Category: Tic Disorders

The COVID-19 pandemic and quarantine was a massive paradigm shift in how many people carried about their day to day lives. As with any large or small change to someone’s habits and routines, there is a level of stress associated with this. This stress alongside prolonged negative emotions such as loneliness and powerlessness drove the occurrence of the initial episodes of mental illnesses to occur in people or worsened them (Chatterjee & Chauhan, 2020). One section of the population where this trend was observed was children. More specifically, pediatricians and child mental health professionals in the United Kingdom noted an increase in tic symptoms in children and adolescents already diagnosed with tic disorders and an increase in presentations of sudden onset severe tics and “tic-like attacks” (Heyman, Liang, and Hedderly, 2021).

Tics are classified as “sudden, uncontrollable twitches, movements, or sounds that people do repeatedly”(CDC, 2021). There are currently three tic disorders that are included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The three disorders are Tourette’s disorder, Chronic motor or vocal tic disorder, and Provisional tic disorder (DSM-5). One of the main factors that distinguishes the three disorders is the length of time that people have had tics, as well as the number of motor and/or vocal tics they perform (CDC, 2021). Tourette’s is the most involved diagnosis, as it is diagnosed in people who have two more motor tics and at least one vocal tic for at least a year. In comparison to the other two disorders, which vary in the length of time with symptoms and number of tics. 

Medical professionals postulate that tic-like attacks are primarily caused by underlying built-up anxiety in adolescents, but this cannot be used as a blanket explanation because previous studies have shown that the stress-tic relationship is not a linear one (NHS Choices, 2022). In one study that looked at a sample of children with co-occurring tic and anxiety disorders, the data suggested that tic frequencies may not change or change in implausible ways during acute periods of stress (Conelea et al., 2014). The main gripe with this study, though, comes in the form of the researchers not properly defining their definition of “acute”, as the quarantine was certainly not a 1 or 2 week event (2014). Therefore, anxiety may not be entirely the cause of tic disorders. 

The initial rise in tic-like symptoms during quarantine alarmed health care professionals in the United Kingdom, where this rising trend in tic disorders and tic-like attacks were observed, for three reasons. Firstly, the rate at which child mental health professionals received referrals for sudden tic-like attacks between 2020 and 2021 was double the rate in years prior (Heyman et al., 2021). Secondly, the onset of symptoms included a mix of both motor and vocal tics in adolescents, which is seen in individuals with Tourette’s. However, what has been generally seen in the past with non-Tourette’s tic disorders, is the normal onset of symptoms is mainly motor tics (Heyman et al., 2021). Thirdly, the main population of new adolescents who were affected by these sudden tic-like attacks were girls, a drastic contrast to the usual 4:1 ratio of tic-like symptoms present in boys as opposed to girls (Heyman et al., 2021). At the time the original study was conducted, the time frame between the onset of symptoms and the end of the study was less than a year, so the psychologists could not officially diagnose the new wave of people with new tic-like behavior with Tourette’s. Furthermore, when the adolescents were examined, there was no other neurological reason that could be found to explain the sudden onset of tic-like attacks, which coincided with the medical professionals believing the children developed some form of a tic disorder (Heyman et al., 2021).

The consensus belief held by the medical professionals involved in the care of these children, is that the children all had some form of underlying anxiety which could have unearthed their predisposition to tics and other neurodevelopmental impairments such as ADHD and autism (Heyman et al., 2021). Additionally, the sudden nature of the tic-like attacks, as opposed to a steady wind up of episodes, coincides with the sudden halt of their regular daily routines because of quarantine. Moreover, another confounding factor found by the professionals was the increased consumption of social media by these adolescents as a result of being stuck at home all day. More specifically, it is the consumption of content made by creators who have tic disorders, such as Tourette’s. Adolescents who presented with a sudden onset of tic-like attacks told medical professionals that posting videos and discussions about their symptoms to peers, gave the adolescents a sense of support and belonging (Heyman et al., 2021).  The medical professionals believe that as a result of this echo chamber of support, and a lack of proper therapeutic intervention, such as Cognitive Behavioral Intervention, the adolescents weren’t attempting to improve their tics. Cognitive Behavioral Intervention works to establish three things in people with tics: tics can improve and worsen on their own, tics are often done in response to a feeling or urge, and tics can be stopped, at the minimum for a short time (Cincinnati’s Children, 2021). Further research into this phenomenon is being heavily pushed by the medical professionals to try and definitely see a correlation between social media and an unintentional reinforcement of tic-like symptoms (Heyman et al., 2021).

Given the small sample size and the already non-consensual data on stress-tic relationships, there can be no definitive answer as to whether social media or pandemic anxiety played a role in the seemingly subsequent rise in tic-like attacks in children. However, it will definitely be something to keep an eye on for child mental health care professionals moving forward as the world returns to a state post-quarantine, but in the advent of social media’s continued growth. 

References

fancycrave1. 2015. “Hands Ipad Tablet – Free Photo on Pixabay.” Pixabay.com. June 25, 2015. https://pixabay.com/photos/hands-ipad-tablet-technology-820272/.

CDC. 2021. “Diagnosing Tic Disorders.” Centers for Disease Control and Prevention. April 15, 2021. https://www.cdc.gov/ncbddd/tourette/diagnosis.html#:~:text=Tics%20are%20sudden%20twitches%2C%20movements,make%20a%20grunting%20sound%20unwillingly.. 

Heyman, Isobel, Holan Liang, and Tammy Hedderly. 2021. “COVID-19 Related Increase in Childhood Tics and Tic-like Attacks.” Archives of Disease in Childhood 106 (5): 420–21. https://doi.org/10.1136/archdischild-2021-321748. 

Conelea, Christine A., Krishnapriya Ramanujam, Michael R. Walther, Jennifer B. Freeman, and Abbe M. Garcia. 2014. “Is There a Relationship between Tic Frequency and Physiological Arousal? Examination in a Sample of Children with Co-Occurring Tic and Anxiety Disorders.” Behavior Modification 38 (2): 217–34. https://doi.org/10.1177/0145445514528239. 

Chatterjee, Kaushik, and V.S. Chauhan. 2020. “Epidemics, Quarantine and Mental Health.” Medical Journal Armed Forces India 76 (2): 125–27. https://doi.org/10.1016/j.mjafi.2020.03.017.

NHS Choices. 2022. “Overview – Tics.” 2022. https://www.nhs.uk/conditions/tics/#:~:text=Tics%20can%20happen%20randomly%20and,talked%20about%20or%20focused%20on.. 

Cincinnati Children’s. “Cognitive Behavioral Intervention for Tics (CBIT).” 2021. Cincinnatichildrens.org. 2021. https://www.cincinnatichildrens.org/health/t/tic-intervention. 

There are three main types of tic disorder which are Tourette’s syndrome (TS), persistent (chronic) motor or vocal tic disorder, and provisional tic disorder. TS affects children who are younger than 18 years old and have at least two motor tics or 1 vocal tic that has been continuing for more than 1 year. Persistent motor or vocal tic disorder consists of motor or vocal tics that have been present for more than one year, but individuals cannot have both. Lastly, provisional tic disorder consists of motor and/or vocal tics that have been present for more than 1 year but do not meet the criteria for TS or persistent motor or vocal tic disorder. Tics are typically experienced from ages 5 to 7, increasing in frequency and severity between the ages of 8 to 12, but most people with TS experience improvements in late adolescence, and some become tic-free. However, a minority of individuals with TS continue to have frequent or severe tics into adulthood. The causes of tic disorder remain unknown. However, research has demonstrated that familial, genetic, environmental, and developmental factors may also be involved (What is Tourette ). Although there are no treatments available for tic disorder, there are therapies available to manage tics (Tics and Tourette Syndrome). 

A study seared international internet movie databases using the term “Tourette’s,” “Tourette’s Syndrome,” and “tics” to generate a list of all movies and television programs that had characters or scenes with TS or a person imitating TS. A total of 37 movies and TV shows were reviewed from 1976 to 2010, and although times and the media have changed since then, people still view these movies and shows. Most of the content viewed in the study misrepresented TS in multiple ways including characters being portrayed as having only autism spectrum disorder (ASD) instead of ASD with TS, coprolalia being overrepresented as a tic, as well as other examples (Calder-Sprackman, Sutherland and Doja, 2014).

Coprolalia is known as a vocal tic that specifically involves involuntary swearing and utterance of derogatory remarks. From the study it was found that of the characters imitating TS, 73% exhibited coprolalia, feeding into the misconception to viewers that it is the most common form of tic or symptom of TS. However, in reality, coprolalia is found in only 8.5% of individuals with TS. Additionally, when coprolalia was portrayed by actors, it was done so in a comedic manner. Combined with the comedic effect and overrepresentation of the media’s portrayal of coprolalia, a common negative and false stereotype of TS that may have been interpreted by viewers is TS as the “cursing disease” (Calder-Sprackman, Sutherland and Doja, 2014).

Another major misrepresentation in the media that was found in this study was that many characters who were portraying TS were made to have an “eccentric” appearance. However, in reality, children with TS do not appear physically different from others. The issue with falsely representing the appearance of individuals with TS lies in the fact that it inaccurately represents TS and promotes stigmatization towards individuals who have TS or other tic disorders (Calder-Sprackman, Sutherland and Doja, 2014). 

In recent times, new stereotypes can be created or old ones can be reinforced on social media platforms such as Tik Tok, Instagram, Facebook, and more. Therefore, it is absolutely essential to educate individuals about tic disorders and types of tics while destigmatizing stereotypes by eradicating desensitizing language or behaviors in scripts and other forms of media. Although the media can misrepresent TS and tic disorders, it can still be a useful tool for educating the public and representing those who have tics. For instance, it was found that some movies and TV shows such as South Park and Harvie Krumpet accurately portrayed tics as uncontrollable urges that can be suppressible in certain situations or worsened in stressful situations (Calder-Sprackman, Sutherland and Doja, 2014). This accurate depiction gives hope that the general public can become educated and less likely to promote stereotypes and misrepresentations to others. Thus, social media and other forms of media can be used in a positive way as well, and that is something our generation can look forward to.

References

Tourette Association of America. n.d. What is Tourette – Tourette Association of America. [online] Available at: <https://tourette.org/about-tourette/overview/what-is-tourette/#1461071540054-f0944fbc-3f2b>.

Cdc.gov. n.d. [online] Available at: <https://www.cdc.gov/ncbddd/tourette/documents/tics-and-tourette-fact-sheet-final.pdf> [Accessed 8 March 2021]. 

Calder-Sprackman, S., Sutherland, S. and Doja, A., 2014. The Portrayal of Tourette Syndrome in Film and Television. Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 41(2), pp.226-232.

It is difficult enough for parents to receive phone calls from teachers that their child is “disruptive” or “disobedient” in class, but some parents may receive more concerning phone calls from their children’s teachers as they are told their child’s behavior may be a result of a neurodevelopmental condition.. In the case of children with tic disorder, this concern of disruptive behavior could be alarming and may point to a larger issue the child may be facing, over which they have no control over. In addition to facing the stereotypes of exhibiting disruptive behavior, many young children who have tic disorder are consequently discriminated against. According to the CDC, children with tic disorder, especially those who experience severe tics, are more likely to be bullied than children without tic disorder (Tourette Syndrome and Bullying).  

Tic disorder is a neurodevelopmental disorder that is characterized by repetitive and uncontrollable bodily movements, known as motor or vocal tics. The age of onset for most tic disorders in children spans from ages four to six. However, many of those who are affected by tic disorder see a great decline in their tics as they grow older (Leckman et al., 2014). This decline varies based on the different types of diagnosed tic disorders. Specifically, provisional tic disorder affects young children in their early school years, and the tics have a tendency to substantially diminish in less than one year. However, they may become worse under certain conditions including anxiety and fatigue. Children who experience chronic tics that may last a year or more are often diagnosed with Tourette’s syndrome, another severe tic disorder (Tic Disorders).  

Although more research on Tourette’s syndrome is needed, a few studies have shed light on the connections between fine motor movements and Tourette’s syndrome. A study examined the differences between fine motor skills in individuals with Tourette’s syndrome and individuals without it, and the results indicated that individuals with Tourette’s syndrome exhibited a lower performance in the categories of hand steadiness and aiming their right hands in comparison to individuals without Tourette’s syndrome. Results also demonstrated that right hand steadiness had a significantly lower performance than left hand steadiness in individuals with Tourette’s syndrome. Conclusions from the study indicated that this reduced control of fine motor skills in individuals with Tourette’s syndrome may be due to alterations in the subcortical and cortical components of one’s brain (Neuner et al., 2012). 

This evidence suggests that individuals with Tourette’s syndrome that engage in activities to improve their fine motor skills through their constant application may be able to limit the occurrence of their motor tics. In fact, older studies have concluded that by focusing concentration on improving these fine motor control skills and movements may be linked to a reduction in motor tics. Children and individuals can improve their fine motor control skills by playing musical instruments that require immense focus in exhibiting fine motor skills by plucking strings and pushing buttons. Other helpful activities include participating in dance or sports (Leckman et al., 2013). In fact, professional soccer players with tic disorder, David Beckham and Tim Howard, are some of the many talented people that have engaged in such activities that improve fine motor skills. 

Although much research regarding the connection between engaging in activities to improve fine motor skills and reduce motor tics is still needed, this finding provides hope for improving future treatments for tic disorder. For instance, current treatments for tic disorder include behavioral therapy to replace a tic with another behavior, like placing one’s hands on one’s knees, to prevent the tic from happening. Although there have not been any treatments created involving improving fine motor skills to reduce the occurrence of tics, increasing research within this area can eventually lead to the creation of such a treatment. Improvement of treatment in reducing tics will substantially help children focus better in classrooms.

References

American Academy of Child & Adolescent PsychiatryTic Disorders.(2017). Tic Disorders. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Tic-Disorders-035.aspx 

Centers for Disease Control and Prevention. (2020, May 13th). Tourette’s Syndrome: Help stop bullying. https://www.cdc.gov/ncbddd/tourette/features/tourette-bullying.html 

Cottonbro, P.(2020). [Photo of a toddler playing a ukulele] [Photograph]. Pexels. https://www.pexels.com/photo/a-girl-holding-brown-ukulele-3662750/

Leckman, J.F., Bloch, M.H., Sukhodolsky, D.G., Scahill, L., & King, R.A.(2013) Phenomenology of tics and sensory urges: The self under siege. Tourette Syndrome Oxford: Oxford University Press,3–25. 

Leckman, J.F., King R.A., & Bloch, M.H. (2014) Clinical features of Tourette Syndrome and tic disorders. J Obsessive Compuls Relat Disord, 3(4), 372–379.doi:10.1016/j.jocrd.2014.03.004

Neuner, I., Arrubla, J., Ehlen, C., Janouschek, H., Nordt, C., & Fimm, B.(2012). Fine motor skills in adult Tourette patients are task-dependent. BMC Neurology, 12(120). doi:doi.org/10.1186/1471-2377-12-120