By Claire Mitchelmore – Provisional Psychologist

You may have noticed your child making regular sudden jerking movements or seemingly involuntary sounds.   You may be worried that these behaviours, called tics, are drawing unwanted attention from others, interfering with your child’s daily life, or are impacting negatively on their wellbeing.

Here’s what you need to know about Tic Disorders and Tourette’s syndrome, and what we can do to support your child manage these behaviours and improve their quality of life.

What are tics and how do they manifest?

Tics are sounds or movements that are often described by parents and their children as repetitive, annoying, ritualistic, and uncontrollable. It is important for parents and carers to understand that they are involuntary and out of the child’s conscious control. Children experience an overwhelming urge to perform the sound or movement which results in the action taking place, followed by a sense of relief. They are different to autistic stimming behaviours which provide a sense of comfort, or OCD compulsions which feel functional and safety related.

Tics are neurological conditions and seem to be largely hereditary. Differences in brain wiring may explain why you may see these behaviours in your child. Specifically, it appears that there may be faulty communication between your child’s decision making and urge centres in the brain which results in unconscious urges being acted on instead of being naturally suppressed. Increased activity in the motor centres of your child’s brain may also magnify their response to communicated urges.   Environmental factors such as stress and poor sleep can make their tics worse.

Tics are fairly common, with one in five children experiencing tics at some point in their development, usually starting between the ages of 4 and 6, with symptoms becoming more noticeable in early adolescence. Most tics are mild and resolve naturally over time whilst others may become more persistent and interfere significantly with daily living. They are often accompanied by other neurodivergent brain styles such as attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), or anxiety disorders.

It is when tics persist and start to interfere in daily living that your child may be diagnosed with a tic disorder. Tics are usually categorised in the following way:

Simple motor tics – such as eye blinks, shoulder shrugs, or head jerks

Simple Vocal tics – such as throat clearing, grunting, or humming

Complex motor tics – such as touching objects, twisting in a certain manner, or hopping

Complex vocal tics- such as repeating phrases or saying socially inappropriate words

It is more common for children to exhibit either motor or vocal tics. Children who present with both motor and vocal tics may be diagnosed with Tourette’s Syndrome, which is considered a more complex and severe presentation of tics. Although approximately one third of children will have symptoms that carry on into adulthood,  many find that the condition improves over time with the right treatment and support. Treatment may include medication supported by behavioural interventions such as that described below.

The Benefits of Comprehensive Behavioural Intervention for Tics

Comprehensive Behavioral Intervention for Tics (CBIT, pronounced see-bit) is considered the gold standard treatment for managing tics and is particularly effective in helping people gain control over their tic behaviours without relying solely on medication. It is a behavioural intervention in which the child, and their parents and caregivers, are provided with the skills to become aware of the urge to tic, identify situations that trigger tics, and develop strategies to suppress the tic by practicing ‘competing responses’.  The benefits of CBIT are a reduction in symptoms and improved quality of life.

Key benefits of CBIT for tics:

• Increased awareness:

CBIT helps individuals identify the premonitory urge, the feeling that occurs just before a tic, allowing them to anticipate and potentially manage the tic before it happens.

• Competing response training:

This core technique involves learning a deliberate movement that opposes the tic, making it difficult to perform the tic when the urge arises.

• Environmental modification:

CBIT assists in identifying situations or stressors that worsen tics and developing strategies to manage these triggers, creating a more stable environment.

• Improved coping skills:

By learning relaxation techniques and stress management strategies, individuals can better cope with the urge to tic in challenging situations.

• Empowerment and self-efficacy:

CBIT provides individuals with a sense of control over their tics, enhancing their self-esteem and confidence.

• Non-medicated approach:

Unlike medication, CBIT is a behavioural therapy that does not involve side effects from drugs.

• Suitable for diverse populations:

CBIT can be adapted for children, adolescents, and adults with tic disorders who may also present with co-occuring neurodevelopmental disorders and mental health conditions.

Whilst numerous studies have shown that CBIT can show benefits in just 6-8 sessions, its success depends on the motivation of the child and the willingness of parents, caregivers, and teachers to support the child throughout therapy.

Success stories of children and teens reducing tics through CBIT

Children and teenagers often come to our practice with complex needs and varying presentations. Your CBIT trained therapist will work with you and your child to tailor a treatment plan, using CBIT and other skills, to meet your specific needs. Here are some interesting success stories that we’d like to share (names and some details have been changed to protect clients’ identities):

• Lucy, 13 years old

Lucy, diagnosed with Tourette’s syndrome, came to the practice displaying vocal as well as significant motor tics in which she twisted her body uncomfortably and resulted in pain.  Lucy had also been diagnosed with OCD, in which she felt compelled to maintain daily routines such as making her bed in a certain way. She was already taking medication for her tics and, with the support of her parents, Lucy participated in CBIT with one of our therapists. Whilst Lucy responded well to the treatment, she still displayed some tics when she was excited or overwhelmed. Her therapist then worked on strategies to better regulate her in these situations and helped her to more effectively manage stress, reducing her tics even further and bringing much relief to the pain and discomfort her tics caused.

• Mark, 9 years old

Mark’s parents complained of annoying vocal tics (humming) particularly whilst the family was travelling in their car. He also displayed simple physical tics such as clicking his fingers and knuckles. Mark himself was not bothered by these behaviours and was therefore not motivated to engaged in therapy for his diagnosed Tourette’s. Inattentive and hyperactive behaviours due to possible undiagnosed ADHD also interfered in Mark’s ability engage effectively in CBIT. His therapist therefore adjusted her approach, working with Mark’s parents to identify functional issues that could be addressed through problem-solving. Mark’s parents worked with the therapist to implement some changes to his environment, such as finding activities to relieve Mark’s boredom in the car, which assisted in a significant reduction in his humming and joint clicking in the car and at home.

• Stan, 11 years old

Stan’s teacher had raised concerns about Stan’s simple, yet significant, motor tic. She had noticed that Stan was started to be teased by children at school for thrusting his tongue out many times within short periods of time. Stan and his parents participated in CBIT, but his therapist found medication for a severe neurological condition was interfering with his ability to build awareness of his urge to stick his tongue out. The therapist therefore adjusted her approach to involve his parents and teacher more intensely to support him in developing the required habit reversal behaviours. She also engaged with his neurologist to provide him with ongoing support. Over several weeks, Stan’s teacher and parents reported a substantial decrease in the frequency of his tic.

With the right treatment and support, children with Tourette’s or tic disorder can help to feel in control of their bodies and be relieved of uncomfortable, annoying, or embarrassing symptoms.  If tics are a concern to you or child, please do not hesitate to reach out to our friendly team so that we can support you in returning to live your best life.

If you would like to meet more of our team, or learn more about our services you can do so here https://spencerhealth.com.au/spencer-health-team/ or if you are ready to book in, you can do so here https://spencerhealth.com.au/contact/