Are Tics in Children a Passing Phase or Tourette Syndrome?

Tics in children are often a passing phase. Many are brief blinks, sniffs, throat clearing or shoulder shrugs that come and go and may fade over weeks or months. Tourette syndrome is diagnosed when both movement and vocal tics have lasted a long time, and it is much less common than a short-lived tic. This article explains how clinicians tell them apart, what can make tics worse, and which signs need urgent care.

Tics in children: a passing phase or Tourette syndrome?

A tic is a sudden, repetitive movement or sound that is not planned. Common examples are eye blinking, nose twitching, head jerks, throat clearing, sniffing and grunting. Many children have a tic at some point, and in many cases it is temporary.

MedlinePlus (NIH) describes Tourette syndrome as a nervous system disorder that causes people to make sudden, repeated movements or sounds. Clinicians generally separate a temporary tic from Tourette syndrome by the types of tics and how long they have lasted. A single short episode in a school-age child is a different situation from tics that have continued for a year or more.

Motor tics and vocal tics

Tics fall into two groups, and each can be simple or complex.

• Simple motor tics: eye blinking, facial grimacing, shoulder shrugging, head jerking.
• Complex motor tics: a pattern of movements done in sequence, such as touching an object or hopping.
• Simple vocal tics: throat clearing, sniffing, grunting, squeaking.
• Complex vocal tics: repeating words or phrases. Saying inappropriate words is much less common than many people expect from television portrayals.

Some children describe a feeling just before a tic, like an itch or pressure that is relieved when the tic happens. Many can hold a tic back for a short time, but doing so can be tiring and the tic may return afterward.

How clinicians tell a temporary tic from Tourette syndrome

There is no single test that settles the question. Clinicians combine the child's history, a description or video of the tics, an examination, and sometimes other testing to rule out other causes. Parents can help by writing down which tics appear, when they began, and how often they change.

The features a clinician usually looks at include:

• Whether both movement tics and at least one vocal tic have been present.
• How long the tics have lasted. Tics lasting more than a year point toward a persistent tic disorder or Tourette syndrome, while tics lasting less than a year are classed as provisional.
• The age when tics began. Tics often begin in early childhood.
• Whether another condition, a medicine or a medical problem could explain the movements.

Diagnostic criteria for Tourette syndrome, as summarized on the MedlinePlus (NIH) Tourette Syndrome page, involve two or more motor tics and at least one vocal tic, present for more than a year, with onset in childhood or adolescence. A shorter course is called a provisional tic disorder. Your child's doctor can explain where your child's pattern fits. A tic that has lasted a few weeks cannot be sorted into a final category on its own.

Why tics wax and wane

Tics often change over time. One tic may fade and a new one may appear, and a child may have weeks when tics are barely noticeable followed by weeks when they are more frequent. This pattern is common and does not by itself suggest the condition is getting dangerous.

Stress, excitement, tiredness and illness can make tics more noticeable in some children. Tics may also be more visible when a child relaxes after school. Scolding or pointing out a tic may increase tension, which can make it more frequent. The exact cause of tics is not fully understood. Researchers think several factors contribute, including genetic influences and differences in brain circuits such as the basal ganglia, which a PubMed Central (NIH) review describes in general terms.

What else can look like a tic

Not every repeated movement is a tic. Other possibilities include habits such as nail biting, eye irritation from allergies or a vision problem that causes blinking, a cough after a cold, and other movement disorders. MedlinePlus (NIH) has an overview of movement disorders. Seizures can sometimes be confused with tics, and a clinician can help sort out the difference. So can a medicine reaction: some tic medicines can cause sustained twisting spasms of the neck, tongue or eyes (an acute dystonic reaction) that are easily mistaken for tics and need urgent care.

Tics that start abruptly with a sharp change in behavior can have other causes, such as a post-infectious syndrome or functional tic-like behaviors, and need prompt evaluation.

Throat clearing or sniffing can be mistaken for allergies, and frequent blinking may lead to an eye exam first. If a child's symptoms have not improved with treatment for those problems, tell the child's clinician that tics are a possibility.

Conditions that often come with tics

Some children with persistent tics also have other conditions. These may include attention-deficit/hyperactivity disorder, anxiety, and obsessive-compulsive symptoms. MedlinePlus (NIH) provides information on obsessive-compulsive disorder, in which unwanted thoughts lead to repeated behaviors. These can differ from tics because they are usually driven by a worry, while a tic is usually described as an urge or an automatic movement.

Sometimes these related conditions affect a child's daily life more than the tics themselves. Our article on signs of anxiety in children parents often miss may help you notice them. If you are also noticing a speech pattern that repeats sounds, the topic of preschool stuttering is covered separately.

How tics affect school and friendships

Tics can be disruptive in class and may draw attention from other children. Some children are teased or bullied. MedlinePlus (NIH) offers guidance on bullying and cyberbullying. Tell your child's teacher what tics are, that they are not done on purpose, and that the child should not be punished for them.

Sleep, physical activity and predictable routines can support a child's overall well-being. A clinician can help you decide what else your family needs.

Being teased or bullied can weigh heavily on a child. If your child talks about self-harm or suicide, take it seriously and stay with them. The 988 Suicide and Crisis Lifeline (call or text 988) is available any time if your child talks about self-harm or suicide. If your child has hurt themselves, has taken pills or other substances on purpose, or is in immediate danger, call 911 and do not leave the child alone.

What treatment can look like

Many children with mild tics do not need medicine. Education for the child, family and school is often the first step. When tics cause distress, pain or problems at school, clinicians may recommend a behavioral therapy such as Comprehensive Behavioral Intervention for Tics (CBIT). Medicines are sometimes used for tics that cause significant problems, and each class has label cautions worth knowing.

• Clonidine and guanfacine (alpha-2 agonists): can cause drowsiness, low blood pressure, dizziness and fainting. Stopping them suddenly can cause rebound high blood pressure and a fast heart rate, so do not stop them suddenly; call the prescriber about missed doses or vomiting, and let the prescriber direct any change.
• Antipsychotics such as risperidone, aripiprazole, haloperidol and pimozide: can cause sustained twisting spasms of the neck, tongue or eyes (acute dystonic reactions), restlessness, new or unusual movements, sedation, weight gain, and changes in blood sugar or cholesterol. Pimozide and haloperidol in particular can affect heart rhythm. A rare but serious reaction called neuroleptic malignant syndrome causes high fever, severe muscle stiffness and confusion. Antipsychotic labels carry warnings that the pharmacist can go over with you.

Ask the prescriber or pharmacist which label warnings apply to your child, including any boxed warning, and whether blood pressure, heart rate, weight or blood sugar checks are needed while your child takes the medicine. Tell the prescriber about drowsiness, dizziness or new movements. Do not change the timing or dose of any prescription on your own.

Some families look into herbal or traditional Chinese medicine approaches. Research on these is still developing, and outcomes vary. Tell your child's clinician about any supplement or herbal product your child takes, because products can interact with prescription medicines.

What parents can do at home

• Stay calm and avoid commenting on tics, which can add pressure.
• Keep a short log, or take a short video on your phone, to show the clinician.
• Note what appears to make tics more frequent or less frequent.
• Protect sleep and plan breaks during busy days.
• Talk with your child about how they feel about tics.

When to see a doctor for a child's tics

Book a visit with your child's pediatrician if tics have lasted for weeks, are becoming more frequent, cause pain or injury, or affect school, sleep or friendships. Tics that begin suddenly alongside a major change in behavior, new compulsions or severe anxiety deserve prompt evaluation, because other causes may need to be considered. A tic starting in an older teen or adult is less typical for childhood tics and should be evaluated. The emergency box below lists signs that need urgent attention, including serious reactions to tic medicines.

When to Seek Medical Care