Scott is in kindergarten. His teacher sent a note home with Scott. It turns out Scott makes faces in class. It’s usually the same face – a wincing or grimace. These faces are starting to disrupt the class. Scott claims that he cannot help making the faces. Fortunately, Scott’s parents took him to their pediatrician instead of scolding him. Scott was diagnosed with chronic motor tic disorder.
There are many different tic disorders. The most famous is Tourette’s syndrome. Although tics disorder can afflict people of all ages, it seems to happen mostly to children. Tic disorders in adults can sometimes be controlled in part through conscious effort of the sufferers. Children tend to lack these inhibitions and have not had the chance to practice suppressing these motions as often as adults with a tic disorder.
What is a Tic?
A tic is a repetitive motion that a person cannot control. The tics are caused by involuntary muscle contractions. They often happen in the head or the neck. There are about as many different types of tics as there are people suffering from a tic disorder. Tics are generally placed in two different categories – physical and verbal. A verbal tick is still a repetitive motion, even though it may appear as if someone shouting has conscious control over his or her mouth.
Kaplan and Sadock’s Concise Textbook of Child and Adolescent Psychiatry (Lippincott, Williams & Wilkins; 2009) divides tics into four basic categories:
- Simple motor tics: this is where usually one small area of the body is affected, such as constantly blinking one’s eyes, grimacing or shrugging.
- Simple vocal tics: this is usually one or two sounds repeated over and over again. Sounds include barking, coughing, humming, growling or shouting.
- Complex motor tics: more movements and body areas are involved in producing a tic, such as constantly combing the hair, making obscene gestures or imitating the actions of anyone else in the room.
- Complex vocal tics: where entire phrases are used in socially inappropriate places but the person cannot stop their mouths. Tourette’s syndrome is an excellent example. Others may repeat the last words they heard on television, radio or spoken by another person.
Sometimes tic vanish when the patient sleeps. Sometimes they are still present even when the person is sleeping. Childhood tick disorder often disappears or is greatly reduced in adulthood. Tic disorders like Scott’s for example, chronic motor tic disorder, have a good outlook. He may have symptoms for an average of five years, but since he is still so young, the chances are good that the tic disorder will be controlled by the time he is 20.
Is This Epilepsy?
Many parents fear that a child with a tic disorder will have epilepsy. Remember that not all children with epilepsy experience the dramatic grand mal (or tonic-clonic) seizures. Other seizures includes suddenly losing all muscle coordination, suddenly falling over or seeming to stare into space, being completely oblivious to whatever is going on around him or her.
If your child experiences strange, repetitive behavior that you are sure he or she cannot control, it’s best to take the child to a doctor or neurologist for a diagnosis. Never try to self-diagnose. Although some people with tic disorders will also have epilepsy, many will not. Tic disorder such as transient tic disorder can show very similar symptoms. An accurate diagnosis is crucial for any treatment to be effective.
Is This the Sign of Mental Illness?
Tic disorders have been classified as mental disorders by the latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V.) There has been some controversy as whether or not tic disorders are actually mental illnesses. Since they affect behavior, they are often considered mental illnesses or disorders.
There is no shame in having a tic disorder or a mental illness. Many people with tic disorders may also suffer from a more conventional mental illness like obsessive compulsive disorder or major depression. Not all patients with a tic disorder have other mental disorders. Your insurance company may require a tic disorder to fall under the DSM-V classifications in order to for you to get coverage.
Common Types of Tic Disorders
There are many different types of tic disorders. Here are some of the most common:
- Transient tic disorder: Patients experience motor or vocal tics many times a day. The tics need to be present every day for at least four weeks before a doctor is comfortable diagnosing this disorder. Symptoms appear before the patient is 18. This is the most common tic disorder in children.
- Chronic motor tic disorder: Patients show a quick movement or vocalization. This often begins when a child is five or six years old. Tics tend to worsen in certain situations, such as when the child is highly stressed. This often goes away in adulthood.
- Tourette’s syndrome: Patients have two or more motor tics and at least one vocal tic. Vocal ticks an include yelling out curse words, but not always. These tics occur multiple times a day for about a year. It usually starts before a child turns 18. Boys are prone to this disorder far more often than girls.
- Tic disorder not otherwise specified: This is a tic disorder with no known cause or that just does not fit in any other previously established medical category. Children with tic disorders may be diagnosed as this if they do not meet all of the criteria for the other categories, or experience long gaps of weeks or months between tic episodes.
Causes of Tic Disorders
It is unknown what causes tic disorders. However, it does seem that tic disorders run in families. It could be that a combination of factors has to occur before a child or adult starts showing signs of a tic disorder.
Tics can be worsened under certain conditions. By avoiding these conditions, the intensity or duration of tics can often be reduced. Conditions known to bring on tics include highly stressful situations, lack of sleep, being overheated and the side effects of certain medications.
Unfortunately, there are no tests to show if a child is prone to developing tics before taking any medication. Illnesses like viral infections or encephalitis can also trigger the appearance of involuntary twitches and tics.
Long Term Prognosis for Tic Disorders
The long term prognosis for managing tic disorders is excellent, provided that the child has begun showing symptoms before they reach adulthood. Many young children seem to outgrow tic disorders, just as many children with epilepsy seem to outgrow epilepsy. It is possible that some children diagnosed with a tic disorder may never need medication.
The prognosis is less rosy if the symptoms begin after puberty or in adulthood. Some children with tic disorders not only grow up to be adults with tic disorders, but experience a worsening of their symptoms, notes the New York Times. There is no known cure for any tic disorder. Many adults learn to suppress tics, but they cannot do that 24/7. Still, adults with tic disorders can still have children, get married and hold down good jobs. Famous people with Tourette’s syndrome, for example, international soccer star David Beckham, US soccer star Tim Howard, multi-millionaire Howard Hughes and Wolfgang Amadeus Mozart (yes – THAT Mozart.)
Although many children with tic disorders never need treatment, some do. Treatment varies according to the individual’s needs. Some patients need talk therapy to help cope with their lives while some seem to do fine with medications. In talk therapies, patients can learn behavior modification techniques to help suppress their symptoms, at least for a short while. There are also many support groups that patients and their families can join. It’s good to know that you are not alone.
There are many medications available for suppressing tics. One of the most common is clondine, which is available in a convenient transdermal patch. Some psych medications are used, such as haloperidol, which was originally used to treat schizophrenics. Pimozide, an anti-spasmotic, is also a popular medication for children with tic disorders. SSRI antidepressants like fluoxetine (Prozac) may also be prescribed whether or not the patient shows signs of depression.
Warning: Don’t Go Cold Turkey
All of these medications can give side effects like weight gain, drowsiness or problems with the blood being able to clot. You have to balance the positives and negatives of all medications before talking to your doctor about discontinuing medications. There are no tests available to determine if someone is going to have bad side-effects in taking a particular drug. The only way to find out is to take the drug and see what happens.
Never just stop taking these medications unless instructed to by a medical professional. Going “cold turkey” from these medications can cause severe withdrawal symptoms like migraines, vomiting, fainting or seizures. Patients need to taper off these medications gradually. This has to be done under medical supervision.
It is very tempting for a person with a tic disorder to experiment in self-medicating with alcohol, prescription drugs or illegal drugs. There is much conflicting information in the press and online about marijuana helping to calm tics, even in adults with Tourette’s syndrome. Unfortunately, there is not enough reliable clinical studies available to determine if medical marijuana could be a treatment option.
Any substance that alters your body significantly, like alcohol or drugs, can also interact badly with any other medication you happen to be taking. For example, people taking antidepressants should severely limit or cut out alcohol. It should not be part of tic disorder treatment.
Sources: http://www.nlm.nih.gov/medlineplus/ency/article/000745.htm, http://psychcentral.com/disorders/transient-tic-disorder-symptoms/, http://www.childbrain.com/ticdisorder.shtml#4