When people think of tics, they often think of Tourette syndrome, people who blink frequently, bang their heads against the wall and swear out of the blue because they feel an urge to do so. Perhaps you know someone who has certain tics or you may have had them yourself when you were young. This does not mean that it is immediately a disorder, but perhaps a little insight into tic disorders is useful to have so that you can recognize it better. Table of contents
- What is a tic?
- Tourette’s Disorder
- Chronic motor or vocal tic disorder
- Passagère tic disorder (Transient tic disorder)
- Tic disorder not otherwise specified (NOS)
- Statistics
- Therapy
What is a tic?
A tic is a sudden, rapid, repetitive, non-rhythmic, stereotyped motor movement or vocal expression. The movements and expressions are abnormal in frequency and pattern over time. Typically, motor tics affect the muscles of the face and neck, such as abnormal blinking and abnormal head movements. Typical vocal tics include clearing the throat, coughing, grunting and sniffling. The movements are always involuntary, but can sometimes be suppressed for a certain period of time. Often they are shown as a response to some stimulus or internal urge.
Tics can be divided into two groups: simple tics and complex tics. Simple motor tics consist of repetitive, rapid contractions of functionally equivalent muscle groups (such as blinking, shrugging, etc.). Simple vocal tics include sniffing, barking and throat clearing. Complex motor tics are more purposeful/meaningful and more ritualistic than simple tics. This includes grooming behavior, smelling objects, touching, jumping and echopraxia (imitating behavior). Complex vocal tics include repeating words or sentences out of context, coprolalia (uttering obscene words or sentences), palilalia (repeating one’s own words or sentences) and echolalia (repeating the last heard words of another person). ). Stress and anxiety are known to make tics worse, but there is no evidence that tics are caused by stress and anxiety.
Please note: children sometimes have tics, but this does not immediately mean that they have a disorder. It is only a disorder if it causes significant suffering or dysfunction in daily life (or aspects thereof, such as social and/or emotional problems).
Tourette’s Disorder
The disorder was first described around 1885 by Georges Gilles de la Tourette, from whom the disorder is also named. Individuals with this disorder suffer from multiple motor and one or more vocal tics that have been present at some point during the illness. It is not necessary that the tics were/are present at the same time. The tics occur several times a day (usually in the form of attacks). This can happen almost every day or at intervals of up to three consecutive months. This must occur for at least one year. Tourette’s disorder almost always develops before the age of eighteen and is not the result of direct physiological effects of a substance (for example stimulant drugs) or of a general medical condition such as Huntington’s.
Four to five in 10,000 people suffer from this disorder. These are mainly children. The development of motor tics begins on average around the age of seven. Vocal tics generally develop a little later, around the age of eleven. The disorder is three times more common in boys than in girls.
Chronische motorische of vocale tic-stoornis (Chronic motor or vocal tic disorder)
In contrast to Tourette’s disorder, individuals with this disorder have either single/multiple motor tic(s) or single/multiple vocal tic(s). The two types of tics were therefore not present together at any point during the illness. Like Tourette’s disorder, the tics occur almost every day or at intervals of up to three months for at least one year and the disorder occurs before the age of eighteen. Here too, the disorder may not be the result of direct physiological effects or of a general medical condition. It is very important with this disorder that it is ruled out that the criteria for Tourette’s disorder have never been met.
It is estimated that this disorder is 100 to 1000 times more common than Tourette’s disorder. The current prevalence is estimated at 1% to 2% of the population, with school-age boys at highest risk. Children who develop tics between the ages of six and eight have the most positive prognosis. Symptoms usually last four to six years and then stop in early adolescence. Children whose tics are mainly expressed in their limbs have a worse prognosis than children whose tics are only expressed in the face.
Passenger tic-stoornis (Transient tic disorder)
This disorder involves single or multiple motor and/or vocal tics. These tics must also occur frequently almost every day for at least four weeks, but no longer than twelve consecutive months (otherwise they are likely to become one of the previous tic disorders). Here too, the criteria that the disorder arises before the age of eighteen and must not be the result of direct physiological effects or a general medical condition. Tourette’s disorder and chronic motor or vocal tic disorder must therefore first be ruled out.
The prevalence is unknown. It is clear that 5%-24% of all school-age children have (had) tics. The tics disappear over time or return during periods of certain stress, but these tics are often not associated with serious dysfunction. Only a small percentage of individuals with this disorder develop chronic motor or vocal tic disorder or Tourette’s disorder.
Tic disorder not otherwise specified (NOS)
This category includes tic disorders that do not meet the criteria for the previous specific tic disorders, but are characterized by tics. This includes, for example, tic disorders that last less than four weeks, only arise after the age of eighteen or do not occur almost every day, but in certain situations.
Statistics
About half to two-thirds of individuals with Tourette’s disorder show a reduction or even complete remission in adolescence. One-third to two-thirds of children and adolescents with Tourette’s disorder have co-morbidity with obsessive-compulsive disorder (OCD) or features thereof, and one-third of adults with Tourette’s disorder have long-term OCD. The OCD symptoms common in people with Tourette’s disorder are related to order and symmetry, counting, and repetitive touch. The risk of developing co-morbid OCD is much higher in children/adolescents who have a high IQ (of 120 or higher) than in children/adolescents with an average IQ (of 100). Tic disorders have a genetic component, so it is very likely that there will be a family history of tic disorders if a person has developed a tic disorder.
Therapy
Often family members and teachers describe it as a behavioral problem, but having involuntary tics is not a behavioral problem. It is therefore necessary to carefully inform all people around the person in question about the disorder, so that the child, for example, is not unjustly punished for his or her behavior. In addition, pharmacotherapy (medication) can help reduce tics. Behavioral interventions can help make the person aware of their tics and teach them to initiate voluntary counter-movements (habit conversion treatments). Learning relaxation techniques can also contribute to improvement, so that the stress that often comes with it can be kept under control.
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