Tic disorders in children and adults: symptoms, Tourette syndrome and treatment
CareOps editorial team · · 10 min read
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Read our full editorial standards →Your child keeps blinking, or clears their throat over and over without a cold. Saying “stop it” works only for a moment. Some adults, too, find their shoulders jerking on their own when they are tense. Tics are not done on purpose. Here is what tic disorders are, what the symptoms and types look like, how common they are, how they tend to change with age, what parents and adults can do, and how they are treated.
At a glance
- A tic is a sudden, quick, repeated movement (motor tic) or sound (vocal tic). Tics using only a few body parts, such as blinking or shrugging, are simple; tics combining several movements in a pattern are complex.
- Starting before age 18, tics lasting more than a year are a persistent tic disorder; multiple motor tics plus at least one vocal tic for over a year is Tourette syndrome; under a year is a provisional tic disorder. A meta-analysis of child studies found Tourette syndrome in 0.77% of children.
- Tics often peak around ages 10 to 12 and ease during adolescence. Stress and tiredness can make them worse, so supporting a calm routine helps more than pointing tics out. If they interfere with daily life, behavioral therapy (CBIT) or medication can be discussed with a doctor.
What is a tic disorder?
A tic is a sudden, quick movement or sound that repeats in the same way, without the person meaning to do it. When tics continue for a certain period, it is called a tic disorder. Because tics are not a deliberate habit, telling someone to “just stop” rarely works.
Many people feel an itchy, tight or building sensation just before a tic, as if something has to be done to relieve it. This is called a premonitory urge. Doing the tic briefly eases that uncomfortable feeling, which makes the tic more likely to repeat. This idea is also the starting point for the behavioral therapy described below.
Tic symptoms: motor vs vocal, simple vs complex
Tics are described by whether they involve the body (motor tics) or the voice (vocal tics), and by whether they are simple or complex. Below are common examples.
| Simple tics | Complex tics | |
|---|---|---|
| Motor tics | Blinking, nose scrunching, shrugging | Head bobbing while jerking an arm and jumping |
| Vocal tics | Throat clearing, sniffing, humming | Calling out a word or phrase |
The CDC explains that the types of tics and how often they happen change a lot over time, and that tics can appear, disappear and reappear. Blinking may fade just as throat clearing starts, for example. So a tic that returns after a quieter stretch is not unusual.
Types of tic disorders: provisional, persistent and Tourette syndrome
The diagnostic manual used in psychiatry (DSM-5) divides tic disorders into three types by the kind of tics and how long they have lasted. In all three, tics start before age 18 and are not caused by a medication, substance or another medical condition.
- Provisional tic disorder: motor or vocal tics have been present for less than a year since they first began. It used to be called transient tic disorder.
- Persistent (chronic) motor or vocal tic disorder: only motor tics, or only vocal tics, for more than a year.
- Tourette syndrome: multiple motor tics and at least one vocal tic, lasting more than a year since they first began. The two kinds do not have to appear at the same time.
Tourette syndrome is often pictured as shouting swear words, but according to the CDC most people with Tourette syndrome do not have swearing tics, and they are not required for a diagnosis. What separates Tourette syndrome from other tic disorders is not how severe the tics are, but whether both motor and vocal tics have been present, and for how long.
Tic disorders in children: how common, and do they get better?
Tics are not rare in children. A meta-analysis pooling 13 studies of children (Knight et al., 2012) found Tourette syndrome in 0.77%, more often in boys (1.06%) than girls (0.25%). The most common tic disorder in children was tics lasting under a year (transient tic disorder), at 2.99%.
The course is fairly predictable. A review (Bloch & Leckman, 2009) found that tics usually start around ages 4 to 6, peak around ages 10 to 12 and, on average, ease during adolescence. By early adulthood, about three quarters of children with Tourette syndrome had much milder tics, and over a third were tic free. So severe tics now do not mean they will stay that way for life.
Tics in adults
Not all tics go away. The CDC notes that tics can continue into adulthood and occasionally get worse then. In studies of adults, Tourette syndrome was found in 0.05%, far less than in children. For adults, tics can add tension and embarrassment in situations where others are watching, such as meetings or presentations. Movements that first appear in adulthood do not fit the tic disorder criteria (onset before 18), so see a neurologist first to check for other causes.
What makes tics worse: stress, excitement and tiredness
The UK National Health Service (NHS) notes that tics can be triggered by stress, excitement or tiredness, and that stress can make them worse. It is common for tics to increase during exams, a new school term or a week of short sleep, and to ease during holidays or when someone is absorbed in something they enjoy. More tics can be a cue to look at what your child, or you, has been tense about lately. Our guide to stress relief covers habits that ease tension.
What parents can do when a child has tics
- Don't point it out or scold: comments like “You're doing it again” or “Stop that” make children more tense. Tics are not deliberate, so scolding rarely stops them, and tension can make them worse. If a tic happens, just carry on with the conversation.
- Keep a regular day with physical activity: a consistent daily routine with plenty of physical activity is the first thing the NHS recommends.
- Build a calm sleep routine: keep phones and screens away before bed and help your child sleep at the same time. Tiredness is a common reason tics increase.
- Share with the school: if your child has a diagnosis, telling the teacher can help reduce the chance of being called out or teased for tics in class.
- See the child, not just the tics: supporting friendships and favorite activities matters. A review (Bloch & Leckman, 2009) concluded that efforts like these, which protect self-esteem, are crucial for a good outcome in adulthood.
Long-running worry about a child can wear parents down too. If parenting has left your mood low for a while, read about parenting depression.
Treating tic disorders: behavioral therapy (CBIT) and medication
Not every tic needs treatment. The CDC explains that many people's tics don't interfere with daily life and need no treatment, while behavioral therapy and medication are options when tics cause pain or injury, interfere with school, work or social life, or cause significant stress.
The behavioral therapy with the strongest evidence is the Comprehensive Behavioral Intervention for Tics (CBIT). Its core is habit reversal training: learning to notice the premonitory urge before a tic, and practicing a different movement that can't be done at the same time as the tic (a competing response) when the urge comes. It also adds relaxation practice and work on the situations that make tics worse.
In a randomized controlled trial of 126 children aged 9 to 17 (Piacentini et al., 2010), 52.5% of those who received eight CBIT sessions over 10 weeks were rated much improved or very much improved, compared with 18.5% of those who received supportive therapy and education. Among responders who could be followed up, 87% were still improved six months later.
Medication is also an option, typically when tics are severe or behavioral therapy alone isn't enough. Whether to use medication, and which one, is decided with a doctor.
Tic disorders with ADHD and OCD
Tic disorders, especially Tourette syndrome, often come with other difficulties. In a study of 1,374 people with Tourette syndrome (Hirschtritt et al., 2015), 85.7% had at least one other psychiatric diagnosis during their lifetime, and 72.1% met criteria for OCD or ADHD. These usually began between ages 4 and 10. A review (Bloch & Leckman, 2009) noted that these co-occurring difficulties are often longer lasting and more impairing than the tics themselves.
If trouble focusing and finishing tasks is the bigger part, read about adult ADHD symptoms and self-checks. If unwanted thoughts and checking are hard to stop, read about OCD symptoms.
When to see a doctor about tics
See a doctor if tics cause pain or injury, disrupt school, work or friendships, or cause your child or you significant distress. Children can be seen by a child and adolescent psychiatrist or a pediatric neurologist; adults by a psychiatrist or neurologist. It is also worth getting checked if you're not sure whether a movement is a tic, if it first appeared in adulthood, or if attention, obsessive, anxiety or mood difficulties are present too.
If you need somewhere to talk about the stress around tics
Tics tend to increase with tension, and worrying about tics tends to raise tension further. CareOps Maeumi is an AI counseling app that runs sessions with approaches such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). It helps you put into words the embarrassment and tension that build up around tics, or a parent's worry, and remembers past sessions so the next one picks up where you left off. Get the app
Frequently asked questions
- What is a tic disorder?
- A tic is a sudden, quick, repeated movement or sound that a person doesn't do on purpose. When tics start before age 18 and continue for a period of time, it is called a tic disorder. Depending on duration and type, it is classed as a provisional tic disorder, a persistent motor or vocal tic disorder, or Tourette syndrome.
- What is the difference between Tourette syndrome and a tic disorder?
- Tourette syndrome is one type of tic disorder. It is diagnosed when there are multiple motor tics and at least one vocal tic, lasting more than a year since they began. Only motor or only vocal tics for over a year is a persistent tic disorder; tics present for less than a year are a provisional tic disorder.
- Do tics in children go away on their own?
- Often they improve. Tics usually peak around ages 10 to 12 and ease during adolescence, and one review found that about three quarters of children with Tourette syndrome had much milder tics by early adulthood. If tics interfere with daily life or your child is distressed, though, discuss behavioral therapy with a doctor rather than just waiting.
- How are tic disorders treated?
- If tics don't interfere with daily life, they are often simply monitored. When treatment is needed, behavioral therapy (CBIT), which teaches noticing the urge before a tic and replacing it with a different movement, has evidence behind it, and medication is also available; whether medication is needed is decided with a doctor. At home, reducing stress and tiredness and not pointing tics out can help.
- Can adults have tic disorders?
- Yes. Tics that begin in childhood can continue into adulthood, although Tourette syndrome is much less common in adults (0.05%) than in children. Movements that first appear in adulthood don't fit the tic disorder criteria, so see a doctor first to check for other causes.
Sources
- CDC, About Tourette Syndrome
- CDC, Diagnosing Tic Disorders (DSM-5 criteria)
- NHS, Tourette's syndrome
- Knight et al. (2012), Prevalence of Tic Disorders: A Systematic Review and Meta-Analysis, Pediatric Neurology
- Bloch & Leckman (2009), Clinical course of Tourette syndrome, Journal of Psychosomatic Research
- Piacentini et al. (2010), Behavior Therapy for Children With Tourette Disorder: A Randomized Controlled Trial, JAMA
- Hirschtritt et al. (2015), Lifetime Prevalence, Age of Risk, and Genetic Relationships of Comorbid Psychiatric Disorders in Tourette Syndrome, JAMA Psychiatry
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