What Causes Tics and When They May Need Medical Attention

Tics are sudden, quick movements or sounds that you do repeatedly and involuntarily. They can range from simple eye blinks to more complex coordinated movements, and they affect a significant portion of children at some point during their development. Most people experience tics without serious concern, but understanding what causes them and recognizing warning signs can help you determine when professional evaluation is needed.

The good news is that many cases of tics are temporary and resolve within a year. However, tics can sometimes signal an underlying condition or cause enough disruption to warrant medical attention. Learning to distinguish between harmless, temporary tics and those that require professional care is an important part of supporting your health or your child's wellbeing.

Understanding What Tics Are

Tic disorders are characterized by sudden, rapid, recurrent movement (motor tics) or vocalization (vocal or phonic tics). If you have tics, you can't stop your body from doing these things. Rather than being deliberate actions, tics happen involuntarily, though some people report an unusual sensation or premonitory urge beforehand.

Before a tic occurs, you may feel an urge to perform the tic. This urge is similar to the need to scratch an itch or sneeze. A feeling of tension builds up in the affected part of your body, and giving in to the tic provides momentary relief. This sensation can help distinguish tics from other involuntary movements.

Types of Tics: Motor and Vocal

Movements of the limbs and other body parts are known as motor tics. Involuntary repetitive sounds, such as grunting, sniffing, or throat clearing, are called vocal tics. Both categories can be subdivided into simple and complex patterns.

Motor Tics 🔄

Simple tics are brief and sudden repetitive movements that involve just a few muscle groups. They're more common than complex tics. Examples of motor tics include blinking, shrugging the shoulders, or jerking an arm. Other common motor tics involve eye rolling, facial grimacing, and head jerking.

Complex tics usually involve several different parts of the body and can have a pattern. An example of a complex tic is bobbing the head while jerking an arm and then jumping up. These more elaborate movements may appear purposeful but are nonetheless involuntary.

Vocal Tics

Simple vocal tics include coughing, throat clearing, sniffing, grunting or barking. Complex vocal tics involve speech, such as repeating words or phrases, animal sounds or yelling out unexpected words.

What Causes Tics to Develop

The cause of tics is unknown. However, research has identified several factors that contribute to their development. The most accredited hypothesis believes that they emerge from a heterogeneous combination, differing from subject to subject, of environmental, psychological, genetic, immunological, and neurobiological factors.

Genetic and Neurological Factors

Tics tend to run in families, so there may be a genetic basis to these disorders. Some experts believe that tics are related to dysfunction in the basal ganglia, the part of the brain that controls movement. The underlying brain mechanisms involve how the nervous system regulates movement signals and impulse control.

Environmental and Psychological Triggers

Stress or anxiety: Tics can be exacerbated during stressful or exciting times. Fatigue: A lack of sleep can sometimes increase the frequency of tics. These external factors don't cause tics to develop in the first place, but they often intensify existing tics. Tics usually are worse during times that are stressful or exciting. They tend to improve when a person is calm or focused on an activity.

Associated Medical Conditions

Attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD) are frequently associated with tics. Additionally, tics can occur due to the use of substances or medications which raise dopamine levels. In rare cases, tics can be associated with more serious medical disorders, such as Huntington's disease or Creutzfeldt-Jakob disease.

Types of Tic Disorders

Tics are classified into different categories based on their duration and characteristics. Understanding these distinctions helps determine when monitoring alone is sufficient versus when professional evaluation is warranted.

Provisional tic disorder is the most common diagnosis, particularly in preschoolers and younger children. The child has developed tics for less than one year. Transient tic disorder occurs for less than one year, and are more commonly motor tics.

When Tics Require Medical Attention

Not every tic needs professional evaluation. Just because a person has tics doesn't mean medication is needed. Tics can improve without medication. However, certain warning signs indicate that seeing a healthcare provider is advisable.

Red Flags to Watch For 🚩

• Sudden onset with severity: A sudden, rapid onset of tics, especially if accompanied by other neurological symptoms, requires immediate medical attention.
• Persistence beyond one year: If tics last for more than a year, this may be suggestive of a chronic tic disorder or Tourette Syndrome.
• Functional impairment: If tics affect your child's ability to focus at school, sleep or interact with others, they may require treatment.
• Physical injury: Tics that cause pain or result in self-injury (e.g., head banging, excessive blinking leading to eye irritation) should be evaluated.
• Associated conditions: Signs of OCD, ADHD, or other behavioral concerns alongside tics should be evaluated by a healthcare provider.
• Progressive worsening: If the tics are progressively worsening in frequency or intensity, a medical evaluation is recommended.

When to Monitor and Wait

Parents who are concerned that a child may have a tic disorder should begin by visiting their pediatrician. The pediatrician can then determine if more help is needed and offer a referral to a neurologist or a psychiatrist.

One question to ask yourself if your child is experiencing tics is, "Is the tic bothering the child?" If it is not, and if the tic is not interfering academically it likely does not need to be addressed by a specialist, although discussing it with your primary care physician is always a good idea. Many tics are mild, non-bothersome, and resolve on their own without intervention.

Treatment and Management Options

Treatment decisions should be guided by the severity of tics and their impact on quality of life. In mild cases, no treatment is needed. Regular check-ins with your pediatrician may be all that's necessary.

Techniques like Comprehensive Behavioral Intervention for Tics (CBIT) can help your child manage their tics. This therapy focuses on helping individuals recognize the urge preceding a tic and develop alternative responses. When behavioral approaches are insufficient or tics cause significant distress, medication may be considered, though this is typically reserved for cases where tics substantially interfere with daily functioning.

If attention deficit hyperactivity disorder (ADHD), OCD, anxiety or depression symptoms are present, sometimes treating these other problems can help to reduce tics. For example, sometimes tics fade when ADHD or anxiety is more effectively treated. Addressing coexisting conditions often has the added benefit of reducing tic severity.

Outlook and Natural Course

Understanding the typical trajectory of tics can provide reassurance. In most cases, tics decrease during adolescence and early adulthood, and sometimes disappear entirely. Tics often will diminish within one year.

Tics can increase and decrease in severity (often described as waxing and waning) over time (days to weeks to months). Tics may also become less frequent if the patient is engaged in other mental tasks and may increase in frequency with increasing stress, anxiety, or exciting situations. This fluctuating pattern is normal and does not necessarily indicate worsening disease.