The eye blinks repeatedly. The shoulder jerks. A sound escapes—a grunt, a sniff, a word. These aren’t habits or attention-seeking behaviors. They’re tics—involuntary movements and sounds that the brain generates whether the person wants them or not.
Tic disorders, including Tourette syndrome, are widely misunderstood. The reality is far different from stereotypes, and understanding helps both those with tics and everyone around them.
What Are Tics?
The Simple Explanation
Tics are sudden, rapid, recurrent, non-rhythmic movements or vocalizations. They’re involuntary—the person doesn’t choose to make them, though they may be able to suppress them briefly (at a cost). Tics are generated by the brain, not by choice or habit.
Think of it like this: You know the urge to sneeze? You might be able to hold it back briefly, but the urge builds and eventually you have to let it out. Tics are similar—there’s often a building sensation (a premonitory urge) that’s relieved by performing the tic. Holding it in is possible but exhausting, and the tic usually happens eventually.
Types of Tics
Motor tics: Movements
– Simple: Eye blinking, shoulder shrugging, facial grimacing, head jerking
– Complex: Touching objects, jumping, making obscene gestures (rare)
Vocal (phonic) tics: Sounds
– Simple: Throat clearing, sniffing, grunting, coughing
– Complex: Words, phrases, echolalia (repeating others), coprolalia (obscene words—rare)
Tic Disorders
Provisional Tic Disorder
What it is:
– Motor and/or vocal tics
– Present for less than one year
– Many children have transient tics
– Often resolves on its own
Persistent (Chronic) Tic Disorder
What it is:
– Motor OR vocal tics (not both)
– Present for more than one year
– Began before age 18
– May persist into adulthood
Tourette Syndrome
What it is:
– Both motor AND vocal tics (not necessarily at same time)
– Present for more than one year
– Began before age 18
– The most well-known tic disorder
Understanding Tourette Syndrome
The Reality vs. the Stereotype
The stereotype:
– Everyone with Tourette’s yells obscenities
– It’s a rare, dramatic condition
– People with Tourette’s can’t function
The reality:
– Only about 10-15% have coprolalia (involuntary obscene words)
– It’s relatively common (about 1 in 160 children)
– Most people with Tourette’s live normal lives
– Many are highly successful
The Spectrum
Tourette’s ranges widely:
– Mild: Hardly noticeable tics
– Moderate: Noticeable but manageable
– Severe: Significantly impairing (less common)
Most cases are mild to moderate.
The Course
How it typically progresses:
– Onset usually between ages 5-7
– Tics tend to peak around ages 10-12
– Often improve significantly in adolescence
– Many adults have minimal or no tics
– Some continue to have tics into adulthood
The Experience of Having Tics
The Premonitory Urge
Most people with tics describe:
– A building sensation before the tic
– Like an itch that must be scratched
– Tic provides temporary relief
– Urge builds again
Suppression
Can tics be controlled?
– Briefly, with effort
– Takes significant mental energy
– Often leads to “tic rebound” (more tics later)
– Like holding your breath—can’t do it forever
The Exhaustion
What people don’t realize:
– Managing tics is exhausting
– Suppressing in public means release in private
– Constant background effort
– Energy drain
The Variability
Tics change:
– Wax and wane (better and worse periods)
– Different tics over time
– Affected by stress, fatigue, excitement
– May be worse at home (safe to release)
What Causes Tic Disorders?
Brain Differences
Neurological basis:
– Involves basal ganglia and related circuits
– Differences in dopamine systems
– Not psychological in origin
– Brain-based condition
Genetic Factors
Strong genetic component:
– Runs in families
– Complex inheritance
– Not all family members affected equally
Environmental Factors
May influence:
– Prenatal factors
– Stress can worsen tics
– Not caused by parenting or trauma
– But environment affects severity
Co-occurring Conditions
Very Common with Tic Disorders
ADHD:
– 50-60% of people with Tourette’s have ADHD
– Often more impairing than tics themselves
OCD:
– 30-40% have OCD or OCD-like symptoms
– May be related genetically
Anxiety:
– Very common
– Often about having tics in public
Learning disorders:
– More common than in general population
Important to Address
Treating co-occurring conditions:
– Often improves quality of life more than treating tics
– Comprehensive evaluation important
When Treatment Is Needed
Not Everyone Needs Treatment
Consider treatment if tics:
– Cause pain or injury
– Interfere significantly with functioning
– Cause significant social problems
– Bother the person (not just others)
Mild tics may not need treatment.
Behavioral Treatment
CBIT (Comprehensive Behavioral Intervention for Tics):
– Most evidence-based behavioral approach
– Includes habit reversal training
– Learns to recognize premonitory urge
– Performs competing response
– Very effective for many people
Habit Reversal Training:
– Core component of CBIT
– Awareness training
– Competing response training
– Can significantly reduce tics
Medication
When used:
– Moderate to severe tics
– Significant impairment
– When behavioral treatment isn’t enough
Options include:
– Alpha-2 agonists (clonidine, guanfacine)
– Antipsychotics (various, used carefully)
– Other medications
– All have potential side effects
The Goal
Treatment aims to:
– Reduce tics to manageable level
– Improve functioning
– Not necessarily eliminate tics completely
– Help person live their life
For Parents
When Your Child Has Tics
Initial response:
– Don’t call attention to tics
– Don’t tell them to stop
– Stay calm
– Many childhood tics resolve
– Watch and wait initially
Seeking Help
Get evaluation if:
– Tics are frequent or severe
– Lasting more than a year
– Causing functional problems
– Child is distressed
– You’re unsure
Supporting Your Child
What helps:
– Educate yourself and your child
– Inform teachers (with child’s consent)
– Address bullying
– Treat co-occurring conditions
– Focus on strengths
– Reduce unnecessary stress
School Accommodations
May be helpful:
– Breaks to release tics
– Alternative testing environment
– Understanding from staff
– Anti-bullying protection
– 504 plan or IEP if needed
Reducing Stigma
Common Misconceptions
Not true:
– Tics are controllable/done for attention
– Everyone with Tourette’s swears
– People with tics are less intelligent
– Tics are caused by bad parenting
– It’s a psychological problem
How to Respond to Tics
If you notice someone’s tics:
– Don’t stare
– Don’t comment
– Don’t imitate
– Don’t ask them to stop
– Treat them normally
– Ask how you can help (if appropriate)
Living Well with Tics
Coping Strategies
Things that help:
– Education about the condition
– Stress management
– Adequate sleep
– Support from family and friends
– Connecting with others who have tics
– Focusing on strengths and interests
Success Stories
Many people with Tourette’s:
– Have successful careers
– Have families
– Achieve their goals
– Contribute to their communities
– Live full lives
The Message
For anyone with tics:
– You are not your tics
– You have the same potential as anyone
– Help is available if needed
– Many find tics become less prominent with age
– You can live the life you want
Moving Forward
Tic disorders involve involuntary movements and sounds that the person cannot fully control. While tics can be challenging—especially during the peak years—most people with tic disorders, including Tourette syndrome, live full and successful lives.
Understanding replaces stigma. Education replaces fear. And for those who need it, effective treatments exist that can significantly reduce tics and improve quality of life.
If you or your child has tics, know that you’re not alone, help is available, and tics don’t define anyone’s future.
This article is for educational purposes only and is not a substitute for professional evaluation or treatment. If you’re concerned about tics, please reach out to a healthcare provider, ideally a neurologist or psychologist experienced with tic disorders. Arise Counseling Services offers compassionate support for individuals and families throughout Pennsylvania.
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