UNC Clinic for Tourette Syndrome and Tic Disorders
What 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 25% of children will experience at least one tic at some point during childhood. Somewhere between 1-5% of 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:
Approximately 50-70% of children with tics will also have one or more mental health disorders including attention deficit-hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and/or anxiety. Many children actually have some combination of all three. 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 incredibly 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.
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.
As part of our comprehensive clinic for tics and Tourette syndrome, our goal at UNC is to offer CBIT therapy (See “How are tics and related disorders treated?” above for a description). However, given the ongoing COVID crisis, all formal training sessions for CBIT by the Tourette Association of America have been put on hold. Once training resumes, our neurology nurse practitioner, Ms. Colaianni, will be formally trained in CBIT in order to offer it to our patients with tics.
Given that psychiatric conditions such as ADHD, OCD, anxiety, and depression 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 including Dr. Bedford and the Child Psychiatry Neurodevelopmental clinic as well as Dr. Duquette (neuropsychology). For families who would prefer to address any psychiatric needs closer to home, our neurology social worker, Ms. Draffin, is available to help coordinate care.
Given the ongoing crisis with COVID-19, the UNC Clinic for Tourette Syndrome and Tic Disorders is now seeing patients exclusively via telehealth. Follow up visits with neurology, psychology, and psychiatry can also be made via telehealth. A telehealth visit will be by video communication over a HIPAA compliant service.
Meet our team:
Steven Trau, MD
Dr. Trau graduated from Emory University Medical School 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.
Christine Gabriella Colaianni, CPNP
Gabby Colaianni is a pediatric nurse practitioner in the Division of Child Neurology. She sees patients with a variety of neurological concerns, and is particularly interested in comprehensive behavioral intervention for tics (CBIT). In the Tourette clinic, she will provide CBIT to patients as well as manage pharmacological treatments for tics and Tourette syndrome in coordination with Dr. Trau. Before coming to UNC, Gabby worked as an inpatient nurse at Duke Children’s for nearly eight years. She has a holistic approach to care and enjoys developing long-term relationships with her patients and families, as well as empowering children and adolescents to live their best lives.
James E. Bedford, MD
James E. Bedford, MD, is a child, adolescent, and adult psychiatrist who after training at the University of North Carolina and the University of California–Davis MIND Institute returned to Chapel Hill in 2016 to join the faculty of the UNC Department of Psychiatry. As co-director of the Neurodevelopmental Psychiatry Program, he specializes in high-quality psychiatric assessment and treatment of people with developmental disabilities and other neuropsychiatric concerns including Tourette syndrome.
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.
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 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.
Appointments and Clinic Location
Our clinic is located at:
UNC Hospitals Children’s Specialty Services at Raleigh
2801 Blue Ridge Road
Raleigh, NC 27607