Tics are fast, involuntary and repetitive muscle movements. They look like jolts to the body or head, or sudden vocalisations or sounds. They are fairly common in children, but often improve over time, and may even disappear after puberty. Tics often run in families, suggesting that they may be genetically linked.

There are various conditions that are designated as ‘tic disorders’, meaning that tics are an important part of those conditions. These include Tourette Syndrome (also known as Tourette’s Syndrome or simply Tourette’s). This is a genetically linked neurological condition that lasts at least a year and often much longer. This page explains more about tics and tic disorders.

More About Tics and Tic Disorders

Tics are fast, involuntary and repeated muscle movements that result in jerks or jolts to the body or head, or sudden sounds or vocalisations. There are two main types of tics:

• Motor tics affect body movement. They include blinking or grimacing, jerking the head, clicking the fingers, touching other people or things, and shrugging.

• Vocal tics are associated with the production of sounds. They include coughing, grunting, sneezing, whistling, animal sounds, swearing and saying random words or phrases.

Tics are not usually directly harmful to health. However, the repeated movements can become very painful over time, and are also extremely tiring.

People with tics may also be bullied or have psychological problems linked to embarrassment or other social concerns about having tics. Tics may vary in their severity from day to day, and may be made worse by stress and tiredness.

People often report what is known as a ‘premonition’ before a tic. This is a feeling of discomfort like an itch, which is only relieved when the tic has been carried out.

Tics usually first start somewhere between the ages of five and ten years old. In many cases, they are at their worst during the pre-teen years, up to about 12 years old. After that, and especially after puberty, many people find that they decrease or even disappear. However, this is not the case for everyone, and there are many adults who have tics for their entire lives.

Tic Disorders

There are several conditions that are associated with tics, and known as tic disorders. They include:

• Transient tic disorder or provisional tic disorder. This is characterised by motor tics that are usually confined to the face and neck, although they may also affect other body parts, and sometimes also vocal tics. The tics only occur for a few weeks or months.

• Chronic tic disorder. People with this disorder tend to have either vocal or motor tics, but not both, and the tics occur for longer than a year;

• Tourette Syndrome. People with Tourette Syndrome have several different motor tics and one or more vocal tics, and the tics must occur for at least 12 months. However, the different types of tics do not always occur at the same time.

• An unspecified tic disorder. When tics are present, but they do not meet the criteria for any specific tic disorder, then the person concerned may be given a diagnosis of an unspecified tic disorder.

It is often very hard to diagnose a particular tic disorder, because the signs are very non-specific, and there are no diagnostic tests.

The symptoms of tics generally, and specific tic disorders, can come and go throughout life. Generally speaking, Tourette’s is accepted to be a lifelong condition, but many children find that their symptoms get less severe as they reach adulthood.

Causes of Tics

It is not really known what causes tics or any of the tic disorders. However, they seem to be associated with changes in the parts of the brain that deal with movement, particularly the basal ganglia, frontal lobes, and cortex, and the connections between these.

The latest research suggests that tics may also be associated with an imbalance in the function of brain neurotransmitters (chemical messengers in the brain that send signals between nerve cells). These neurotransmitters include dopamine—and, indeed, many of the drugs used to treat tics suppress the dopamine system.

Tics and tic disorders often run in families, but they are certainly not controlled by just one single gene. Researchers are now trying to identify combinations of genes that may be relevant, but this work is still at a very early stage. The current focus is on genes that control how neurons (nerve cells) grow and connect to each other.

It also seems likely that environmental factors play a role in tic disorders, but the precise role is unclear. Tics are also more likely to occur in boys than in girls, and current research suggests that girls who are genetically vulnerable to neurodevelopmental problems are more likely to develop obsessive compulsive behaviours.

People with tics and tic disorders also often have other conditions alongside their tics. In particular, many people with Tourette’s have other co-existing conditions, including attention deficit hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD).

Treatment for Tics

Generally speaking, tics are not harmful. However, people often consult a doctor about them when:

• They occur very often, or are very severe;

• They are causing social or emotional problems, such as embarrassment, bullying, or social isolation;

• They cause pain or discomfort, either from the tics themselves or because they cause the person concerned to hurt themselves in some way;

• They start to interfere with work or school, or any other activities; and

• The person concerned is becoming very angry or even depressed about it.

Formal treatment is often not provided for tics unless they are very severe. The most common advice is often to avoid stress or tiredness—which may be helpful but is not always possible.

Controlling the movements associated with tics is sometimes possible but takes a lot of concentration and is also very tiring. It also cannot be done for very long (see box).

It is, for example, sometimes possible for children to suppress their tics while at school, but as soon as they get home, their tics increase significantly.

If tics are very severe, doctors may suggest therapy.

There are generally three types. Habit reversal therapy is finding behaviours that can ‘compete’ with the tic. Comprehensive behavioural intervention for tics is a set of behavioural techniques that help to reduce tics. Exposure with response prevention helps to develop tolerance to the unpleasant sensations that occur before a tic, which can reduce the level of tics. All these behavioural therapies aim to change how you think about tics, as well as how you respond to them.

There are also some medicines available to control tics.

However, this is usually only recommended when tics are very severe or having a serious effect on ability to carry on with life because many of these medicines can have unpleasant side effects. They are also not effective in everyone.

Some people find that particular diets or exercise regimes may be helpful in managing Tourette’s. So far, there is no scientific evidence for this, but mostly because there have been no reliable studies. However, eating a good diet with plenty of vegetables, and avoiding ultra-processed food, and getting plenty of exercise, is unlikely to be harmful.

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In Conclusion

Surprisingly little is known about tics and tic disorders, especially considering that they are relatively common, and have been recognized for a long time. The fact that they are not usually directly damaging to health may also make it harder to get treatment or support.

However, both treatment and support are available if you need them, so it may be worth pushing harder if you feel that your concerns have not been taken seriously enough.

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