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Tic Disorder

Sudden, repetitive, involuntary muscular movement or vocal pattern.

Tic disorders feature involuntary repetitive (but non-rhythmic) patterns, and may be either motor tics (muscle movements) or vocal tics. Although tics are involuntary, the individual with a tic disorder can often repress the tic for a period of time. The occurrences of tics appear to be more likely when the individual is under stress or concentrating on a task, such as reading or writing. Most tics seem to nearly disappear during sleep.

The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, lists the following examples:

Both motor and vocal tics may be categorized as simple or complex, although the distinction between the two is not precise. Generally, a simple motor tic involves only one part of the body, while a complex tic is more involved and takes the form of some recognizable action. They also include imitating the actions of others and making involuntary obscene gestures. Complex vocal tics involve recognizable words or animal sounds as opposed

	Simple	Complex
Motor tics	eye blinking	facia! gestures
	neck jerking	grooming behaviors
	shoulder shrugging	jumping
	facial grimacing	touching
	repeated coughing	stamping
		sniffing an object
		echokinesis, i.e., imitation of someone else's movements
Vocal tics	throat clearing	repeating words or phrases out of context
	grunting	coprolalia, i.e., use of socially unacceptable words, usually obscene
	sniffing	palilalia, i.e., repeating one's own sounds or words
	snorting	echolalia, i.e., repeating the last word, sound, or phrase heard
	barking

to simple noises. These may include the repetition of short phrases,. such as "Oh, boy," the repetition of a single word, repetition of the words of others, called echolalia, or involuntary swearing, known as coprolalia.

The health care professional will distinguish a tic disorder from other categories of involuntary movements, such as those that are related to other problems such as medical conditions, alcohol or drug abuse, side effects from medication, or other behavior or psychological disorders. When a tic disorder has been diagnosed, further definition of the nature and scope of the tic will be made. Factors such as age at onset and duration of the tic will be taken into account.

Transient tic disorder

As the name implies, transient tic disorder is characterized by motor or vocal tics that are not permanent and appear before age 18. The tic occurs many times a day for at least four weeks, but dissipates after no more than 12 consecutive months. Persons with transient tic disorder experience impairment in social and school settings. When the tic lasts longer than 12 months, the diagnosis may be Tourette syndrome or chronic motor or tic disorder.

Chronic motor or tic disorder

Chronic motor or vocal tic disorder features tics that persist for more than 12 consecutive months. The factor that distinguishes this disorder from Tourette's is that only one type of tic—motor or vocal, not both—is present. The other factors for diagnosis are the same. These include tics that first appear before age 18, occur many times a day, and persist for longer than one year. (Periods of up to three months with no tic occurrences do not rule out tic disorders). The person with chronic tic disorder is adversely affected in his or her ability to function in social or school settings because of the tic, although the impairment is usually less than for Tourette syndrome.

School-aged children with any tic disorder may have problems functioning in social and school settings. It is not uncommon for them to experience other learning difficulties such as attention deficit/hyperactivity disorder, or problems with visual motor integration or auditory processing. Parents and educators should be alert to warning signs of learning problems related to tic disorders to prepare for intervention and remedial help.

For Further Study

Publications

Davidovicz, Herman, et al. Fact Sheets on Tourette Syndrome. Bayside, NY: Tourette Syndrome Association, Inc., 1994. (Set of three fact sheets, "Learning Problems and the TS Child," "Specific Classroom Strategies and Techniques for Students with Tourette Syndrome," "Techniques To Aid Students with TS in Completing Written Assignments.")

Organizations

Tourette Syndrome Association, Inc.
Address: 42-40 Bell Blvd.
Bayside, NY 11361-2874