While there’s currently no cure for tic disorders, effective treatments are available to manage tics. If tics lead to physical discomfort, injury, interfere with daily life at school, work, or social settings, or cause significant stress, both medication and behavioral therapies can provide relief. Accurate diagnosis is the crucial first step in accessing the right support and management strategies.
Classifying Tic Disorders: A Diagnostic Overview
Healthcare professionals rely on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) 1 as the standard guide for diagnosing tic disorders. This manual provides specific criteria to differentiate between various tic disorders.
Within the DSM-5-TR, tic disorders are categorized into three main types:
- Tourette Syndrome (TS), sometimes referred to as Tourette Disorder
- Persistent (or Chronic) Motor or Vocal Tic Disorder
- Provisional Tic Disorder
These disorders are distinguished based on the type of tics present – motor, vocal, or a combination – and the duration of symptoms. Tourette Syndrome is characterized by the presence of both motor and vocal tics lasting for at least a year. Persistent Motor or Vocal Tic Disorder involves either motor or vocal tics, also present for at least a year. Provisional Tic Disorder is diagnosed when tics, either motor, vocal, or both, have been present for less than a year.
Diagnosing Tourette Syndrome (TS)
For a diagnosis of Tourette Syndrome to be made according to the DSM-5-TR, an individual must meet the following criteria:
- Presence of Multiple Tics: The individual must exhibit two or more motor tics (examples include eye blinking or shoulder shrugging) and at least one vocal tic (such as humming, throat clearing, or uttering words or phrases). These tics do not necessarily need to occur simultaneously.
- Duration of Tics: Tics must have been present for a minimum of one year. They can occur frequently throughout the day, often in bouts, nearly every day or intermittently.
- Age of Onset: The onset of tics must occur before the age of 18 years.
- Exclusion of Other Causes: The symptoms must not be attributable to the physiological effects of a substance (e.g., medication, drugs) or another medical condition (such as seizures, Huntington’s disease, or post-viral encephalitis).
Alt text: A child exhibiting eye blinking, an example of a common motor tic in tic disorders.
Diagnosing Persistent (Chronic) Motor or Vocal Tic Disorder
The diagnostic criteria for Persistent Tic Disorder, as outlined in the DSM-5-TR, are:
- Type of Tic: The individual must have one or more motor tics (e.g., blinking, shoulder shrugs) or vocal tics (e.g., humming, throat clearing, yelling words or phrases), but not both motor and vocal tics concurrently.
- Tic Frequency and Duration: Tics must occur many times a day, nearly every day or intermittently, for a period exceeding one year.
- Age of Onset: The tics must begin before the age of 18 years.
- Ruling Out Other Causes: Symptoms should not be due to the effects of medications, drugs, or a medical condition known to cause tics (e.g., seizures, Huntington’s disease, or post-viral encephalitis).
- Exclusion of Tourette Syndrome: The individual must not meet the diagnostic criteria for Tourette Syndrome.
Alt text: Individual demonstrating shoulder shrugging, a motor tic associated with persistent tic disorder.
Diagnosing Provisional Tic Disorder
Provisional Tic Disorder Diagnosis is considered when the following criteria are met:
- Tic Presentation: The individual experiences one or more motor tics (e.g., blinking, shoulder shrugging) or vocal tics (e.g., humming, throat clearing, uttering words or phrases).
- Symptom Duration: Tics have been present for less than 12 consecutive months.
- Age of Onset: Tic onset occurs before 18 years of age.
- Excluding Secondary Causes: The tics are not a result of medication, drugs, or an underlying medical condition known to induce tics (e.g., Huntington’s disease or post-viral encephalitis).
- Exclusion of Other Tic Disorders: The individual must not have been diagnosed with Tourette Syndrome or Persistent Motor or Vocal Tic Disorder.
Tics Following Strep Infections and PANDAS/PANS
In some instances, a sudden onset or worsening of tics in children may be linked to a streptococcal (strep) infection, such as strep throat or scarlet fever. This condition is often referred to as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). A broader term, Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), encompasses similar sudden onset neuropsychiatric symptoms, including tics, that are not necessarily linked to strep infections but may be triggered by other infections or environmental factors.
Learn more about PANDAS and PANS
It’s important to consult with a healthcare professional if a child experiences a sudden onset of tics, especially following an infection, to determine if PANDAS/PANS might be a contributing factor.
Differentiating Tic Disorders from Tic-Like Behaviors
It’s crucial to distinguish between tic disorders and sudden onset tic-like behaviors, particularly in adolescents, especially girls. These tic-like behaviors may resemble tics but differ in presentation and underlying causes. Often, individuals experiencing these behaviors are developing movement symptoms for the first time without a prior history of tics. These behaviors can sometimes occur in clusters among groups of children or teenagers.
Experts suggest that these sudden onset tic-like behaviors may stem from various factors and might necessitate different treatment approaches compared to classic tic disorders like Tourette Syndrome. A comprehensive assessment by a healthcare provider experienced in tic disorders is essential for accurate diagnosis and appropriate management.
Further Reading: Explore more about Functional Tic-like Behaviors
Navigating a Tic Disorder Diagnosis: Next Steps
Receiving a tic disorder diagnosis, whether for yourself or your child, can be overwhelming. Taking a proactive approach by learning about the specific tic disorder, available treatments, and symptom management strategies is empowering.
- Consult with Healthcare Professionals: Address any questions or concerns with your healthcare provider. Open communication is key to effective management.
- Educate Yourself: Gain in-depth knowledge about tic disorders. Reliable resources include fact sheets, treatment guides, and information on co-occurring conditions.
- Address Co-occurring Conditions: Discuss any other symptoms or concerns beyond tics with your healthcare provider. Many individuals with tic disorders also have other mental health, behavioral, or developmental conditions, which require integrated care. Learning difficulties are also common.
- Utilize Support Organizations: The Tourette Association of America and similar organizations offer valuable information, resources, newsletters, videos, and local healthcare provider directories.
Alt text: A supportive conversation between an adult man and woman, representing resources for individuals and families affected by tic disorders.
Finding Support and Community
Parenting, in general, presents challenges, and raising a child with a chronic condition like a tic disorder can add further complexities. Connecting with other parents of children with tic disorders can provide invaluable peer support, a space to share experiences, and exchange helpful information. Similarly, adults with tic disorders can benefit significantly from connecting with peers.
Remember, every family’s journey is unique. Treatment and management choices that work for one family may not be suitable for another. Therefore, understanding all available options and discussing them thoroughly with healthcare providers is crucial for making informed decisions tailored to your specific needs.
Resources
- National Institute of Neurological Disorders and Stroke (NINDS)
- Centers for Disease Control and Prevention (CDC)
- Tourette Association of America
[1] American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
