Tics
What are Tics?
Tics are repetitive, sudden, quick, and uncontrollable movements or vocalizations. They are often associated with a preceding urge or uncomfortable feeling that builds and is temporarily relieved by the tic. Tics may be associated with stress, fatigue or excitement [1]
Tics typically begin around age 6 and are more common among males. [1]
It’s estimated that up to 24% of children have transient (provisional) tics. [1] This diagnosis is used when people demonstrate tics (one or more, which begin in childhood and last for less than a year). [2]
Tourette syndrome (TS) is diagnosed when tics have gone on for at least one year and the patient has experienced at least one phonic/vocal tic and at least two motor tics. It’s estimated that 1% of children and teens have Tourette syndrome. Tourette syndrome diagnosis requires a comprehensive neurological examination. [3]
Tics are typically not serious and can disappear over time. However, if they occur regularly and consistently, are becoming more severe or if the person is being harmed (by themselves or others) then it may be time to seek medical help from a neurologist, psychologist and/or psychiatrist to uncover potential causes and strategies that may help reduce/control the tics.
Among children with autism, it is possible that tics may co-occur with stereotypies, typical repetitive movements and sounds. For example, rocking and hand flapping are typical stereotypies. It can be difficult to distinguish between the two by stereotypies typically begin around age 2 while tics occur later, around age 6-7. [9] Repetitive movements in ASD may help reduce or increase sensory input. Both tics and stereotypies increase with stress or excitement.
Tics are common among people with Tourette syndrome and PANS/PANDAS. The difference here is that the cause of Tourette syndrome is unknown, while PANS/PANDAS are thought to be caused by infections or inflammation sometimes in the case of PANS. In addition, PANS/PANDAS is often accompanied by sudden onset of OCD behaviors, restricted eating, behavioral regressions and other symptoms.
Signs/Symptoms
Common tics include [3]:
Blinking
Wrinkling of the nose
Shrugging the shoulders
Jerking the head or limbs
Head banging
Coughing
Grunting or clearing the throat
Sniffing
Repeating a sound or phrase
Potential Root Causes
Tics may be genetic. They also co-occur with other conditions including:
Tourette syndrome (often co-occurs with Autism, anxiety and mood disorders as well). [10]
Next Steps
Nutritional Considerations for Tics
An increase in tics has been related to the consumption of caffeine and refined sugar. Diets that eliminate common allergens (wheat, dairy, eggs, soy, shellfish, fish, peanuts, tree nuts) and low sugar diets have been identified as significantly reducing tics. [4]
In one small study, among 15 children with Tourette Syndrome using special diets, 53% of caregivers reported at least one positive change, the most common being improved vocal tics and improved motor tics attributed to gluten-free, dairy-free, and sugar free diets. [7]
It may also be beneficial to eliminate common food additives like preserving agents or artificial colors or sweeteners. More information on removing additives can be found in the Failsafe or Feingold diets. [7]
Supplement Considerations for Tics
Research tells us that the supplements most used by children with Tourette syndrome include probiotics, omega-3s, multivitamins and magnesium. 75% of supplement users noted improvement, mainly in motor and vocal tics, sleep quality and anxiety reduction. [7]
Supplementation of L-Theanine and Vitamin B6 may help in the treatment of tic disorders associated with anxious symptoms. [8]
CBD is being investigated for use in Tourette syndrome though the safety is still being investigated and is currently not recommended for children due to potentially harmful cognitive effects. [11, 12] CBD is often used for anxiety, the reduction of which may reduce the occurrence of tics.
Lifestyle Considerations for Tics
Deep slow breathing, through the nose, with tight lip closure has been shown to lessen the severity of tics in patients with Tourette syndrome. [5] Mindfulness based stress reduction has also shown to improve tic severity and tic related impairment. [7]
Some research has demonstrated that tics can be suppressed, especially if suppression is practiced soon after onset of the tic(s). In one study school-age children demonstrated some capacity to suppress tics, especially when an immediate reward was present. [6]
Psychiatrists can make recommendations for medications (typically antipsychotics) which may help alleviate problematic tics by controlling body movements. Behavioral therapy may be recommended or in some cases, deep brain stimulation. [12]
DISCLAIMER: Before starting any supplement or medication, always consult with your healthcare provider to ensure it is a good fit for your child. Dosage can vary based on age, weight, gender, and current diet.
Tics & Autism in the Research
Autism and Tourette Syndrome
Both autism and Tourette Syndrome (TS) consist of stereotypic behaviors and both affect males predominantly. Brain imaging studies in TS patients have shown abnormal hyper-connectivity between cortical regions and the striatum, along with abnormal structural organization and volumes in the cortico-striatal circuitry. ASD patients also have overconnectivity between cortico-striatal circuits, as well as abnormal striatal growth ratio and shape. [10]
Inhibitory interneuron abnormalities are linked to two pediatric psychiatric disorders with high comorbidity: autism spectrum disorder (ASD) and Tourette syndrome (TS). There has been little to no reported overlap between the genetics of TS and ASD, although they do share the fact that Excitatory/inhibitory neuron imbalance is common in both conditions and occurs in cortico-striatal circuits. The origin of this imbalance is thought to be due to an interneuron dysfunction that leads to overall disinhibition of the areas compromised. [10]
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[1] Tics and kids: When should I seek care? Texaschildrens.org. Accessed August 4, 2022. https://www.texaschildrens.org/blog/2014/01/tics-and-kids-when-should-i-seek-care
[2] CDC. (2022, May 17). Diagnosing tic disorders. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/tourette/diagnosis.html
[3] Tics and tourette syndrome 101. Texaschildrens.org. Accessed August 4, 2022. https://www.texaschildrens.org/blog/tics-and-tourette-syndrome-101
[4] Ludlow AK, Rogers SL. Understanding the impact of diet and nutrition on symptoms of Tourette syndrome: A scoping review. J Child Health Care. 2018;22(1):68-83.
[5] Kaido T, Hirabayashi H, Murase N, et al. Deep slow nasal respiration with tight lip closure for immediate attenuation of severe tics. J Clin Neurosci. 2020;77:67-74.
[6] Greene DJ, Koller JM, Robichaux-Viehoever A, Bihun EC, Schlaggar BL, Black KJ. Reward enhances tic suppression in children within months of tic disorder onset. Dev Cogn Neurosci. 2015;11:65-74.
[7] Smith BL, Ludlow AK. Patterns of Nutritional Supplement Use in Children with Tourette Syndrome. J Diet Suppl. 10.1080/19390211.2021.1958120
[8] Rizzo R, Prato A, Scerbo M, Saia F, Barone R, Curatolo P. Use of Nutritional Supplements Based on L-Theanine and Vitamin B6 in Children with Tourette Syndrome, with Anxiety Disorders: A Pilot Study. Nutrients. 2022;14(4):852.
[9] Termine C, Grossi E, Anelli V, Derhemi L, Cavanna AE. Possible tics diagnosed as stereotypies in patients with severe autism spectrum disorder: a video-based evaluation. Neurol Sci. 2021;42(4):1559-61.
[10] Rapanelli M, Frick LR, Pittenger C. The Role of Interneurons in Autism and Tourette Syndrome. Trends Neurosci. 2017;40(7):397-407.
[11] Aran A, Cayam-Rand D. Medical Cannabis in Children. Rambam Maimonides Med J. 2020;11(1):
[12] Pringsheim T, Okun MS, Müller-Vahl K, et al. Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology. 2019;92(19):896-906.
[13] Differences and similarities of ASD and Tourette Syndrome. Org.uk. Accessed August 4, 2022. https://www.tourettes-action.org.uk/storage/downloads/1610981978_Tourette's-&-Autism-article.pdf
Authors
Edited and Reviewed by Brittyn Coleman, MS, RDN/LD, CLT
