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signsofchildhood andadolescent ticdisorders andexplain alternative responses.
ofany agecanexperience tics,butthey aremore prevalent inchildren. Itis estimated thataround 25%
children experience tics.Ticsarealso more likelytoaffect boysthangirls. Thepeak ageofonset is7years.
ticsoccur inless than 1%ofchildren.
aresudden twitches, movements, orsounds thatpeople dorepeatedly. Peoplewhohave ticscannot stop
body fromdoing thesethings. Forexample, aperson withamotor ticmight keepblinking overandover
Or,aperson withavocal ticmight makeagrunting soundunwillingly. Ticsandtwitches arespasm- like
inparticular muscles.Theyoften affect theeyelids orface, butcan occur anywhere inthe body.
people experience themfromtimetotime, butthey aremostly temporary andharmless. However,they
sometimes becaused byatic disorder, whichresults inmore severe ticsand twitches thatrequire
andsometimes changestoaperson’s lifestyle.Ticsoften firstoccur during atime ofemotional
DSM isused byhealth professionals tohelp diagnose ticdisorders.
children whodevelop ticsonly have onekind oftic, but afew have multiple types.Theygenerally become
whenthechild experiences anxietyorisstressed, andmay becalmed duringperiods ofintense activityor
Ticsmight alsobecome moreprevalent whenthechild isrelaxed e.g.watching television at
Ticsusually ceaseduring sleepalthough afew children maybewoken byasudden ticduring sleep.
manychildhood ticsdissipate afterseveral weeks,otherscanpersist forlonger. Thevast majority of
havegone within fiveyears butafew cases become long-term.
andtwitches aretwo terms thatareoften usedinterchangeably, howevertherearedifferences between
aresometimes considered involuntary movements, ratherthanvoluntary movements. Thismeans the
isable tosuppress theactions foratime, BUTthesuppression ofthe ticwill cause discomfort forthe
untilitis relieved bythe performance ofthe tic.
may notbepossible tosuppress severetics.
twitches areisolated occurrences, notrepeated actions.Muscletwitches arealso known asmyoclonic
Theyareinvoluntary andcannot becontrolled orsuppressed.
twitches canmimic tics.Forexample, aneyelid twitch canmimic aneye- blinking tic,but itis different as
twitch cannot becontrolled. Itis asimple spasmodic movement.
usually occursuddenly duringperiods ofotherwise normalbehaviour. Theticsareoften repetitive, so
arenumber occurrences ofthe same action. Forexample, aperson mightblinktheireyesmultiple times
twitch theirnose multiple times.
mentions threetypesoftic –
Chronic/persistent motororvocal ticdisorder
Tourette’s Disorder(alsocalled Tourette’s Syndrome)
Provisional TicDisorder Chronic/Persistent
areshort- lasting, sudden movements. Motorticscan besimple orcomplex.
Simplemotortics-can include movements suchasnose twitching, headjerking, shrugging shoulders
Complex motortics-are aseries ofmovements lastingseveral seconds thatareperformed in the
same order. Forexample, theperson mighttouchsomething severaltimesthenkickout one
leg,then theother. Echopraxia involvesinvoluntarily copyingsomeone else'smovements. Copropraxia
involvessuddenvulgarorobscene gestures. Vocal
areuttered sounds. Aswith motor tics,these toomay besimple orcomplex.
Simplevocaltics-these involve therepetition ofmeaningless soundssuchasgrunts, snorts, sniffs,
Complex vocaltics-these caninclude sudden expression ofsingle words orphrases, sudden changes
inpitch, volume oremphasis inspeech, orspeech blocking. Echolaliaisthe repetition of
the last heard wordorphrase. Palilalia isrepetition ofone's ownlastwords. Coprolalia is sudden
expression ofblasphemies orobscenities andaffects lessthan 10%ofsufferers. Sometimes
complexticsaredifficult todistinguish fromthecompulsions observedinOCD andindeed OCDis
inchildren withticdisorders. However,compulsions areusually moreelaborate andareusually
byintrusive thoughts andconcerns whereasticsareusually preceded byabuild- upofphysical
typesoftic disorders aremost easily distinguished bymeans ofage atonset andtheduration andtype
tics involved. Forinstance, whilstTourette's DisorderandChronic TicDisorder mustbothlastforlonger than
months Tourette's includesmultiple ticsand atleast onevocal tic.Bycontrast, transient ticdisorder lastsfor
than 12months butmore thanfourweeks. Anycases which beginaftertheage of18 years aregiven a
ofTic Disorder NotOtherwise Specified.
be diagnosed withaprovision ticdisorder, thechild must –
Not have been diagnosed withTourette’s Syndromeorapersistent vocalormotor ticdisorder.
Present withoneormore motor tics,such asblinking, shrugging theshoulders, orvocal ticks(such as humming
oryelling outwords orphrases).
Show onset before theage of18.
Have ticsthat have been present fornolonger than12months inarow.
Have symptoms thatarenot due totaking drugs, medication oramedical condition. Tourette’s
isalso known asGilles delaTourette Syndrome. Thisisprobably themost widely known ticdisorder dueto
unusual natureofthe symptoms. Itis named afterGilles delaTourette whodescribed itin 1885, butwas
identified byItard in1825.
is characterised bymultiple motorticsand atleast onevocal tic.Tics may firstappear atthe same timeorat
timesduring thecourse ofthe disorder. Following onset,ticsareexperienced manytimeseachday
must lastforatleast oneyear. Symptoms beginbefore theage of18 years.
ticsmay arise inany part ofthe body andthelocation ofthem maychange overtime, astoo may the
ofdifferent typesoftics, andtheir frequency, complexity andseverity. Simplemotorticsmay include
blinking ormuscle contractions, complexmotorticscan include repeatedly squatting,bendingtheknees, or
aroundwhenwalking. Sometimes stereotyped movementsarepresent e.g.dancing orjumping or
vocalticsinclude utterances suchasgrunting, coughing, orbarking. Coprolalia (utteringobscenities) is
onlyinaminority ofcases withestimates varyingbetween 10and 30%, anditis rarer inchildren.
10and 40% have echolalia orechopraxia (copyingsomeone else'sspeech ormovements).
featuresincludeobsessions andcompulsions whichalsooccur morefrequently inbiological relatives
thegeneral population. ADHDisalso more frequent amongstchildrenwithTourette's disorderthaninthe
population. Emotionaldisturbances arealso often present suchasfeeling demoralised, shamefulorself-
Learningdifficulties andsocial problems mayalsobepresent. Younger childrenmaynotshow any
orother impairments relatedtotheir symptoms. Manychildren andadolescents donot seek medical
butthose withsevere symptoms whichcausethemsocial stigma do.
Syndromeaffectsthreetofour times moreboysthangirls. Itaffects morechildren thanadults with
ofaround 5in 10,000 children beingaffected compared to1-2in 10,000 adults(bydefinition, in
itmust havebegun before age18years andpersisted intoadulthood). Onsetmaybeasearly asage 2
withtheaverage ageofonset beingaround 6-7years. Sometimes symptomsmayremit formonths or
atatime before recurring. Symptoms oftendiminish inseverity andfrequency duringadulthood andmay
completely inearly adulthood. Occasionally, symptomsbecomeworseinadulthood. Oftenticsand
compulsive symptomsendureovertheindividual’s lifetime.
isevidence tosuggest agenetic basiswithsome children inheriting agenetic vulnerability tothe disorder.
thetype oftic disorder inherited mayvary from onegeneration tothe next anditwould seemthat
isamongst thepossible vulnerabilities. Ifthere isan inherited geneticvulnerability itsexpression islikely to
influenced bythe environment. Notallcases areofgenetic originthough. Someotherstudies indicating a
connection withaneuro- chemical disorderinvolving dopamine production.
ingeneral, donot always needtreatment isthey aremild. Themore severe theyareand themore they
thechild’s dailylife,themore likelytreatment isrequired. Whichever ticisdiagnosed, theimpact upon
ticswill goaway orimprove ontheir ownafter some years, butsome willgetworse ifuntreated andlead
difficulties atschool andsocially forthe child, andeventually adult.There aresome tipsthat thechild canuse
help reduce thetics themselves, suchas–
Avoid anxiety, stressandboredom. Childrenshouldbeencouraged tofind enjoyable andrelaxing activities
todo, such assports orhobbies.
The child should beencouraged tosleep wellandavoid becoming tootired.
Drawing attention tothe tics can make thechild more conscious ofthem, which canmake them worse,
soitis best toavoid talking abouttheticordrawing toomuch attention toitifpossible.
Parent should nottelltheir childoffwhen theticoccurs. Theyshould bereassured thateverything is
ok and they should notfeel embarrassed.
Teachers andother people whoareregularly incontact withthechild should alsobemade aware of these
therapyisoften recommended asthe first treatment fortics, ifself help treatments arenot
Thechild maybereferred toaspecialist psychology team.Theaimofthe therapy isto help thechild to
Become awareoftheir condition
Understand whenthetics occur andidentify anyurges thechild feelsatthe time
Find anew response forthe child when theyfeeltheurge totic. For example, ifthe child wants to shrug
theirshoulders, theymaybetaught tostretch theirarms outside insteaduntilthetick urge passes.CBiT
(Comprehensive BehaviouralIntervention forTics) canalso beused. Withthistherapy, thechild is
tolearn anew setofbehavioural techniquestoreduce theirtics.
(Exposure andResponse Prevention) helpsthechild tolearn tosuppress thefeeling thatthechild needs to
child istaught thedifferent techniques butitcan take some sessions withthepsychologist forthe child to
howtouse them effectively andthechild willneed tocontinue touse them afterthetreatment finishes.
different typesoftreatment havebeen usedtocontrol thesymptoms ofTourette's disorder.Where
aremild tomoderate notreatment maybenecessary, ratheritis sometimes bettertoallow
torun their course andgradually remit.Where symptoms persistandareseverely problematic
hasbeen used. Various medications canbeused, butcare needs tobe taken whengiving
particular, Haloperidol provedreasonably effective,butitcan produce side-effects whichmightalsogenerate
Selective serotonin reuptakeinhibitors maycontrol obsessive- compulsive symptoms.Ifthere isco-
ADHDorOCD then these areoften treated inpreference.
(antipsychotics) altertheeffect ofthe chemicals ofthe brain thatcontrol bodymovements. These
auseful treatment fortics. However, theside effects cancause weight gain,blurry vision, drymouth and
Someneuroleptics alsolead todrowsiness, shakingandtwitches.
medication canbeused tohelp reduce theeffects ofthe tics.
extreme cases,atype ofsurgery calleddeepbrain stimulation canbeused onpeople withTourette’s
Electrodes(smallmetallic discs)areplaced inthe area ofthe brain associated withthetics. This is
under general anaesthetic. Wiresrunfrom theelectrodes toapulse generator. Thisissimilar toa
Itis placed undertheskin ofthe person’s chest.Itgives outanelectric current thathelps to
thesigns inthe person’s brainandcontrol theirtics.More research isrequired onthis asitis still not
howeffective andsafe thisis.Also, asso few adults haveticssosevere thatthey have notresponded to
thegroup ofpeople whohave been studied forresearch isconsequently small.
to,and read anyreference materialyouhave access tothat relates tothe aim ofthis lesson. Thismay
•Books inyour ownpossession, orwhich youfind inalibrary
•Periodicals youhave access to(i.e. magazines, journalsornewspapers)
nomore than1hour doing this.
outone ofthe following settasks –
Talk tosomeone withatic disorder andfind outmore about theirexperiences.
Look online forvideos about“ticdisorders.”
Enter the password to open this PDF file:
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