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Childrens HospitalWhat are tics?

Tics are involuntary movements or noises that some children make. Tics may be “simple” or “complex” depending on what specific movements or noises are made.

“Simple” motor tics are movements that only involve one muscle group. They commonly include eye movements (blinking, darting), facial movements (nose or mouth movements), or simple shoulder or arm movements. “Complex” motor tics involve multiple muscle groups and may include head or neck jerking, complicated arm or leg movements, repetitive touching, jumping, pacing, or copying other peoples’ movements.

“Simple” vocal tics commonly include throat clearing, sniffling or coughing (frequently confused with seasonal allergies), grunting, and other noises. “Complex” vocal tics include repetitive use of phrases and words.

What are tic disorders?

Children with tics fall into multiple diagnostic categories. These include:

  • Provisional (transient) tic disorder: motor and/or vocal tics that have been going on for less than one year
  • Chronic motor or vocal tic disorder: motor OR vocal tics that have been going on for more than one year

What is Tourette syndrome?

The diagnosis of Tourette syndrome is made when the following criteria are met:

  • The child has vocal AND motor tics
  • The tics have been going on for more than one year
  • The onset of tics occurred before the age of 18 years

Tourette syndrome gets a bad reputation in the media and popular culture which commonly depict it only as exceptionally frequent and uncontrollable swearing and cursing. This type of tic is known as coprolalia, and it occurs in less than 10% of children with Tourette syndrome.

Who gets tics and tic disorders?

Tics are exceptionally common. Approximately 20-25% of children will experience at least one tic at some point during childhood. Approximately 1% of all children will go on to have tics that last for more than one year (chronic motor/vocal tic disorder or Tourette syndrome).

Why do people get tics?

Tics are thought to have a genetic basis based on the fact that many patients with tics have a family history of tics. However, no single gene has been found to cause tics. There is approximately a 50% chance that the child of a parent with tics will go on to have tics as well.

Conditions that commonly occur along with tics:

Eighty-six percent of children with tics will also have one or more mental health disorders with attention deficit-hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and anxiety being the most common. In some children, the symptoms of these co-existing conditions may be very mild; however, in some children, these symptoms may be even more severe than the tics themselves. Addressing these psychiatric symptoms for all illnesses is important in comprehensive care of tic disorders.

How are tics and related disorders treated?

For many children, tics are very mild and may not warrant treatment. However, tics can sometimes be bothersome and negatively affect a child in many different ways including issues with self-esteem, bullying, and pain in rare cases. In these cases, treatment for tics may be warranted.

There are both pharmacologic (medication) and non-pharmacologic treatments available for tics. The treatment of choice is a type of behavioral therapy called Comprehensive Behavioral Intervention for Tics (CBIT). CBIT is a specialized type of therapy designed to teach a child to recognize an “urge” to tic and then channel that urge into a non-tic activity. Approximately 50-70% of children who complete a course of CBIT go on to have long-term improvement in their tic control.

Medication options also exist to help manage tics. There is no medication that is a “cure” for tics, but they can help improve both the frequency and/or severity of a child’s tics. Multiple medications exist to help tics.

In the News

Read this informative UNC Health Talk story for more information: Tics Are Uncontrollable—and Completely Normal >

How We Can Help:

At UNC, our goal is to individualize the care approach to your child. During your first visit, your child will undergo a thorough evaluation by our child neurologist, Dr. Trau, who will screen your child for both tics and tic-related disorders. A primary goal is to determine how your child’s tics (and potential co-existing psychiatric disorders) are affecting him or her. Since no two children are identical, an individualized plan will be made based on your child’s unique needs. Potential plans may include monitoring the tics (no therapy recommended), CBIT, pharmacological intervention, and addressing any co-existing conditions.

We are happy to announce that the UNC Clinic for Tourette Syndrome and Tic Disorders will be able to offer CBIT starting in May 2022.

Given that other conditions such as ADHD, OCD, anxiety, depression and learning difficulties are common in children with tics, addressing these conditions may be warranted. At UNC, we stand ready with a dedicated group of professionals who specialize in these conditions. Psychological treatments (counseling and cognitive behavioral therapy) are addressed in the clinic overseen by Dr. Jennifer Youngstrom, PhD, and consideration for psychiatric medical management is available in our child psychiatry department. To help evaluate the various learning conditions that frequently occur in children with tic disorders, neuropsychiatric testing is offered by Dr. Peter Duquette, PhD. For patients who would prefer to address psychiatric needs in other ways or closer to home, our clinical social worker, Alyssa Draffin, LCSW, is available to help.

Meet our team:

Steven Trau, MD

Steven Trau, MD

Dr. Trau graduated from Emory University School of Medicine in 2012. After completing a general pediatrics residency, he completed his child neurology residency at Duke University and is board certified in Neurology with Special Qualification in Child Neurology. During his residency, Dr. Trau developed a special interest in tic disorders and Tourette syndrome. He has specialized his practice as an attending physician at UNC to see patients with tics and Tourette syndrome as well as develop and direct the UNC Center for Tourette Syndrome and Tic Disorders.

Gabby Colaianni, CPNP

Christine Gabriella Colaianni, CPNP

Gabby Colaianni is a pediatric nurse practitioner in the Division of Child Neurology. While she sees patients with a whole spectrum of neurological disorders, she has a specific interest in patients with Tourette syndrome and tic disorders. In the Clinic, she specializes in seeing children in follow up care for both medical management and to track their progress for various co-occurring conditions.

Jen Kogos Youngstrom, PhD

Jen Kogos Youngstrom, PhD

Dr. Youngstrom is a clinical professor, director of clinic services and director of assessment in the UNC Department of Psychology and Neuroscience. Serving as a research associate professor in psychiatry at UNC-Chapel Hill, she is also a licensed psychologist in North Carolina. She conducts and supervises evidence-based assessment practices as well as cognitive behavioral therapy and family systems work, and she is an investigator on assessment and therapy effectiveness grants. In addition to supervising graduate students in the UNC Child and Family Clinic for assessment and therapy, she teaches and conducts research on transporting treatments into the community.

Alyssa Draffin, LCSW

Alyssa Draffin, LCSW

Alyssa Draffin is a licensed clinical social worker specializing in care management to pediatric neurology patients. She has been a medical social worker for nearly a decade and holds certifications in trauma, infectious disease and clinical care management. In the clinic, Alyssa works to address barriers to care by providing resource coordination, psycho-education as well as crisis intervention to individuals experiencing mental health emergencies. In previous roles, Alyssa has facilitated group and individual psychotherapy as well as harm reduction techniques for people living with chronic illness.

Peter Duquette, PhD

Peter Duquette, PhD

Dr. Duquette is a clinical neuropsychologist who provides assessment and consultation services to children, adolescents, and young adults. By better understanding the impact of tics and related psychiatric conditions on daily functioning, Dr. Duquette helps develop an individualized treatment plan that supports patients and families at home, school, and in the community. Dr. Duquette also provides short-term psychotherapeutic support to address symptoms of anxiety, obsessive-compulsive tendencies, and attention deficits via in-person and telemedicine visits.

Appointments and Clinic Location

To make an appointment, please have your primary care provider send us a referral through UNC Carelink.

Our clinics are located at:

UNC Hospitals Children’s Specialty Services at Raleigh
2801 Blue Ridge Road
Raleigh, NC 27607
Phone: (984) 974-0500
Fax: (984) 974-0506
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UNC Hospitals Child Neurology Clinic at Carolina Pointe II, Chapel Hill
6011 Farrington Road, Suite 101
Chapel Hill, NC 27517
Phone: (984) 974-7337
Fax: (984) 974-5437
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