Tics

Disclaimer These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Introduction

Tics are fast, repetitive muscle movements that result in sudden and difficult to control body jolts or sounds. They’re fairly common in childhood and typically first appear at around 5 years of age. For most children, tics will get worse around adolescence and then will reduce, but for others their tics will stay the same. One in every three children with tics will get better as they grow into adulthood.

Tics can occur everywhere in the body. The first motor tics tend to be of the face and as they get older tics can move to other areas such as the neck, arms and legs.

Sound tics tend to start off as a simple noise such as sniffing or one sound. They can later become more complex and include words or sentences.  Not everyone experiences these in the same order.¹Tourette's syndrome is caused by the way our brain is wired. It is often hereditary and most people can identify someone in their extended family with tics or obsessive compulsive disorder (OCD).    

Some children with Tourette's syndrome may have co-existing conditions such as OCD, attention deficit hyperactivity disorder (ADHD) and/or anxiety.

Main types of tics

• Movement or motor tics can be simple like shoulder shrugs or touching things.
• Complex motor movement tics affect more than one muscle group, for example arms and legs tense at the same time or when several tics happen together- such as twisting your body and slapping themselves.
• Simple sound or vocal tics can include repeated sounds, such as throat clearing or making a specific noise
• Complex sound tics may involve making several sounds or sentences. 

Pre-referral management  

Consider a referral to Child and Adolescent Mental Health Services (CAMHS) for:

• Children and young people who have a diagnosis of Tourette’s syndrome/tics who need management of co-existing conditions such as OCD, ADHD or anxiety.
• Some CAMHS teams will also be able to deliver behavioural therapy for managing tics, because they have clinicians with an interest in Tic disorders. ²

Management of tics

There is no known cure for tics.

Treatment can include drug and non-drug approaches and with continued support and understanding from others it is possible for them to lead a fulfilling life. ²

Encourage a healthy lifestyle which includes  regular exercise and a balanced diet to promote general well-being and help reduce stress. Helping them to feel good about themselves can help them cope with times when symptoms might be uncontrolled. ²

Medication does not treat the underlying cause of tics but can treat some of the symptoms. It is important for clinicians to work closely with the patients and their families when deciding on treatment.  Finding the right treatment is an individual process. Someone may have to try different types of medication under the supervision until they find the right combination that best suits them. ²

References

1. www.gosh.nhs.uk
2. www.tourettes-action.org.uk 

Reviewer/team:	Dr Helen Wright, Dr Ciara Peake, Claire Franklin GENP CNS	Review date:	Jan 2022
		Next review date:	Jan 2025
Endorsed by:	Medical Advisory Committee (MAC)	Date:	Jan 2022

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