A Tic Disorder is listed separately in the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) under the heading of those disorders frequently diagnosed in childhood. Actually, it is one of several disorders where abnormal movement plays a major role.

An individual with a tic disorder has rapid repetitive, nonrhythmical and, at times, stereotypical motor movements or vocalizations. On the surface, the movements appear useless and the individual with the disorder is distressed by the movements but cannot control them, except for a limited period of time. Tics are more frequent during periods of stress and diminish greatly or stop during intense concentration and sleep.

Tics may often be subtle and therefore not noticed by the casual observer. Simple eye blinking, mouth twitching, head turning, throat clearing or coughing may be the only manifestation of a tic disorder. In children, some of these minor symptoms are often viewed as an allergic disorder or a chronic respiratory infection. On the other hand, tics can become quite alarming, with disturbing head and shoulder movements and/or vocalizations that are socially unacceptable.

Tics may be multiple, complex and even stereotypical in some cases. The latter may be difficult to separate from still another disorder, where movements are deliberate. At times tics do appear deliberate as in vocal tics where there is cursing and motor tics where an affected individual mimics the movements of another person. In reality, these complex tics are unintentional and can cause a great deal of concern for both the affected child and parent.

Tics may change over time, one simple tic replacing another. In others, tics can become more severe or multiple. They usually involve the face and head at first and then move to the neck, shoulders and outward to the extremities. If a tic lasts less than twelve months it is designated as a transient tic or movement disorder; if more than twelve months a chronic tic or movement disorder. If a chronic tic is manifest by two or more motor phenomena and one or more vocalizations the condition is called Tourette's Disorder.

Other medical conditions involving the central nervous system should be addressed and rejected when diagnosing a tic. So should other movement disorders such as Stereotypic Movement Disorder and activities associated with Pervasive Developmental Disorder and Obsessive Compulsive Disorder, although simple tics are often seen as a coentity in children with Obsessive Compulsive Disorder (20%).

Tics have been linked to an infection by a streptococcal organism (strep throat or impetigo). The later form of tic disorder often has the clinical picture of "waxing and waning" as the result of recurrent infections with the strep. Individuals with this disorder also have behaviors much like those seen in Obsessive Compulsive Disorder.

Tics should not be confused with excessive motor activity or talking often seen in Attention Deficit Hyperactivity Disorder (ADHD). Tics, including Tourette's Disorder, do occur in ADHD, but only as a coentity and not as a symptom of ADHD.

Tics are often seen in individuals who are under treatment for other disorders with psychotherapeutic medications (methylphenidate or dextroamphetamine). Some experts believe the medications do not cause the tic but rather act as a catalyst for what would have occurred naturally over the individual's lifetime. One has to raise one's eyebrows to this observation because many medication induced tics subside when the suspected medication is discontinued. A good clinician always checks out his or her patient for disordered movements before beginning a medication. Very often the problem is present and unrecognized before the medication is initiated. Most clinicians agree that if the tic caused by mediation is not of a severe nature or causing distress, the medication, if effective, should be continued.

It is easy to see why an individual with single or multiple tics is compromised socially and can suffer from the insecurity of being unable to control the problem. For individuals with a tic disorder it should be encouraging to know that there are numerous medications for the treatment and relief of tics. Many who suffer from this embarrassing disorder can be relieved with its recognition and appropriate treatment.

Articles about the Stereotypic Movement Disorder, Stereotypies in Pervasive Developmental Disorders and compulsions will be added to the ABLE Resource Room.

For more information about the terms used in this article, go to www.Abledev.com and see the ABLE Glossary.

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