Tic Disorder and Tourette’s

A tic is an involuntary, recurring and stereotyped motor movement or vocalisation. Tics are more common in children than adults and usually present around 6-7 years of age. Although tics often resolve spontaneously, they can have a significant impact on self-esteem and social interactions.

The most well known tic disorder is Tourette’s Syndrome. People with Tourette’s Syndrome experience both motor and vocal tics while those with other tic disorders may experience one or more motor (or vocal) tics. Tics can be variable or chronic in nature and are often preceded by a tension or sensation in the particular muscle group (a premonitory urge) and followed by a feeling of relief succeeding the expression of the tic. Although obscene gestures (Copropraxia) and words (Coprolalia) are commonly associated with Tourette’s Syndrome in the media, these tics are actually relatively uncommon.

 

Examples of motor tics

  • Eye blinking
  • Nose wrinkling
  • Neck jerking
  • Shoulder shrugging
  • Facial grimacing
  • Hand gestures
  • Stomping
  • Touching

Examples of vocal tics

  • Throat clearing
  • Grunting
  • Sniffing
  • Snorting
  • Whistling
  • Hissing
  • Spontaneous expression of single words or phrases

 

Treatment for Tics

Although tics have a neurological basis environmental factors have been shown to interact with biological factors in influencing tic variability. Behavioural interventions, such as Habit Reversal Therapy (HRT) and Comprehensive Behavioural Intervention for Tics (CBIT), can help with managing the intensity, frequency and duration of tics and provide confidence to cope effectively in situations when tics occur.

 

What are the main components of HRT and CBIT?

Awareness Training: This involves teaching awareness of the urges associated with tics and of how tics start and progress. This is followed by practice noticing the urge or beginning of the tic.

Competing Response Training: A behaviour is selected that is physically incompatible with the tic and this behaviour is practiced when the urge or beginning of the tic is noticed, in order to break the link between the urge and the tic. For example, if the tic involves opening the mouth the competing response might be to practice clenching teeth together.

Environmental Analysis: An examination of possible environmental triggers and reinforcers of the tics is undertaken. If triggers or reinforcing consequences are identified, a problem-solving approach is taken to identify strategies to manage these environmental factors.
People with tic disorders often experience a number of co-morbid conditions including anxiety, low self-esteem, feelings of shame, self-consciousness, social isolation/rejection and depression. Obsessions and compulsions are also common. Cognitive Behavioural Therapy (CBT) can be used to teach strategies to cope with and manage the symptoms of these co-occurring conditions. This is particularly important as internal states such as stress and anxiety are likely to influence tic frequency, intensity and duration and can often be a source of greater distress than the tics themselves.

 

If you would like to find out more about our treatment for tic disorders, or to book an appointment with one of our clinical psychologists who provides treatment for this condition, please email or call the clinic on 0405 430 530.

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