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.
