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How to handle a child's tics

Involuntary movements aren't uncommon. Some eventually disappear, but those that evolve into other symptoms can be serious.

June 02, 2003|Valerie Ulene | Special to The Times

My neighbor's child, Daniel, was only 5 when she noticed that he blinked a lot. Reassured by numerous family members and friends (some of whom were physicians) that it would go away on its own, she tried to ignore it.

Such tics are, in fact, common. Almost 20% of children develop one before age 10. The most common tics -- called "simple tics" -- involve straightforward gestures, such as eye blinking, lip smacking or facial grimacing, and meaningless noises, such as throat clearing, coughing or grunting.

They seem to occur suddenly and without any warning. "While tics can seem extremely purposeful, they are not voluntary," says Dr. Robert Suddath at the UCLA Child OCD, Anxiety and Tic Disorders Program. "There's only a certain degree of control that a child has over them." Some children are able to contain the urge to have a tic for a short period of time, but most cannot suppress it indefinitely. A child who tries very hard to contain tics at school, for example, will probably release them at home.

Although many experts believe that simple tics are often a response to stress or anxiety, no one knows why they develop -- or, for that matter, why they disappear. In fact, most simple tics disappear within a few weeks to months without treatment.

In some children, however, tics don't resolve. Or they may progress to more complex movements and sounds, such as jumping or kicking. In Daniel's case, both problems arose.

When he was 8, his mother started to notice other unusual things about her son's behavior. During basketball games, for instance, he would "point his fingers" as he ran or took a shot. Sometimes when he was alone, he'd repeat the same word again and again. By the time Daniel saw a doctor, there was no question about his diagnosis: Daniel had Tourette's syndrome, a disorder characterized by physical and verbal tics.

Although even severe tics -- such as those associated with Tourette's syndrome -- are not usually physically harmful, they can create a host of social and emotional difficulties that can interfere with a child's ability to function and learn. When this occurs, most experts agree that medications should be considered. A variety of drugs are used to treat tics, but not all of them work for all children. Successful treatment is often a matter of trial and error: When one drug fails, another one is tried.

Even when a drug works, the effect may not be lasting. Other types of treatment, such as behavioral therapy, are also sometimes used. They can be effective not only in helping control tics, but in ameliorating some of the associated emotional and behavioral problems.

Unfortunately, for children with Tourette's, the problem is often much larger than tics alone. "While tics may be the most distinguishing feature of Tourette's, these children often have a variety of other equally disabling behavioral problems," Suddath says.

It's estimated that half of all children with Tourette's also have attention-deficit hyperactivity disorder, or ADHD, and more than a third suffer from obsessive-compulsive disorder, or OCD. (It's not uncommon to have all three.) Learning difficulties and poor impulse control are also both common. Although tics may be unsightly and embarrassing to the child with Tourette's, the disability caused by these associated conditions is frequently far more devastating.

If you have a child with a tic and are worried that it might be something more serious, start by discussing your concerns with your child's doctor. A consultation with a pediatric neurologist or psychiatrist may be indicated if further evaluation is felt to be necessary.


Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. Our Health appears the first Monday of the month.

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