What are the symptoms of a Tic Disorder?

Tics are repetitive, rapid movements or sounds. Most are called “simple” tics, meaning tics that are one movement, like a squint or a quick head nod. Some are called “complex” tics, meaning they are larger combinations of movements or sounds, like reaching up and shaking your head, or a blink followed by throat clearing.

Motor Tics

Vocal Tics

  • Shoulder shrugging
  • Eye blinking
  • Lip biting
  • Facial grimacing
  • Clearing the throat
  • Humming, sniffing, snorting, or squealing
  • Repeating words

There are multiple types of Tic Disorders, each with slightly differing symptoms:

  • Provisional Tic Disorder involves single or multiple motor and/or vocal tics that have been present for less than one year
  • Persistent (Chronic) Motor or Vocal Tic Disorder involves single or multiple motor or vocal tics, but not both, that have been present for more than one year
  • Tourette’s Disorder involves both multiple motor and one or more vocal tics that have been present for more than one year

A child’s or adolescent’s tics may wax and wane over time, but the onset of the tics must occur before 18 years of age. Additionally, the tics must not be secondary to the effects of a substance or to a medical condition, in order for Tic Disorder to be diagnosed.

How are Tic Disorders diagnosed?

A medical professional will diagnose a child or teen with a Tic Disorder after determining whether the motor movements or vocalizations they are experiencing meet the diagnostic criteria, and after determining how long the child’s or teen’s tics have persisted.

The child-adolescent psychiatrist may interview and/or assess both the child or teen and a caregiver in order to determine the specific nature of the child’s or teen’s tics. The practitioner will also seek to determine that the child’s or teen’s tics are not related to something unforeseen.

Tic Disorder Facts

Worldwide frequency of the condition

Tics are present in about 0.03% to 3% of the world's population, and Tourette’s Disorder is present in about 0.03 to 0.77%.

Burden of the condition in Greece

Tic Disorders accounts for less than 0.03% for all disability adjusted life years (DALYs) lost to health conditions in Greece for 5- to 14-year-old children and adolescents.

Gender ratio

Male-female comparative data for Tics and Tourette’s Disorder varies, ranging from 2:1 to 4:1.

Peak age of onset

Tics tend to emerge in childhood, between 4 and 6 years of age, and peak between 10 and 12 years of age. The peak age of onset for neurodevelopmental disorders, in general, is 5.5 years of age.

Proportion of the condition that emerges before age 18

Tics that are not secondary to a substance or medical illness must emerge before 18 years of age. As such, the proportion that emerges before age 18 years is 100%. This means that 100% of individuals with a Tic Disorder will have been diagnosed by the time they are 18 years old. By contrast, the proportion of neurodevelopmental disorders in general, including Tic Disorders, that ​​​​​​emerges before 18 years of age is 83.2%.

What are the associated factors for Tic Disorders?

Some common factors associated with Tic Disorders are:

  • Genetic and familial factors. Most likely a combination of multiple genes that interact in a complex way with multiple environmental factors.
  • Developmental factors. These include premature birth and low birth weight.
  • Complications during pregnancy. These include nicotine or caffeine consumption during pregnancy.
  • Complications during childbirth. These include hypoxia.
  • Environmental factors. Excitement, anxiety, or fatigue may exacerbate tics
  • Infections and immune response. Pediatric acute-onset neuropsychiatric syndrome (PANS) results from a bacterial or viral infection, triggering an autoimmune response in basal ganglia of certain susceptible children. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) is a specific subtype of PANS resulting specifically from a streptococcal infection. The symptoms of PANS and PANDAS are acute-onset tics, OCD symptoms, and mood lability.

What other disorders co-occur with Tic Disorder?

Even though each child and adolescent are different, Tic Disorders might commonly co-occur with other mental health disorders, including ADHD and OCD.

How are Tic Disorders treated?

Tic Disorders are usually treated with psychotherapy or a combination of psychotherapy and medication.

Psychotherapy for Tic Disorder typically involves cognitive-behavioral therapy (CBT) with a component called habit reversal training (HRT). If a child gets a premonitory urge before the oncoming tic, he’s taught to recognize it and identify the situations that may trigger it. The child and therapist develop a “competing” response - an action the child performs when he feels the urge - that is incompatible with the tic, and less noticeable to others. For example, a child whose tic involves sniffing his nose may do a breathing exercise instead. Kids may also be taught relaxation techniques to decrease the frequency of the tics. Another component of CBT, exposure and response prevention (ERP), which helps kids to prevent tics from occurring by learning about and resisting the feelings or sensations they feel before their tics occur, also has some evidence showing its efficacy. When kids resist tics for a long time, they learn to tolerate unpleasant warning feelings (i.e., habituation).

Children and adolescents with Tic Disorders tend to respond well to certain medications, especially when symptoms are moderate to severe. The medication most commonly used is a medication called aripiprazole. While other types of medications have been studied as well (such as risperidone and tiapride), evidence of their efficacy for kids is limited. When symptoms co-exist with Attention Deficit-Hyperactivity Disorder, medications such as clonidine and guanfacine can also be considered. Medications can have side effects, but they are safe for kids to use with proper monitoring by their doctor and close supervision from their caregivers. A child or adolescent who is taking one of these medications should see their doctor regularly, especially if their dosage has recently changed.

The combination of CBT and medication can also be considered.

Where to find more information

If you need more information on tics and reasons for concerns, you can also go to "Ritualistic behaviors and repetitive movements" on our website.

To learn more about the technical work conducted to develop this guide, please consult our reference list:

References

Clinical description, symptoms, and diagnostic information

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Child Mind Institute. (2021, September 7). Quick guide to Tourette’s Disorder. https://childmind.org/guide/quick-guide-to-tourettes-disorder/
  • Child Mind Institute. (2022, December 20). Quick guide to chronic motor or vocal tic disorder. https://childmind.org/guide/what-is-chronic-motor-or-vocal-tic-disorder/
  • Jacobson, R. (2022, December 20). Tics and Tourette’s: What to do (and not do) if your child develops a tic. https://childmind.org/article/tics-and-tourettes/
  • World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 8A05.00 Tourette Syndrome. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f119340957
  • World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 8A05.01 Chronic Motor Tic Disorder. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1649340159
  • World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 8A05.02 Chronic Phonic Tic Disorder. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f169010223

Facts

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, Available from http:// vizhub.healthdata.org/gbd-compare. (Accessed 11/15/2022)
  • Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. https://doi.org/10.1038/mp.2013.50
  • Knight, T., Steeves, T., Day, L., Lowerison, M., Jette, N., & Pringsheim, T. (2012). Prevalence of Tic Disorders: A Systematic Review and Meta-Analysis. Pediatric Neurology, 47(2), 77–90. https://doi.org/10.1016/j.pediatrneurol.2012.05.002
  • Scharf, J. M., Miller, L. L., Gauvin, C. A., Alabiso, J., Mathews, C. A., & Ben-Shlomo, Y. (2015). Population prevalence of Tourette syndrome: A systematic review and meta-analysis: Meta-Analysis of TS Prevalence. Movement Disorders, 30(2), 221–228. https://doi.org/10.1002/mds.26089
  • Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. https://doi.org/10.1038/s41380-021-01161-7
  • Ueda, K., & Black, K. J. (2021). A Comprehensive Review of Tic Disorders in Children. Journal of Clinical Medicine, 10(11), 2479. https://doi.org/10.3390/jcm10112479

Associated factors

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Chao, T.-K., Hu, J., & Pringsheim, T. (2014). Prenatal risk factors for Tourette Syndrome: A systematic review. BMC Pregnancy and Childbirth, 14(1), 53. https://doi.org/10.1186/1471-2393-14-53
  • Child Mind Institute. (2023, February 23). Complete guide to PANS and PANDAS. Complete Guide to PANS and PANDAS. https://childmind.org/guide/parents-guide-to-pans-and-pandas/
  • Girgis, J., & Pringsheim, T. (2020). Prenatal Risk Factors for Tourette Syndrome: A Systematic Review Update. Current Developmental Disorders Reports, 7(4), 258–269. https://doi.org/10.1007/s40474-020-00217-7
  • Jiang, J., Chen, M., Huang, H., & Chen, Y. (2022). The Aetiology of Tourette Syndrome and Chronic Tic Disorder in Children and Adolescents: A Comprehensive Systematic Review of Case-Control Studies. Brain Sciences, 12(9), 1202. https://doi.org/10.3390/brainsci12091202
  • Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. https://doi.org/10.1038/mp.2013.50
  • Ueda, K., & Black, K. J. (2021). A Comprehensive Review of Tic Disorders in Children. Journal of Clinical Medicine, 10(11), 2479. https://doi.org/10.3390/jcm10112479

Co-occurring disorders

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Hirschtritt, M. E., Lee, P. C., Pauls, D. L., Dion, Y., Grados, M. A., Illmann, C., King, R. A., Sandor, P., McMahon, W. M., Lyon, G. J., Cath, D. C., Kurlan, R., Robertson, M. M., Osiecki, L., Scharf, J. M., & Mathews, C. A. (2015). Lifetime Prevalence, Age of Risk, and Genetic Relationships of Comorbid Psychiatric Disorders in Tourette Syndrome. JAMA Psychiatry, 72(4), 325. https://doi.org/10.1001/jamapsychiatry.2014.2650
  • Kloft, L., Steinel, T., & Kathmann, N. (2018). Systematic review of co-occurring OCD and TD: Evidence for a tic-related OCD subtype? Neuroscience & Biobehavioral Reviews, 95, 280–314. https://doi.org/10.1016/j.neubiorev.2018.09.021
  • Rothenberger, A., & Heinrich, H. (2022). Co-Occurrence of Tic Disorders and Attention-Deficit/Hyperactivity Disorder—Does It Reflect a Common Neurobiological Background? Biomedicines, 10(11), 2950. https://doi.org/10.3390/biomedicines10112950

Interventions

  • Andrén, P., Jakubovski, E., Murphy, T. L., Woitecki, K., Tarnok, Z., Zimmerman-Brenner, S., van de Griendt, J., Debes, N. M., Viefhaus, P., Robinson, S., Roessner, V., Ganos, C., Szejko, N., Müller-Vahl, K. R., Cath, D., Hartmann, A., & Verdellen, C. (2022). European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part II: Psychological interventions. European Child & Adolescent Psychiatry, 31(3), 403–423. https://doi.org/10.1007/s00787-021-01845-z
  • Besag, F. M., Vasey, M. J., Lao, K. S., Chowdhury, U., & Stern, J. S. (2021). Pharmacological treatment for Tourette syndrome in children and adults: What is the quality of the evidence? A systematic review. Journal of Psychopharmacology, 35(9), 1037–1061. https://doi.org/10.1177/02698811211032445
  • Farhat, L. C., Behling, E., Landeros-Weisenberger, A., Levine, J. L. S., Macul Ferreira de Barros, P., Wang, Z., & Bloch, M. H. (2022). Comparative efficacy, tolerability, and acceptability of pharmacological interventions for the treatment of children, adolescents, and young adults with Tourette’s syndrome: A systematic review and network meta-analysis. The Lancet Child & Adolescent Health, S2352464222003169. https://doi.org/10.1016/S2352-4642(22)00316-9
  • Pringsheim, T., Holler-Managan, Y., Okun, M. S., Jankovic, J., Piacentini, J., Cavanna, A. E., Martino, D., Müller-Vahl, K., Woods, D. W., Robinson, M., Jarvie, E., Roessner, V., & Oskoui, M. (2019). Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology, 92(19), 907–915. https://doi.org/10.1212/WNL.0000000000007467
  • Pringsheim, T. (2017). Tic Severity and Treatment in Children: The Effect of Comorbid Attention Deficit Hyperactivity Disorder and Obsessive Compulsive Behaviors. Child Psychiatry & Human Development, 48(6), 960–966. https://doi.org/10.1007/s10578-017-0718-z
  • Roessner, V., Eichele, H., Stern, J. S., Skov, L., Rizzo, R., Debes, N. M., Nagy, P., Cavanna, A. E., Termine, C., Ganos, C., Münchau, A., Szejko, N., Cath, D., Müller-Vahl, K. R., Verdellen, C., Hartmann, A., Rothenberger, A., Hoekstra, P. J., & Plessen, K. J. (2022). European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part III: Pharmacological treatment. European Child & Adolescent Psychiatry, 31(3), 425–441. https://doi.org/10.1007/s00787-021-01899-z
  • Ueda, K., & Black, K. J. (2021). A comprehensive review of tic disorders in children. Journal of Clinical Medicine, 10(11), 2479. https://doi.org/10.3390/jcm10112479

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