Tics in ADHD children

By Dr Michael Lippert, Paediatric Neurologist

Tics are stereotyped nervous movements, only partly under voluntary control. They’re sudden and rapid, recurring and non-rhythmic movements. They seem irresistible to the patient and suppression leads to unpleasant feelings.

They frequently occur in primary school children, often as a part of Tourette Syndrome or Attention Deficit Hyperactivity Disorder (but also in isolation, sometimes for a temporary period, but in other cases for several years).

About a third of children with ADHD suffer from a tic, whereas two thirds of children with Tourette Syndrome have ADHD. This suggests there’s a compelling association between ADHD and tics. They vary from mild mannerisms to grotesque contortions that fluctuate over time. Tics disorder has a 5-15% prevalence in school-aged children.

Tics are classified as Tourette Syndrome when an individual experiences two or more tics with at least one vocal tic before the age of 18 years old – the children are usually around the age of six and half. Tics often affect facial muscles, and they occur less often in the limbs. Motor tics include grimacing, neck-jerking, eye-blinking, pulling at or chewing clothes and vocal tics include grunting, throat-clearing, hissing, squawking and screeching.

They tend to dissipate in high school years, although, sadly, some patients carry one tic into their adult lives. Tics can overwhelm children, interfere with functioning and are often annoying to those around the child.

Where do tics come from?
Tics are heritable. However, despite much research, scientists can’t pin-point a major offending gene. There are environmental factors that either decrease or increase tic severity. Tics lessen when patients are creatively engaged (like painting or building), when outdoors in nature or doing sports. But they’re aggravated when the child is anxious, doing school-work, watching television or playing on-screen games. They’re decreased by distractors like chewing gum or fiddling with squeeze-balls.

Tourette Syndrome and tics
A defining symptom of Tourette Syndrome is the presence of tics. Tourette Syndrome also presents itself in other co-morbidities like obsessive-compulsive disorder, anxiety, learning and social impairment. When dealing with tics, healthcare professionals need to be weary of look-alikes – of calling other stereotyped movement disorders tics.

The effects of tics
Tics have a number of effects like fatigue, isolation and social marginalisation. For example, a loudly screeching child is disruptive in a classroom setting, therefore can’t be in the same classroom as other children. Tics may be mild and transient, but may escalate to intense and disabling states that may leave families in despair.

There are effective ways to treat tics and reduce their effect on the individuals’ life. Parents of children with tics should consult with a health practitioner to find out whether they are a result of ADHD and, if so, seek a suitable treatment plan.