A teenaged hispanic boy with a backpack at school who is smiling while walking in front of three tee

Tics and Tourette Syndrome

Tics are rapid, repetitive, purposeless, involuntary, and unwanted muscle movements. They are classified as simple or complex and as either motor or vocal tics. Motor tics include blinking, eyeball rotation, shoulder shrugging, neck stretching, mouth widening, nose scrunching, torso twisting, jumping, toe flexing, arm extension, and countless other movements. Vocal tics include humming, grunting, coughing, throat clearing, high-pitched sounds, sniffing, and repeatedly saying a word or phrase. Patients who repeatedly must say swear words or racial slurs have a condition called Coprolalia.

Neurologists specializing in Tic Disorders ensure that a proper diagnosis is made when a patient is experiencing tics or tic-like behavior. They often prescribe both medication and a specialized form of Habit Reversal Training (HRT) called Comprehensive Behavioral Intervention for Tics (CBIT). Support often includes the following components.

Sensory training to increase awareness of the tics.
Recognition of internal triggers (premonitory urges).
Competing Responses to physically block current tics.
Environmental modification.
Accommodation suggestions.
Referrals to medical and mental health specialists.
Family education.
Advocacy.

Click here to learn more about CBIT .

Common tic disorders and their diagnostic criteria are described below:

Provisional Tic Disorder

Patient has one or more motor or vocal tics.
The tics are present for less than one year.
The tics start before age 18.
The tics are not due to a medication.
The patient has not been diagnosed with another tic disorder.

Persistent Tic Disorder

The patient has one or more motor tics or vocal tics, but not both.
The tics occur many times a day nearly every day or on and off throughout a period of more than a year.
The tics start before age 18.
The tics are not due to a medication.
The patient has not been diagnosed with another tic disorder.

Tourette Syndrome (Tourette Disorder, Tourette's, TS)

The patient has two or more motor tics and at least one vocal tic.
The tics have been present for at least one year. The tics occur many times a day, nearly every day, or off and on for at least one year.
The tics begin before age 18.
The tics are not due to a medication, other drugs, or a medical condition.

Coprolalia

In addition to common motor and vocal tics associated with Tourette Syndrome, the patient repeatedly and involuntarily says words and phrases that are considered taboo such as swears or racial slurs.

Coprapraxia

In addition to motor and vocal tics associated with Tourette Syndrome, the patient repeatedly and involuntarily engages in taboo behaviors, such as spitting, sticking out their tongue, or making inappropriate hand gestures.

Functional Tics

Some patients with complex forms of Tourette Syndrome also develop a form of Functional Neurological Disorder (FND) called Functional Tic-Like Behavior (FTLB). Their behaviors appear more pronounced and disruptive than typical tics. Patients benefit from learning to differentiate the behaviors and to identify triggers.
People who do not have a significant history of tics can also develop FTLB. They benefit from a proper diagnosis and ongoing habit reversal and mental health support.
TikTok Tics is a form of FTLB that is a Mass Sociogenic Illness. It is a disorder in which patients mistakenly think they have Tourette Syndrome. This belief comes from suddenly developing behaviors similar to influencers who claim to have Tourette's on platforms such as TikTok, TLC, and YouTube. TikTok Tics emerged during the pandemic and is thought to be associated with anxiety, isolation, poor sleep, and over reliance on social media.

To learn more about FND, please visit the Neurosymptoms website at https://neurosymptoms.org/en/symptoms/fnd-symptoms/functional-tics/