Tics are sudden, repetitive movements or vocalizations that can occur in children and adults. Tics can be simple or complex. Some common motor tics include eye blinking, shoulder shrugging, and facial grimacing. Common vocal tics include throat clearing, sniffing, and grunting. Tics can range from mild to severe.
Quick Answers
The quick answers to whether tics are present at birth or develop later are:
- In most cases, tics start developing between the ages of 5 and 7 years old.
- Tics often first appear during times of development or stress.
- Genetics and brain abnormalities may contribute to the onset of tics.
- Tics can be present at birth but this is very rare.
- Tics often worsen during adolescence.
- Tics change over time – new tics can develop while old ones fade away.
Onset of Tics
In most cases, tics are not present at birth. Instead, they tend to first appear during key developmental stages or times of stress. Here is an overview of when tics commonly emerge:
- Ages 5-7: This is the most common period for tics to appear, especially in boys. Tics often start with simple motor tics like eye blinking.
- Ages 8-12: More complex tics can develop during this time, including facial grimacing or shoulder shrugging.
- Adolescence: Hormonal changes during puberty often cause tics to worsen. New tics may also emerge.
The onset of tics is often associated with growth spurts or key developmental milestones like starting school. Stressful or anxious periods can also trigger the onset of tics.
Rare Cases of Tics at Birth
While uncommon, some infants are born with tics or develop them within the first year of life. Early-onset tics may indicate a genetic predisposition or abnormalities in brain development.
A study in Pediatric Neurology found that 6% of patients developed tics before age 1, while 94% developed them between ages 3 and 8. So while congenital cases do occur, they are relatively rare.
Underlying Causes
Researchers believe a combination of factors contribute to the onset of tics, including:
- Genetics: Studies show tics often run in families. Certain gene mutations may increase susceptibility.
- Brain abnormalities: Differences in brain structure and functioning are associated with tic disorders.
- Infections: Tics sometimes appear after infections like strep throat or encephalitis.
- Stress: Anxiety, excitement, fatigue, and traumatic events can trigger tics.
So while genetics and neurobiology likely play a role, environmental factors also influence when tics first appear.
Changes Over Time
Tics are dynamic – they change over time. Typically:
- New tics develop while old ones fade away.
- Tics worsen during adolescence.
- Tics improve in late adolescence and early adulthood.
- Waxing and waning severity is common.
Here is a table summarizing the natural course of tics over time:
| Age Period | Tic Pattern |
|---|---|
| Ages 5-7 | Tics first appear, usually motor tics |
| Ages 8-12 | New tics emerge, complexity increases |
| Adolescence | Severity worsens, new tics common |
| Early Adulthood | Gradual improvement for most |
As this table illustrates, tics are dynamic rather than static. Their expression and severity changes over the course of development.
Influence of Triggers
Tics can also wax and wane in response to triggers. Things that commonly exacerbate tics include:
- Stress, anxiety, excitement
- Fatigue
- Illness
- Certain medications
- Caffeine or other stimulants
- Hot, humid weather
Conversely, tics often improve with relaxation, focused activities, or pressure on the tic area. So environmental factors play a role in tic severity at any given point in time.
Types of Tic Disorders
There are several different types of tic disorders characterized by repetitive movements and vocalizations. The main types include:
- Transient tic disorder: Tics last less than a year.
- Chronic tic disorder: Tics occur for more than a year.
- Tourette’s syndrome: Multiple motor and vocal tics lasting more than a year.
Tourette’s tends to be more severe and persistent. Transient tics are generally milder. But all of these disorders involve some combination of unwanted sounds and movements.
Common Tic Types
Some examples of frequent motor and vocal tics include:
Common Motor Tics
- Eye blinking
- Shoulder shrugging
- Facial grimacing
- Head jerking
- Arm thrusting
Common Vocal Tics
- Throat clearing
- Sniffing
- Grunting
- Coughing
- Repeating words/phrases
Coprolalia, the involuntary utterance of obscene words or phrases, occurs in a minority of those with tic disorders. It is not required for a Tourette’s diagnosis.
Diagnosis
Diagnosing a tic disorder involves:
- Taking a medical history of tics
- Conducting a physical and neurological exam
- Ruling out other potential causes of symptoms
- Observing tics directly, if possible
There are no definitive medical tests that can diagnose tic disorders. Doctors instead rely on a thorough evaluation of symptoms and family history.
Criteria in Medical Guidelines
Official diagnostic criteria also help guide tic disorder diagnoses. For example:
- Tics must be sudden, rapid, recurrent, and non-rhythmic movements or vocalizations.
- Tics must wax and wane in frequency, type, and severity over time.
- Onset must be before age 18.
- Symptoms cannot be explained by medications or substance use.
Meeting the specific guidelines in the DSM or ICD medical manuals is required for an official tic disorder diagnosis.
Treatment
While there is no cure for tic disorders, a number of treatment options can help manage symptoms. Common treatments include:
- Behavioral therapy: Habit reversal training and exposure therapy can reduce tic frequency.
- Medications: Alpha-adrenergic agonists like clonidine or antipsychotics may be prescribed.
- Deep brain stimulation: Electrode implants can short circuit tic signals in the brain.
- Complementary approaches: Relaxation techniques, biofeedback, or acupuncture may help some patients.
Treatment plans are tailored to each patient and may involve a combination of approaches for optimal control of tics.
Supportive Measures
In addition to specific interventions, supportive measures can help those living with tics:
- Providing a calm, understanding environment.
- Working with schools to minimize teasing/bullying.
- Encouraging positive self-esteem.
- Identifying and avoiding tic triggers when possible.
With patience and the right treatment plan, most people with tic disorders can manage their symptoms successfully.
Conclusion
In summary, tics are not present at birth in most cases. Instead, they tend to emerge between ages 5 and 7 during key developmental and stressful periods in a child’s life. Both genetic predispositions and environmental triggers likely contribute to the onset of tics.
While tics can be present from infancy in rare cases, this is very uncommon. Tics are dynamic – new tics develop and old ones fade over time, often worsening during adolescence. Waxing and waning is common in response to factors like stress or fatigue.
With a proper diagnosis and access to behavioral therapies, medications, and support, most people with tic disorders can live full, rewarding lives. While tics may not be curable, they can often be managed successfully over the long term.