My Child Experiences Facial Tics: Is It Tourette’s Syndrome?

If your child is experiencing facial tics, it can sometimes be concerning as you want to understand why they are experiencing tics in the first place. Read this article for more information on facial tics and how to know if it is Tourette’s syndrome or not.

Is there a difference between facial tics and Tourette’s Syndrome?

The short answer when wondering if there is a difference between facial tics and Tourette’s Syndrome is, yes. Tics are defined as sudden movements, twitches, or sounds that people do that they are not consciously in control of. This means that these happen without thought, and people may make these movements and/or sounds unwillingly.

All people who have Tourette’s Syndrome have tics. Tourette’s is a neurological condition that affects a person’s nervous system, causing them to tic. These tics usually begin in childhood, around elementary school age. Typically, tics become the most prevalent for young children around the ages of 10-12 years old.

Commonly, the severity will wane slightly through adolescence; however, this is not the case for all people. When tics begin, a person may have movement-based tics, vocal tics, or a combination of both kinds of tics. After a year, if tics continue to occur, a Tourette’s diagnosis may be made by a qualified healthcare provider.

What types of tics exist?

There are three different types of tic disorders defined in The American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These include Tourette’s Syndrome, Persistent (chronic) motor or vocal tic disorder, and Provisional tic disorder. This means that, while a child may tic, they might not have Tourette’s.

For Tourette’s, different types of tics exist, including motor, vocal, simple, and complex tics.

Motor tics involve movements of the body, whereas vocal tics involve sounds that people make with their voice. If the tics are simple, it means that they involve only a few parts of the body. Some examples of simple motor tics include blinking or squinting, grimacing, twitching the nose, jerking of the head or neck, shrugging, moving the arms or hands, tensing the abdomen, and/or rapidly jerking any part of the body.

Complex tics involve different parts of the body. Some examples of complex motor tics include movement of the eyes while touching objects, rubbing or tapping objects or people, sticking out one’s tongue and/or biting one’s lip, clapping while throwing or pinching, kissing or using distinct facial expressions, and bending over one’s body while imitating the movement of others.

The other subgroup of tics is called phonic (or vocal) tics, in which an individual makes audible noises such as clearing of the throat, coughing, sniffing, whistling, grunting, squeaking, making animal noises, repeating phrases, changing one’s volume, and/or repeating phrases.

If someone has persistent (chronic) motor or vocal tic disorders, and they have not been diagnosed with Tourette’s, they may:

• Have one or more motor or vocal tics (not both)
• Have tics consistently over days or years
• Have tics that develop before the age of 18
• Have tics that are not due to taking medications

If someone has provisional tic disorder and has not been diagnosed with Tourette’s, a person may:

• Have one or more motor tics or vocal tics
• Have tics for less than a year
• Have tics that start before the age of 18
• Have tics that are not due to taking medications

How to get tested for Tourette’s

Once you have determined that your child is having tics, the child should undergo thorough testing with a qualified healthcare practitioner to obtain an appropriate diagnosis and/or to receive the appropriate care.

There is no blood test to diagnose Tourette’s, and healthcare providers will typically evaluate a person’s symptoms to make a diagnosis. As mentioned above, because the different types of tic disorders vary based on the types of tics and how long symptoms last, Tourette’s is usually diagnosed through a process of elimination.

To get a Tourette’s diagnosis, a person may:

• Have two or more motor tics and a vocal tic (these two do not have to occur at the same time)
• Have tics that have been present for at least one year and are reoccurring consistently
• Have tics that begin before 18 years of age
• Have symptoms that are not due to taking medications

If your child receives a diagnosis of Tourette’s syndrome, this does not mean that tics will worsen over time. It is also helpful to be aware of any cooccurring conditions that may take place in a child with Tourette’s. Some common conditions that children with Tourette’s experience include:

• Attention Deficit Hyperactivity Disorder (ADHD): difficulty concentrating and/or hyperactivity
• Obsessive Compulsive Disorder (OCD): repetitive, undesired thoughts, ideas, or patterns that make people believe that they need to repeat behaviors in a very particular way or order
• Anxiety: fear, uneasiness
• Learning challenges: difficulties learning in school, not correlated with intelligence
• Behavioral concerns: socially inappropriate or concerning behaviors
• Sleep disturbances
• Sensory issues: difficulty responding to sensory information, such as touch, taste, and smell

While there are not any blood or lab tests conducted for Tourette’s, neuroimaging tests can be used in less common cases to help diagnose Tourette’s. These scans can help to rule out other conditions, again arriving at a Tourette’s diagnosis through the process of elimination.

Because this process of diagnosis is not as clear-cut as a lab test, a formal diagnosis of Tourette’s may take some time. If you do not have a healthcare provider who is knowledgeable about Tourette’s, or if you feel as though a symptom of Tourette’s (such as sniffing) is due to something different, like allergies, it can sometimes take a longer time to reach the diagnosis of Tourette’s.

Interventions that can help manage tics

If your child receives a diagnosis of Tourette’s Syndrome, it can be helpful to understand how to help your child to manage their tics. There is no cure for Tourette’s, but treatments can help individuals to manage their tics.

The first type of intervention when it comes to helping your child manage their tics is behavioral treatment. This is known as Comprehensive Behavioral Intervention for Tics (CBIT). Because Tourette’s affects the nervous system, focusing on behavioral intervention can be effective for some people living with Tourette’s. CBIT teaches a person living with Tourette’s about becoming more aware of their behaviors and helps them to focus on slow, stepwise behavior change.

Steps included in CBIT-based programs focus on:

• Becoming more aware of the tics a person has and what the urges to tic feel like
• Choosing and practicing new behaviors to replace their tic
• Becoming aware of situations that make tics worse
• Interventions for better stress management

The second type of intervention to help people living with Tourette’s to manage tics is medication-based. Medications can be used to reduce tics and are typically those used to reduce symptoms of other conditions such as ADHD or OCD. However, medications cannot eliminate tics and affect each person differently.

A medication that may reduce tics in one person may not be in the next person. It is important to work with a qualified healthcare professional to determine what medication may be best for helping your child to manage tic recurrence. Common side effects often occur with medication usage, such as weight gain, muscle stiffness, tiredness, restlessness, and personality differences.

There are different kinds of medications used to treat Tourette’s, such as:

• Those that block dopamine: these are the most used medications to help reduce tics
• Alpha-adrenergic agonists: these are used in some cases to help reduce blood pressure, but may help to reduce tics for some people
• Stimulant medications: these can reduce symptoms associated with ADHD and can help reduce tics for some people
• Antidepressants: these drugs block serotonin inhibitors and help to provide relief for symptoms of depression, OCD, and anxiety, helping to reduce tic recurrence in some people

Another important intervention to consider is within the school and/or educational setting that a child is in. Because a child with Tourette’s may present with different learning abilities and/or social challenges, you can set them up for success within the right school and/or educational setting. Try to choose a school that is Tourette’s informed, and/or that has options for children with learning challenges.

A child should be provided with a thorough assessment and placed in a setting that meets their needs. Many students may need additional help, tutoring, smaller class sizes, different testing settings, or individual accommodations to best succeed. This helps with managing tic prevalence as it creates an environment that children with Tourette’s can feel less stressed and more aware of themselves and their behaviors.

Overall, Tourette’s is a condition that is worth being knowledgeable about so that you can help your child, or someone that you know living with Tourette’s. Report back, what is the most helpful piece of information that you have learned when it comes to the management of Tourette’s syndrome?

Jordan Stachel holds a Master’s degree in Nutrition and Dietetics from The University of Southern California and is a Registered Dietitian Nutritionist. She has several years of experience helping clients reach their health goals through her clinical work within private practice. Jordan is most fulfilled when guiding others towards making stepwise, sustainable changes that add up to big results over time. Jordan works with a wide variety of individuals, ranging in age from children through the elderly, with an assortment of concerns and clinical conditions. She helps individuals optimize overall health and/or manage disease states using personalized medical nutrition therapy techniques.

References:

1. https://www.cdc.gov/ncbddd/tourette/diagnosis.html
2. https://www.cdc.gov/ncbddd/tourette/treatments.html
3. https://www.cdc.gov/ncbddd/tourette/diagnosis.html#TS
4. https://www.cdc.gov/ncbddd/tourette/features/tourettesyndromeawareness.html
5. https://www.cdc.gov/ncbddd/tourette/facts.html
6. https://www.texaschildrens.org/blog/tics-and-tourette-syndrome-101
7. https://www.ninds.nih.gov/tourette-syndrome-fact-sheet