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Tics are repetitive movements or sounds that someone makes unintentionally.

There are two types of tics:

• Motor tics – these are involuntary physical movements of the body
• Vocal tics – these are involuntary sounds or words

These can be separated into two categories:

• Simple tics – these tics are quick, simple movements or sounds. For example, coughing, blinking or humming
• Complex tics – these tics are longer and more coordinated movements, that involve multiple muscle groups. For example, clapping, jumping or repeating words or phrases

Here is a table showing some common tics.

The kind of tics someone has can change over time, and with age.

Not all tics are noticeable. Some people experience the most difficulty with tics that are not noticeable to others.

“For me, my tics were very unnoticeable when I was younger. I used to tense my knees and obviously people can't see that.” Rayne

Where can tics happen?

Our body has different kinds of muscles that do different jobs. Some are muscles that we can control, like the muscles in our face that we use to smile, or the muscles in our legs that we use to walk or run. Some are muscles that we can’t control, like the muscles in our heart that pump blood around our body. Tics usually only affect the muscles that we have control over so, for example, you can’t get a tic in your heart.

What about swearing?

Some tics involve:

• swearing (coprolalia)
• making inappropriate gestures (copropraxia).

In people who have tics, around 1 in 5 will have coprolalia or copropraxia.

These kinds of tics are overrepresented in TV shows, films and social media. Not everyone with tics or Tourette’s has coprolalia or copropraxia, and you don’t need to have these kinds of tics to be diagnosed.

Coprolalia and copropraxia can be particularly difficult for the people who do have them. If you do develop these kinds of tics, remember that you might not have these kinds of tics forever. They can change or go away over time.

“I find that if people do make more comments about the swearing tics, I'm more likely to do them because I get worried.” Lily

Tics are involuntary, which means that the person doing them isn’t doing them on purpose.

It can be helpful to think of the urge to tic as similar to the urge to blink. If you were told not to blink, you might be able to stop for a short time, but eventually you would have to blink. Some people compare the urge to tic to the urge to sneeze, or to lick your lips if you are eating something sweet.

Premonitory sensation

Before someone tics, they can experience something called a premonitory sensation or premonitory urge. This is an uncomfortable feeling or sensation that happens before a tic. This sensation will build up until the tic happens.

The premonitory sensation might happen in the part of the body in which the tic happens. For example, if someone has a tic where they clear their throat, the sensation could be an itchy feeling in their mouth. The premonitory sensation can also happen in a different part of the body from the part in which the tic happens.

“Sometimes my premonitory urge is quite painful.” Rayne

People describe the premonitory sensation as feeling like:

• “Pressure that builds up in my muscles”
• “贰濒别肠迟谤颈肠颈迟测”
• “A really intense itch”
• “A huge ball in my throat”
• “I’m about to sneeze”

After the person tics, or has repeated the tic enough times that it feels ‘just right,’ this feeling will go away.

Sometimes, tics happen ‘out of the blue’. This might be because the premonitory sensation isn’t as obvious. Or it might be because the person is having a lot of tics one after the other.

The premonitory sensation can be less noticeable in younger children, or in people who have just started having tics. It is not known exactly why this is.

“I think it’s important for people to know that sometimes it’s just as much of a surprise to us as it is to everybody else.” Rayne

Pain and exhaustion

Most people who have tics experience pain at some point. This can be from:

• doing the same movement again and again
• injuring themselves if their tics involve hitting themselves or things around them.

Many people feel tired from doing their tics, especially if they have a lot of tics, or these tics happen for long periods of time.

Can people control their tics?

It is possible for some people to hold in their tics some of the time. This is called tic suppression. This is usually only possible for short periods of time. Some people find that if they stop themselves from ticcing for a long time, they have a period of intense ticcing afterwards.

It is important that people who tic are not forced to stop or hold in their tics. This will probably not work for very long, and can make the tics worse, or make the person worry about having tics.

“It’s like if you put a load of Mentos in a coke bottle and then put the lid on, it might not explode. But the minute you take that cap off, it's going to go everywhere.” Rayne

Tourette syndrome (or Tourette’s for short) is a ‘tic disorder’, which means that it involves tics. Not everyone who has tics has Tourette’s.

When do tics become Tourette’s?

Lots of children develop simple tics for short periods of time, and these usually go away on their own. This is called transient tic disorder.

Some children will have tics for longer periods of time. If you have tics for more than a year, you might be diagnosed with chronic tic disorder.

You might be diagnosed with Tourette syndrome if:

• you have been having tics for more than a year and
• you have several motor tics and at least one vocal tic and
• you have these tics often and on most days.

If your tics are very frequent and noticeable, you might be diagnosed with severe Tourette syndrome.

Tics and Tourette’s often happen alongside other conditions. These are known as ‘co-occurring conditions’. Common co-occurring conditions include:

• attention deficit hyperactivity disorder (ADHD)
• autism
• obsessive-compulsive disorder (OCD)
• depression
• learning disabilities

Tics can also sometimes be a symptom of a physical health condition. Your doctor will check to see if there might be any other reasons for your tics.

Misdiagnosis

Sometimes tics and Tourette’s can seem like other conditions. This can mean that people are sometimes misdiagnosed with another condition before being correctly diagnosed with tics or Tourette’s.

For example, some people with OCD touch things repeatedly to try to soothe their obsessive thoughts. This might look like turning a light switch on and off multiple times or touching the same place on a wall before leaving the house. If someone has a tic that causes them to touch things, they might be incorrectly diagnosed with OCD. The opposite can also happen, and people can be diagnosed with tics or Tourette's when they have another condition.

Treating other conditions

If you are experiencing tics, your doctor should try to find out if this might be linked to another condition. If you do have another condition that is making your tics worse, treating that condition might improve your tics.

For example, if you are experiencing a lot of anxiety, your doctor might suggest that you have counselling to talk about how you are feeling. Or if you have a mental health condition like OCD, treating your OCD might make your tics easier to manage.

“Getting other diagnoses is really helpful, because it can help you get to the root cause.” Rayne

Tourette’s is a neurological condition. Research suggests that differences in parts of the brain that control movement may be involved in how Tourette’s develops. Certain chemicals in the brain, such as dopamine, might also be involved.

As with many conditions, it is hard to say exactly what causes tics and Tourette’s. It seems as though it is probably a mixture of genetic factors and environmental factors.

Genetic factors are differences in our genes that make us unique. Environmental factors are things in the world around us that can affect us while we are in the womb or while we are growing up.

People can have genetic and environmental factors that mean they are more likely to develop tics or Tourette’s. However, this doesn’t mean it will definitely happen.

When does Tourette’s happen?

Tics usually start between the ages of 4 and 6. However, they can start later or earlier in life.

Who is most likely to get Tourette’s?

Tourette’s is more commonly diagnosed in boys than in girls. However, in adults the diagnosis of Tourette’s in men and women is more equal. Girls and women can find it difficult to get a diagnosis because of a misunderstanding that Tourette’s only happens in boys and men. This is not true.

If you think you are experiencing tics, you and your parents or carers might want to speak to your GP and school.

Your GP can check for any other problems you might be having, or any health conditions that might be causing your tics. It might be helpful for your school to know that you are having tics, and that you and your family are watching to see how things develop.

If these tics start to negatively affect your life or have been going on for a long time, your doctor should refer you to the appropriate service. This will depend on what they think might be causing your symptoms. For example, if your movements are related to another condition like autism, or if you have a tic disorder like Tourette’s.

The healthcare professionals assessing you should also check if you have any other conditions as well. For example, mental health conditions or neurodevelopmental conditions like ADHD, which often co-occur with tics.

The treatments for tics and Tourette syndrome vary depending on the person and their needs. For example, how long they have had the symptoms, and how they are affecting their life.

If you have only been experiencing tics for a few weeks or months, your doctor might suggest that you wait to see if the tics improve on their own. They might also suggest that your parents or carers speak to your school to explain what is happening.

What treatment or support you need for Tourette’s will depend on what challenges you are having, and what things you want help with.

Learning about Tourette’s

This is also called psychoeducation. It is where you and your family learn about your condition. For example, you will learn:

• what tics and Tourette’s are called
• why they happen
• how they might change over time
• how to cope with having tics
• and how to help other people understand tics and Tourette’s.

If your tics aren’t bothering you, and the people around you are accepting and understanding, this might be the only support you need. However, if your tics are more intense, or if they are making it difficult for you to do the things you normally do, you might need more support.

Psychological therapies

Psychological therapies, or talking therapies, are where you:

• talk with a professional about how you are feeling
• work with them to develop new and more helpful ways of thinking or behaving.

There are several different psychological therapies that have been shown to be helpful for Tourette’s.

None of these therapies will teach you to completely stop your tics, but they might help you to:

• control your tics in difficult environments – for example, if you have an important exam or family event that you are worried about ticcing at
• tic less or reduce tics you find more challenging – for example, if you have a particularly painful tic or a tic that you find embarrassing
• be less bothered by your tics
• think differently about your tics.

Comprehensive Behavioural Intervention for Tics (CBIT)

CBIT is a psychological therapy that has been shown to help to reduce tics.

In CBIT you will experiment with daily activities that cause you to tic or make your tics worse. You will learn to approach these situations in a different way. In CBIT you will also receive:

• Psychoeducation
• Functional assessment - This involves looking at what triggers your tics, what makes them happen more, and what makes them happen less.
• Relaxation training - Learning different ways to relax can make you less likely to tic, or feel less anxious when you are ticcing.
• Social support – Helping your family to support you through the treatment.

Habit reversal training (HRT)

CBIT uses the techniques of habit reversal training (HRT). This is a psychological therapy that has been shown to help people manage their tics.

HRT has four steps:

• Awareness training – Helping you notice when you are going to tic, and which environments you tic more in.
• Competing response training – Thinking of other ways that you can respond instead of ticcing. For example, if you have the urge to make a loud noise, you might practice using controlled breathing until the urge has gone.
• Intensive training – Practicing the skills you have learnt in therapy. Your parents or carers can help you to do this at home.
• Relaxation techniques

HRT can be given in person, online or as part of a group.

Some people do not find HRT helpful, or don’t want to control their tics.

“I think it depends on what that person wants. It was quite helpful for me at the time. Now I’m older I don't particularly hold my tics in unless I'm in a situation where I need to.” Rayne

Exposure with response prevention (ERP)

In exposure with response prevention (ERP), you will learn techniques to help control and tolerate the urge or sensation to tic. This can be very difficult to start with, and you may only be able to do it for a very short time. This will take place in a very relaxed and calm environment, with lots of support from your therapist.

Eventually, with support and help, ERP can help you to improve your ability to hold your tics in for longer and in more challenging situations. For many people, if they can do this, their urge to tic reduces or they stop feeling as bothered or stressed by it.

Medication

A number of medications have been shown to be helpful in treating tics and Tourette’s. Medications for tics and Tourette syndrome are:

• Alpha agonists – These include medications such as clonidine and guanfacine. We think they work by calming down the brain’s signals, helping to reduce tics.
• Dopamine receptor-blocking medication – These include medications such as aripiprazole and risperidone. These medications work by blocking the effect of a chemical in the brain (dopamine) which we think plays a role in tics. These medications are also called antipsychotics. This is because they are also used to treat psychotic disorders like schizophrenia. This does not mean that Tourette’s is linked to psychosis.
• Other medication – Some other medications can help to reduce tics. For example, those normally used to treat epilepsy. These are usually tried when other treatments haven’t worked well or can’t be used.

“Response to medication can really vary from person to person. It’s not like treating blood pressure where you can easily predict how someone will respond.” Ed

You might be offered medications if:

• you have tried other things like self-help and psychological therapies, and these haven’t helped to reduce your tics as much as you had hoped
• you are finding your tics very distressing, embarrassing or painful
• you are ticcing a lot and this is making it hard to do things you enjoy.

These medications can have side-effects. Your doctor should speak to you and your parents or carers to carefully explain what these side-effects are and what things to look out for.

“I take medication, which I found really does help. I still tic, but it's not as common.” Lily

Managing stress and low mood

If you are feeling stressed, worried, sad or low, speak to someone you trust. This could be a parent, carer, best friend or a favourite teacher. Sometimes just talking about your problems can make them feel less overwhelming. However, if you feel like you can’t cope or things are getting worse, you might need some professional support from your GP.

You might find it helpful to take a look at some of our other resources for young people:

• Anxiety
• Coping with stress
• Depression
• When bad things happen

Support groups

You might also find it helpful to meet other people with tics and Tourette’s at support groups. These can take place online or in person. Speak to your GP to find out more about what kinds of groups are available near you.

The charity Tourettes Action hold a number of online support groups, which you can find out more about .

“I've made very good friends there, and we still talk to each other to this day. I think the Tourette's community is one of the most accepting places that I've ever experienced. You know everyone understand each other.” Rayne

There are lots of things you can do yourself, or with the help of your friends and family, to make your tics easier to manage.

Here are some of the things that the people who helped to write this resource say they find helpful or unhelpful when managing their tics. Remember, everyone is different. Something that works for one person might not work for another.

After you’ve looked at these examples, you might find it helpful to make a list of the things that you find helpful or unhelpful.

Things that can help with tics

• “Sometimes my premonitory urge is quite painful. I find if I exercise, I still need to tic, but it’s not as painful.”
• “For me, music and concerts are the number one thing that really helps me. If I'm having a tic attack, I know to just put my headphones on, and it usually calms down within like 10 to 15 minutes.”
• “Tourettes Action has a lanyard that tells people that you've got it. If I go out and wear that I've noticed that the stares are to a minimum.”
• “If I'm cooking or just doing something really practical with my hands like drawing then my tics really reduce.”
• “I often advise people to try mindfulness and relaxation techniques. Physiotherapy and warm compresses can also be helpful for muscle pain.”

Things that can make tics more pronounced

• “Caffeine - I drank an energy drink one time, and I'll never do it again.”
• “Going into new environments with new people, because I’m normally used to everyone around me already knowing I have Tourette’s.”
• “If I was ticcing badly, a really loud environment like a concert would be a bad environment for me.”
• “I know that if I talk about my tics, then I start ticcing more.”

You shouldn’t necessarily avoid these things, but it can help to know what things make your tics easier or harder to manage. It’s important to note that it’s not only bad things that can make your tics more intense. You might find that your tics get more intense if you are excited or happy.

It is also important to know that sometimes your tics will get worse or better, and you won’t know why. This is called waxing and waning, and it’s a normal part of having tics and Tourette's. This can be frustrating, but it isn’t your fault.

As we’ve already discussed, people with Tourette’s are more likely to have certain mental health conditions. This is why it’s important that young people with tics and Tourette’s receive understanding and support from the people around them.

Tics and Tourette’s can also be affected by your mental health. You might find that if you are feeling particularly stressed, your tics become more pronounced.

If you are struggling with your mental health, speak to someone you trust, or the people involved in your medical care. You can find out more about mental health in young people on our website.

“I think a lot of the mental health issues come from the way other people perceive it. Especially out in public, people telling you to shut up or staring at you, or asking why are you doing that? And while I personally don't mind those questions, it's the way people ask.” Rayne

“I have an anxiety disorder, and I wasn’t able to sit my GCSEs because the anxiety would get really bad and then the tics would get a lot worse. I got a teacher assessment in the end.” Lily

Tourette syndrome is a life-long condition but many children who have tics find they improve a lot over time. Many children with Tourette’s will experience fewer symptoms as they get older. One study looked at young people with Tourette’s as they got older to see how their tics changed. This study suggests that as children with Tourette’s grow up:

• around 2 in 10 find their tics go away
• around 6 in 10 continue to have mild tics
• around 2 in 10 continue to have moderate or severe tics

“I'm nearly 20 now, and they've really calmed down compared to what they were like. But tics can wax and wane. You can go through periods where you might not tic a lot, but then you could go through like a week or two where you're constantly ticcing. If my tics are really mild, I've had people say ‘has your Tourette's gone away?’ and no, I'm just going through a different period of time.” Rayne

“Even though the amount I tic hasn’t changed much, my ability to live alongside my tics has changed as I've gotten older. I've become more experienced with what can trigger my tics or what can help if my tics are really bad.” Ed

Tips for parents

Be patient

It’s understandable to feel stressed if your child is experiencing tics or has been diagnosed with Tourette’s. You might be wondering what this means for their future, and wondering what you can do to help.

It’s important not to become frustrated with your child for ticcing. Remember that it might take a few different therapies or treatments for you to find what works best for your child.

Find out what they find helpful

Ask your child what they find helpful when they are ticcing. For example, they might find it helpful if you ignore it while it is happening. Or they might find it helpful for you to distract them with an activity or conversation.

Finding out more about what your child needs, and what things they are struggling with, can be an important part of them learning to manage their tics.

“if I'm having a hitting tic and you grab my hand to try and stop it, you're going to make things a million times worse.” Rayne

Don’t discourage ticcing

You shouldn’t discourage your child from ticcing, and you should never punish them for ticcing. Some therapies do help to enable young people to control their tics. However, it is important that this is done in a supported and controlled way, with the support of a therapist.

Often, the tics that young people find most difficult are different to the tics that their parents find most difficult. This might mean that you have different aims for treatment. Speak to your child to find out what is most important to them.

“Parents might want the tic where the child is swearing to stop. But actually that's not the one that bothers the child the most. It's the one where they tense their stomach muscles.” Ed

Get support for yourself

Parents can also benefit hugely from support groups, and learning from other parents. This can be a helpful place to ask questions.

You might also want to find out more about what support is available for carers if you are spending a lot of time or money looking after your child. Find out more about this in our carers resource.

Tips for schools

Schools can be one of the most important forms of support for young people with tics and Tourette’s. Often young people feel that they need to suppress their tics in school. This might be because they are embarrassed or because they are worried about distracting others. This can make it difficult for them to learn, and can cause them to feel isolated from their peers.

This information is aimed at teachers and schools and looks at some of the ways that they can support their students.

Offering reasonable adjustments

Teachers can support the children in their class who have tics or Tourette’s by offering adjustments to the learning environment. This could be things like allowing them to do their exams in a private room so that they don’t have to worry about ticcing. Or it could mean allowing them time to go into a private room where they can tic.

Providing a ‘tic-neutral’ learning environment

Many children say they find it helpful for school to be a ‘tic-neutral environment’. This is where students don’t comment on someone’s tics, and are encouraged to ignore them.

This might take some time and practice, and adjustments might need to be made for other students in your class.

“I prefer tic-neutral environments because I’m less likely to tic for long periods of time. I know that if someone's staring at me or commenting on it, then it makes me feel really self-conscious. And then it ends up getting a million times worse than it was before.” Rayne

Ensuring teachers are educated about tics and Tourette’s

It is important for teachers and schools to understand that tics are not a behavioural problem, and should not be treated like one. Children with tics or Tourette’s are not ticcing intentionally or trying to be disruptive.

“Tics can be mistaken for bad behaviour. But actually, we have a really good understanding of what causes Tourette syndrome. And it is a neurological disorder, not a behavioural problem.” Ed

Educating other children about tics and Tourette’s

Tics and Tourette’s are often misunderstood, and many children will only know about tics and Tourette’s from TV or social media. Some of the information they have learned might be incorrect or out of date.

You might find it helpful to share some of the information in this resource with the students in your class. Some young people like to share with their class how their tics or Tourette’s affect them. However, not every young person feels comfortable doing this. Speak to the child in your class and their parents or carers to find out what they would prefer.

“I think the portrayals in media don’t help. I've seen documentaries where they focus on someone who has a very severe case of Tourette's. That obviously then creates the idea that everyone with Tourette's is exactly the same as that.” Rayne

- Tourettes Action is the UK’s only national charity dedicated to supporting individuals with Tourette syndrome and their families.

Books

• Tic disorders: A Guide for Parents and Professionals by Uttom Chowdhury and Tara Murphy – This book is for parents of children and young people with tic disorders and the professionals who work with them.
• The Tourettes Survival Kit: Tools for Young Adults with Tics by Tara Murphy and Damon Millar – This book is recommended for young people over the age of 15.

This information was produced by the 萝莉视频’ Child and Family Public Engagement Editorial Board (CAFPEB). It reflects the best available evidence at the time of writing.

Expert author: Dr Edward Palmer

Expert reviewer: Dr Tara Murphy

Experts by experience: Rayne Huggins and Lily Richards

This resource was developed with young people who have lived experience of Tourette syndrome.

Full references available on request.