Tics and Tourette Syndrome in Children

What tics look like

Tics are classified by type and complexity.

Key features that distinguish tics from other movements:

• Premonitory urge: many children over about 10 describe an itch, pressure or tension just before a tic that the tic relieves.
• Suppressibility: tics can often be held back for a short time, but the urge builds.
• Waxing and waning: tics change over weeks and months, with new tics replacing old ones.
• Triggers: stress, excitement, tiredness, illness and screen time often worsen them; focused activities like sports, music or drawing often reduce them.
• Sleep: tics usually lessen markedly or stop during sleep.

Swearing tics (coprolalia) are much less common than people think, affecting only about 1 in 10 people with Tourette syndrome.

The tic disorder spectrum

All start before age 18 and are not due to medicines or another medical condition. Provisional tic disorder (previously called transient tic disorder) is by far the most common. Most children with it never progress to a chronic disorder. The full diagnosis, causes and treatment of Tourette syndrome are covered on the Tourette syndrome page; see also chronic motor tic disorder.

Are tics normal in kids?

Short-lived tics are a normal part of development for many children. A child who blinks hard for a few weeks during a stressful term, or clears their throat for a couple of months, usually needs nothing more than time. Tics are not caused by bad parenting, and children are not doing them on purpose or for attention.

Causes

Tic disorders run in families and involve differences in brain circuits linking the basal ganglia and frontal cortex, particularly those using dopamine. Risk factors include:

• a family history of tics, OCD or ADHD
• male sex
• prenatal factors such as maternal smoking and low birth weight

Some medicines, particularly stimulants, can bring out or worsen tics in susceptible children, although many children with tics and ADHD can take stimulants safely. Sudden, explosive onset of tics with severe OCD after strep infection is described as PANDAS or PANS, a controversial diagnosis that needs specialist assessment.

Functional tic-like behaviors

Since 2020, specialists have seen more teenagers, often girls, with sudden onset of complex movements and vocalizations that differ from typical tics, sometimes after watching social media videos. These are functional neurological symptoms rather than Tourette syndrome. They respond to a different approach, so assessment by a clinician familiar with tic disorders is important.

Conditions that often come with tics

For many children, co-occurring conditions cause more difficulty than the tics themselves:

• ADHD in about half of children with Tourette syndrome
• OCD or obsessive-compulsive behaviors
• anxiety and depression
• learning difficulties, sleep problems and anger outbursts

When to see a doctor

See your pediatrician if tics last more than a few months, are painful, disrupt school or friendships, or come with attention, mood or behavior problems. The diagnosis is clinical, based on history and observation. A video of the tics on your phone is helpful, since children often suppress them in the clinic. Blood tests, EEG and brain scans are not needed unless something unusual suggests another condition, such as seizures.

How to help a child with tics

At home

• Do not draw attention to tics. Asking a child to stop increases stress and the urge.
• Explain tics simply: "Your brain sometimes sends messages to move or make sounds. It is not your fault."
• Reduce triggers: regular sleep, managing stress, breaks from screens.
• Focus on strengths and activities that absorb your child.
• Treat co-occurring problems, which often improves tics indirectly.

At school

• Share information with teachers so tics are not mistaken for misbehavior.
• Agree on a quiet place to release tics and extra time on tests if needed.
• Address teasing promptly.

Treatment options

• Comprehensive Behavioral Intervention for Tics (CBIT): the first-line treatment when tics cause problems. Children learn to recognize the urge and use a competing response, a movement that makes the tic hard to do. Habit reversal training and exposure with response prevention are related approaches.
• Medicines: considered when tics cause pain, injury or major disruption despite behavioral therapy. Options include alpha-2 agonists (guanfacine, clonidine), which also help ADHD, and antipsychotics such as aripiprazole for more severe tics. Topiramate is sometimes used.
• Botulinum toxin injections for a single troublesome tic in older teens and adults.
• Deep brain stimulation is reserved for rare severe, treatment-resistant adult cases.

Outlook

Tics usually begin around ages 4 to 7, are most intense between about 10 and 12, and then improve during adolescence. By early adulthood, about half of people with Tourette syndrome are nearly tic-free and many others have only mild tics. Provisional tic disorder resolves within a year by definition. The most important influence on long-term well-being is how co-occurring conditions and social challenges are managed.

Frequently asked questions

Are tics in children normal?

Short-lived tics are very common and usually harmless, affecting up to 1 in 5 school-age children. Most last weeks to months and disappear. Tics that persist beyond a year, cause problems or come with other symptoms should be assessed by a doctor.

What is the difference between a tic disorder and Tourette syndrome?

Tic disorders are a spectrum. A provisional tic disorder lasts less than a year. Persistent motor or vocal tic disorder involves only one type of tic for over a year. Tourette syndrome requires multiple motor tics and at least one vocal tic for more than a year, starting before age 18.

Can tics be caused by anxiety or stress?

Stress and anxiety do not cause tic disorders, but they commonly make tics worse. Excitement, tiredness and illness can too. Tics tend to lessen when a child is calm and focused. Managing anxiety and getting enough sleep often reduces tic frequency.

Should I tell my child to stop their tics?

No. Tics are involuntary, and pointing them out or asking a child to stop usually increases stress and makes tics worse. It is better to ignore mild tics, reduce triggers, and if tics are bothersome, seek behavioral therapy such as CBIT, which teaches the child strategies.

Do children grow out of Tourette syndrome?

Many do, to a large extent. Tics usually peak around ages 10 to 12 and improve through the teenage years. By adulthood, about half are nearly tic-free and most of the rest have milder tics. A minority continue to have significant tics as adults.