Tic disorders are relatively common in youth – estimated prevalence rates range from 0.3-3% or about 1 in 50 children. However, many children and adolescents who experience chronic tics never receive a diagnosis and are, therefore, likely to not receive treatment. Recent parent-reported surveys indicate prevalence rates on the lower end of the spectrum (about 0.3%) as compared to estimates from community studies. Even when children are diagnosed, finding treatment can be difficult. One of the primary barriers to widely available treatment for tic disorders is the lack of provider knowledge and comfort in this area. In a large survey of health providers, less than half thought that diagnosing tic disorders was part of their role and only about one quarter thought that treating youth with tics was part of their role. Families have also reported feeling misunderstood and stigmatized by their healthcare providers in relation to tics. It is critical to address this barrier and increase access to effective treatments as chronic tic disorders can be associated with a lower quality of life for youth and their caregivers as well as poorer family functioning. The goal of this article is to outline key information about tic disorders and highlight PracticeWise tools that can help providers increase their knowledge and confidence in this area.
What are tics and tic disorders?
Tics are sudden, rapid, recurrent and often involuntary muscle movements or sounds. They are usually accompanied by a premonitory urge that signals a tic is coming (e.g., a tightness or tingling near the browbone before an eyebrow tic, an itching sensation in the throat before a vocal tic).
About 1 in 5 school-age children experience transient tics that come and go and may not need any intervention. Youths with tic disorders experience tics on a regular basis and for a longer duration (typically at least a year for most tic disorders) with their first tics occurring before age 18. They may experience only motor tics, only vocal tics, or a mixture of both motor and vocal tics, which is referred to as Tourette’s Disorder. Some tics are simple in that they involve one movement like shoulder shrugging or blinking and some are complex in that they involve several movements or vocalizations that occur in rapid succession. Tics tend to start when children are school age (about 4-6 years), increase in intensity in later school years (about ages 10-12 years) and are often more common in boys than in girls.
Are tics becoming more common?
Tics received a lot of attention during the pandemic as several news outlets reported a sudden rise in the onset of tics in children and adolescents, particularly females. These movements, often posted about on social media platforms, are referred to functional tic-like behaviors and are considered distinct from organic tics. It is unclear how these relate to organic tic disorders as their duration tends to be shorter and the trend was propelled by youth observing others with tics on social media.
What causes tics?
As with many mental health concerns, it is unclear what causes tics. They tend to run in families and might be more prevalent and severe depending on environmental factors like the amount of stress the youth is experiencing, their sleep habits, and their setting (e.g., some youth try to suppress tics at school and then may experience them more frequently when they get home).
What else do we know about tics?
Tic disorders often happen in concert with other mental health concerns, especially obsessive-compulsive disorder, anxiety disorders, attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Youths with tic disorders also tend to report negative social interactions related to their tics and may seek out treatment to decrease the stress and scrutiny they may experience in social situations, which can be exacerbated by other disorders that are present.
What psychological treatments work best for tic disorders?
One treatment for tic disorders that has significant research support is called habit reversal training or HRT. In HRT, youth start to increase their awareness of the premonitory urge and develop a “competing response” that counteracts or redirects their behavior when they are experiencing that urge. For example, a youth may pull back their upper lip to provide a counter movement to an eyebrow raise tic. This is different from suppression because it is not about completely preventing the tic from occurring (which can often make tics more frequent) and rather focuses on doing an incompatible behavior at that moment. Cognitive-behavioral treatment for tic disorders often has a habit reversal component and also focuses on changing the youth’s environment to make it less likely for tics to occur as well as using skills like relaxation.
How does PracticeWise support providers who are working with youth with tics and tic disorders?
For providers that are newer to working with children and adolescents experiencing tics or tic disorders, PracticeWise offers several helpful resources:
- Tics are the newest of 13 target areas to be added to the PWEBS application. The PWEBS application allows providers to easily search for the broader treatments and individual practices that work best for tics according to their clients’ characteristics and their desired strength of the evidence.
- Providers can use their results from the PWEBS application in conjunction with the Treatment Planner Process Guide to build a phased plan of evidence-based practices for youth with tics as well as effective practices to address other potentially co-occurring problems that may also be impairing for the youth (e.g., anxiety, attention problems, autism spectrum).
- Mental health providers can also reference several Practitioner Guides that give step-by-step guidance on implementing practices that work well for tics. For example, the Psychoeducation: Adapt to Problem Practitioner Guide offers a helpful framework for tailoring the discussion to relevant information about tics and explaining the rationale for treatment. In addition, the Self-Monitoring Practitioner Guide reviews how to teach youth to track their tics and become more aware of premonitory urges and the Response Prevention Practitioner Guide outlines how to develop a competing response. The Functional Analysis and Relaxation Practitioner Guides can also be beneficial to better understanding what happens before and after tics that may be contributing to their occurrence and learning how to calm the body down when experiencing stress to lower the likelihood of tics.
- The Clinical Dashboard is a simple tool that tracks client progress and treatment interventions. Providers can compare progress with practices they have used to better understand which practices tend to work best and when there might need to be a change in plan. The Clinical Dashboard is extremely flexible in terms of what is measured and can easily be tailored to tic disorders. For example, providers may choose to track youths’ scores on standardized measures like the Yale Global Tic Severity Scale or more personalized measures like the average number of tics per day or hour, the strength of a premonitory urge on a scale of 0-10, or the average number of times a competing response is practiced during the week.
Tic disorders are a common reason children and adolescents seek out treatment and there are several research-backed treatments that work well in reducing them and the negative impacts associated with them. PracticeWise supports providers treating tic disorders in youth with helpful tools that guide treatment planning, outline evidence-based practices, and measure ongoing progress. For more information about these tools, visit practicewise.com.
—
About the Author
Jennifer Regan, Ph.D., serves in multiple roles on the Services and Products Development team for PracticeWise. Learn more about Dr. Regan on the PracticeWise team page.
