Tics In Children: Characteristics And Treatment

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Tics in children: Characteristics and treatment

Tics in children are sudden, rapid contractions, which are the result of involuntary contractions of one or more muscle groups. As it is one of the most common childhood diseases, then the treatment of it is usually very successful.

Tics are involuntary, repetitive, unpredictable, non-rhythmic muscle movements that can be controlled with one’s will for a short time. Tics in children tend to get worse due to stress or anxiety, but it can be reduced by distracting the person or by concentration.

In the real world, tics is one of the most common motor disorders in children. The involuntary part of the tics seems to start with an impulse and the movement is often done to dampen the impulse. But smaller children with rapid repetitive tics describe them as something that comes suddenly and that they cannot control.

How does it develop?

Tics usually begin when one is between four and seven years old. For most children, the first tics come in the form of repeated blinking of the eyes, snoring when escaping or coughing. It is more common in boys than in girls with a distribution of 3 to 1. 

Tics are very varied in strength and frequency. However, many children aged 4 and 6 with weak or transient tics will not go to the doctor at all. In about 55-60% of young people, these tics will usually not be noticeable when they become teenagers or adults.

In 20 – 25% the tics become less frequent and the last 20% will continue to get tics also as adults.

Clinical characteristics of tics in children

Certain characteristics define these motor movements:

  • Tics get worse with anxiety, fatigue, illness, excessive emotions and too much time in front of the screen.
  • Tics tend to become milder if a child engages in a cognitively demanding and interesting task.
  • Exercise will reduce tics, especially while performing physical activity.
  • Tics will not come across important actions or activities, nor will they lead to falls or injuries.
  • There are tics that are called blocking tics that can lead to these things and in that case you should seek medical attention which can give a diagnosis as to why they are coming.
  • You can notice a significant difference in your tics if one starts filming the one who has tics.
  • They usually occur in people with personality disorders and in dysfunctional families.
  • The children can experience a feeling of pleasure, which is expressed in their face.
  • Those who suffer from it feel that they cannot withhold it.
  • They have no feeling with the draws that will occur.
a child crying

Classification of tics

Tics are classified as  motor  or vocal  and  simple  or  complex. Simple tics are described as sudden movements or short repetitive sounds. Complex motor tics are coordinated, inappropriate and constant movements.

This can be, for example, repetitive shaking of the head, repetition of gestures after others (echopraxia) or by making obscene movements (copropraxia).

Complex vocal tics are normally performed in an inappropriate context. An example of this would be repeating syllables, blocking people’s words, repeating their words (palilalia), repeating words they hear (echolalia) or using obscene words (copropraxia.)

How are tics classified according to DSM-5?

  • Temporary tics (transient). Motor or vocal tics (or both) that have been there for less than a year.
  • Chronic tics. Simple or multiple motor or vocal tics that have been present for more than a year.
  • Tourette’s syndrome (TS). Many motor tics along with vocal tics that have lasted for more than a year. They do not necessarily have to be there at the same time or follow a growing pattern.

Coincidence with tics in children

Children with tics are usually unable to control their impulses. There are large differences in their neuropsychological and motor functions, as well as a high rate of psychiatric and developmental sequelae (where one or more conditions or symptoms are present). These include:

  • ADHD (30 to 60%)
  • Coercive actions (30 to 40%)
  • Anxiety (25%)
  • Disruptive behavior (10 to 30%)
  • Mood swings (10%)
  • OCD (5 to 8%)
  • Autism (5%)
  • Problems with motor skills
  • Outbursts of anger

Etiology

Tics have complex multigenetic etiology and are highly inherited. The agreement of identical twins is 87%.

In the past, tics were considered to be related to behavior or stress and were often referred to as “nervous twitches” or “twitches.” Experts now know that tics are neurological movements that can be aggravated by anxiety, but that is not the cause.

The underlying mechanisms involve several neural networks in the brain, between the cerebral cortex and the basal ganglia (fronto-striatum-thalamus connections).

But they also involve other areas of the brain such as the limbic system, the middle of the brain and the cerebellum. Deviations in interoceptive attention and central sensorimotor processes have also been described.

Treatment of tics in children: Behavioral interventions

Behavioral interventions include several techniques. However, the specific treatment that each child needs will depend on how it develops, how they respond to the treatment, and the things that occur along the way in it (Bados, 2002).

Habit change therapy (HRT) and exposure and response prevention (ERP) are evidence-based interventions against tics. HRT and ERP will reduce the degree of combinations and the frequency score (Yale Global Tic severity score) by between 40% and 50%.

Treatment for interventions in the habits

Treatment for interventions in the habits suggested by Azrin (Azrin and Peterson, 1998) involves teaching patients to recognize the impulse before it manifests itself in the form of tics. They teach them to perform an action called  competitive response that lowers the chances of their tics coming.

It involves 11 important techniques, which are divided into five phases:

  • Attention. This involves being aware of stimuli and situations that come before tics show up.
  • Describe the tic in detail and then train yourself to do this regularly.
  • Learn self-observation to be able to spot tics before it comes.
  • Early detection – one trains how to detect the feeling that comes before tics.
  • Detection of dangerous situations where tics are more likely to occur.
  • Relaxing workout.
  • Train you to respond in a way that can prevent tics from breaking out. This treatment has these purposes:
    • Avoid tics appearing.
    • Keep it away for several minutes.
    • Make the person aware of the situations in which tics appear and their characteristics.
    • These methods must be socially acceptable.
    • They must also fit into the person’s everyday life and daily activities.
    • It should strengthen the “hostile” muscles involved in inducing tics so that they are strong enough to refrain from making these involuntary contractions.
    • The training will usually consist of isometric tension of the muscle that elicits the movements at tics.

Motivation

  • Motivation. This phase is for both the patient and the family. It contains three standard techniques for motivation:
    • Review the negative effects of tics.
    • Social support. This involves getting someone close to you involved and helping you get through the procedure.
    • Perform these training methods in the public space.
  • General training. This implies that the patient must imagine performing the exercises in the various dangerous situations identified in phase 1.
a boy with tics

Therapy with exposure and response as prevention

The practice of being able to avoid exposure and repsons in the form of tics leads to the need to make it conditional. Therefore, this therapy is one that encourages the patient to feel and tolerate the need for tics (exposure) without eliciting tics (preventive response).

During a session of a certain period of time, the therapist asks the patient to try to hold tics back and avoid them. Then they find out how long they can do this.

There is no set goal they need to achieve. The patient gets a lot of help in each session and the time in which they are able to control tics gradually gets longer. 

By applying the exposure therapy with response prevention regularly and systematically, it becomes practically possible for the patient to hold back the impulse to tics. As time goes on, the patient’s ability to control his tics will be very good. This exposes them to the anxiety of getting tics, even if they just talk about it.

Medical treatment of tics in children

The decision to use medication depends on how the individual tics are and doctors usually use it only in severe and severe cases of tics where it can cause pain or injury. Recent research shows that  clonidine  (a presynaptic alpha-2 agonist) is the most widely used drug.

In contrast, antipsychotics and antidopamines appear to be more effective in adults. Clinical practice supports the good results for children with Aripiprazole.

Although doctors do not usually resort to using benzodiazepines in the treatment of tics, they can sometimes do so in acute and very severe cases.

They can use it as a way to eliminate anxiety when tics comes, but it is recommended that one does not use it as there may be certain side effects associated with its use which may trigger other problems.

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