UNC Clinic for Tourette Syndrome and Tic Disorders

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.

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
• 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.

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).

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.

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.

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. Greater than 50% 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.

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. For children aging out of pediatric care, Dr. Morita has recently joined to clinic as our adult neurologist.

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 supervised by Dr. Bedford. To help evaluate the various learning conditions that frequently occur in children with tic disorders, neuropsychiatric testing is offered through the Department of Physical Medicine and Rehabilitation. For patients who would prefer to address their needs in other ways or closer to home, Beth Vazquez, LCSW can help with access to and coordination of care.