Tics Disorder and Tourette’s Syndrome

Understanding Tics Disorder and Tourette’s Syndrome

What is Tics Disorder?

Tics are sudden and brief movements or sounds that are repetitive and not within the control of the person. They can vary in type, frequency and severity and can change over time.

Types of Tic

1) /Motor Tics/ refer to the movement of the body 2) /Vocal Tics/ refer to sounds that person makes with their voice 3) /Simple Tics/ refer to sudden, brief and repetitive tics involving limited muscle groups 4) /Complex Tics/ refer to distinct and coordinated tics involving several muscle groups

Tics can worsen when the individual is excited or stressed and is better when individual is calm or focused. It usually worsens in adolescence before getting better in adulthood. Though it is known to disappear or reduce for most, it worsens for some in adulthood. Tics can continue to occur in sleep.

Diagnosis of Tics Disorder

1) Persistent Motor/Vocal Tic Disorder

• Presence of one or more motor or vocal tics (not both)
• Occurs many times a day
• For more than a year
• Symptoms began before 18 years old
• Symptoms cannot be attributed to medications/drugs or medical conditions (i.e. seizures, Huntington’s)

2) Provisional Tic Disorder

• Presence of one or more motor/vocal tics
• Occurs many times a day
• No longer than 12 months
• Symptoms began before 18 years old
• Symptoms cannot be attributed to medications/drugs or medical conditions (i.e., seizures, Huntington’s)

Tourette’s Syndrome

Tourette’s Syndrome (TS) is a neurological condition that causes tics. Symptoms of tics begin around five to ten years of age for most individuals. It usually begins with motor tics in head or neck area before progressing downwards to the trunk.

No causal factors have been found for TS. However, having a family history increases an individual’s risk of developing TS. It is also associated with ADHD, learning disorders and anxiety disorders in children. Depression, bipolar disorder, and substance use disorder have been found to be comorbidities in adulthood.

Diagnosis of TS

• Presence of 2 or more motor tics and at least 1 vocal tic
• Presence of both motor and vocal tics for at least a year
• Occurs many times a day
• Symptoms are present before 18 years old
• Symptoms cannot be attributed to medications/drugs or medical conditions (i.e., seizures, Huntington’s)

Treatment

Treatment for Tics or TS aim to reduce the interference of tics in their daily functioning. It does not cure or eliminate the symptoms.

1) Medications

Medications are available to control tics or reduce symptoms of associated conditions. There is no one specific medication that works for everyone. Hence a physician decides a suitability of the medication depending on the individual’s needs and medical history.

2) Psychological intervention

Though tics are not psychological in nature, psychotherapy can help by increasing awareness about the condition and providing strategies to cope with the social and emotional impacts of tics It can also aid in coping with co-morbid issues such as ADHD, depression or anxiety. Parent training could also be provided to increase awareness and support families with behaviour management at home.

3) Comprehensive Behavioural Intervention for Tics (CBIT)

CBIT is an evidence-based type of behavioural therapy for TS and chronic tics. In CBIT, the individual will go through psychoeducation to increase awareness about their condition. They will also learn relaxation techniques and habit reversal (where they learn to do a new behaviour instead of the tic).

4) Occupational therapy interventions

In addition to CBIT, sensory processing can be helpful in the treatment of tics. A trained OT would also be able to support and introduce new skills to overcome difficulties with daily functioning. Research has shown that OT involvement in treatment results in reduced the number of tic expressions, tic severity, and level of distress associated with tic and improved these children’s self-perception of their competence in and importance of performing everyday activities (i.e., occupational performance).