Transient Tic Disorder (Provisional Tic Disorder)

What a tic is

A tic is a sudden, rapid, repeated movement or sound that is not rhythmic. Tics are often preceded by an uncomfortable urge or itch (a premonitory urge) that is relieved by doing the tic. Children can sometimes hold a tic back for a short time, but it usually returns, often more strongly. Tics tend to:

• come and go in bouts, and change type over weeks or months
• get worse with stress, excitement, tiredness or illness
• get better when the child is calm and focused on an activity, such as sport or a video game
• decrease or disappear during sleep

Types of tics

Transient tic disorder usually involves simple tics. The face and head are the most common sites, and eye blinking is the classic first tic.

Diagnosis: provisional vs chronic vs Tourette

Tic disorders are defined by the type and duration of tics, using the DSM-5-TR:

All require onset before age 18 and that the tics are not caused by a medicine or another medical condition. Because the label depends on duration, a diagnosis of provisional tic disorder can only be confirmed, or revised, over time. See chronic motor tic disorder for tics lasting more than a year.

Diagnosis is clinical: a doctor takes a history, watches for tics (which often stop in the clinic), and examines the child. Parents' phone videos are very helpful. Tests such as EEG or MRI are only needed if something suggests seizures or another neurological problem.

Causes

Tics come from differences in brain circuits linking the basal ganglia and frontal cortex, which help filter unwanted movements. Contributing factors include:

• Genetics: tics often run in families.
• Sex and age: boys are affected about 3 to 4 times more often; tics most often appear between ages 4 and 7 and peak around 10 to 12.
• Triggers that worsen tics: stress, excitement, fatigue, illness, and sometimes allergies or eye irritation for blinking tics.
• Medicines: stimulants for ADHD can occasionally unmask or worsen tics, but large studies show most children with tics tolerate them.

Tics are not caused by bad parenting, and the child is not doing them on purpose.

Conditions that often occur with tics

• ADHD
• Obsessive-compulsive disorder and repetitive behaviors
• Anxiety
• Learning differences and sleep problems

These often cause more difficulty than the tics themselves, so they are worth assessing.

Conditions that can look like tics

• Habits such as nail biting, which are more voluntary
• Stereotypies: rhythmic hand flapping or rocking, often when excited, beginning before age 3
• Absence seizures: staring spells with unresponsiveness
• Eye problems such as dry eye or allergic conjunctivitis causing blinking
• Allergies or asthma causing sniffing and throat clearing

How to help a child with tics

Most transient tics fade with no treatment. The response of family and teachers makes a real difference:

• Do not draw attention to the tics. Asking a child to stop or commenting on them increases stress and often makes tics worse.
• Reduce triggers: good sleep, regular routines, managing stress, and breaks from screens if they seem to increase tics.
• Explain to the child in simple words that tics are common and often go away.
• Inform teachers if tics are noticeable, so they can respond calmly and prevent teasing.
• Keep a diary of when tics occur, their type and possible triggers.

Treatment when tics cause problems

• Comprehensive Behavioral Intervention for Tics (CBIT): first-line treatment recommended by the American Academy of Neurology. It teaches awareness of the urge and a competing response that makes the tic hard to perform. It is effective in children aged about 9 and older.
• Exposure and response prevention: another behavioral approach.
• Medicines such as guanfacine, clonidine or aripiprazole are generally reserved for persistent, severe tics, usually in chronic tic disorder or Tourette syndrome, rather than transient tics.

Outlook

Most children with transient tics improve within weeks to months. Some go on to have tics for more than a year, which is then diagnosed as a chronic tic disorder or Tourette syndrome. Even then, tics usually lessen markedly during the teenage years, and many young adults have few or no tics.

Frequently asked questions

Do childhood tics go away on their own?

Most do. Transient tics often fade within weeks to a few months, sometimes returning briefly during stress or illness. If tics last longer than a year, the diagnosis changes to a chronic tic disorder or Tourette syndrome, but these also tend to improve in adolescence.

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

Transient (provisional) tic disorder means tics have been present for less than a year. Tourette syndrome requires multiple motor tics and at least one vocal tic for more than a year. A child with transient tics may never develop Tourette syndrome.

Why does my child keep blinking their eyes?

Repeated hard blinking in a school-age child is often a simple motor tic, especially if it comes and goes and worsens with tiredness or excitement. Eye problems such as dryness, allergies or a need for glasses can cause similar blinking, so an eye check is sensible if it persists.

Should I tell my child to stop their tics?

No. Tics are involuntary, and telling a child to stop usually increases stress and makes tics worse. Ignore them in daily life, reduce stress, and ask a doctor about behavioral therapy if tics are distressing or interfere with school or friendships.

Can anxiety cause tics?

Anxiety does not cause tic disorders, but stress and anxiety commonly make tics more frequent. Many children with tics also have anxiety, and treating it can reduce tics. Tics often lessen during calm, absorbing activities.