type of tic is called a transient tic.
Chronic tics differ from transient tics in their persistence and their unchanging nature. Both transient and chronic tics are heightened by stress, excitement, or fatigue. Tic disorders occur significantly more frequently in males.
Tourette’s Disorder occurs when there are multiple motor and one or more vocal tics that have been present at some time but not necessarily occurring concurrently. In Tourette’s Disorder, the tics may wax and wane in frequency but have persisted for more than a year since the first onset. To obtain a diagnosis of Tourette’s, the disorder must have had an onset before the age of 18.
Many children may function well in school and with peers in spite of their tics. If a child is exhibiting no other problems, parents may need to wait for the tics to go away. Others may find this troublesome to do because of the repercussions that it has on the child. For some children, having tics can be a source of embarrassment or shame or may intrude on the personal space of others. Some vocal tics can make it difficult for other students to listen. If tics become persistent or interfere with day-to-day functioning, professional help can serve to avoid lasting damage to the child’s self-esteem or social development. It is important that children not be punished for tic behavior since tics are involuntary and the child cannot stop them. However, with family support, an attitude of acceptance, and professional intervention, the intensity of the tics and the resulting stress on the family can be greatly reduced.
The decision to treat or not to treat a tic disorder will depend upon what form the tic takes and the extent to which the tic behaviors are interfering with the child’s day to day functioning. To determine the need for treatment, a proper diagnosis is essential and begins with a medical exam to rule out neurological or other medical issues.
At Silber Psychological Services, we believe that care must be taken to first rule out other existing problems such as ADHD, OCD, or mood disorders. If other problems are discovered, deciding what condition to treat first needs thoughtful evaluation to avoid making the tic behaviors worse. Interfacing with other professionals such as neurologists, psychiatrists, family doctors, and school personnel is an essential component of a thorough evaluation. Medication may be prescribed depending on the severity and chronicity of the tic behavior symptoms.
A primary behavioral intervention for the treatment of mild or transient tics is called Habit Reversal. Habit Reversal is designed to increase a child’s awareness of when the tic behavior is happening and teach a “competing response”. The child engages in this competing response until the tic behavior lessens. Parents are vital in helping their child during treatment.
While psychotherapy will not eliminate tics, it can be beneficial in teaching children how to deal with the “psychological fallout”. That is, the inability to control one’s body movements or sounds can be a significant source of anxiety, guilt, anger, and/or depression. Some children may withdraw, become aggressive, or become extremely perfectionistic in response to their frustration. At Silber Psychological Services, we can help when additional problems develop.
Dealing with a child with a tic disorder can be stressful. Some parents may find it difficult to accept their children’s symptoms, while others worry about the genetic component, experience guilt, or try to overcompensate for the problems. Family therapy may be useful to address these issues. Learning how to be supportive without being overprotective can be quite useful. It is equally important to explore ways of modifying the environment at home or school to reduce stressors. Knowing what activities to avoid to reduce stress and “excitement” levels is also important. Becoming more educated about tic disorders can make a significant difference in a family’s ability to cope with a child with a tic disorder.
At Silber Psychological Services, we look forward to helping parents and the children affected by tic disorders to reach a comfortable degree of relief and to develop successful strategies for mastering the problems.
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