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TIC DISORDER  Tics are a sudden, spasmodic, repetitive movements or utterances that are involuntary and purposeless. The most frequently involved are the muscle groups of the eyes, mouth and neck. The tics are often exacerbated by stress.

Boys are affected twice as frequently as girls and are most common in the school aged child. The incident of tic behavior is from 1 to 13%. Tick disorders are classified as transient tics of childhood, chronic tics and Tourette syndrome.

The transient tic disorder is the most common movement disorder in childhood and may affect up to 10 percent of children during the early school years. It may persist from several weeks to less then a year and may occur several times a day, nearly every day. Onset occurs between 3 and 10 years of age and is more common in boys. Some may get worse with anxiety, tiredness, and some medications. I do not recommend any specific medication or treatment at the onset of transient tic disorder since it usually goes away by itself. I mention below Habit Reversal Training (HRT) for tic disorder that is severe and persisting for several months.

Chronic tick disorder is a rarer form, occurring many times a day, nearly every day, lasting over a year. There may be up to three muscle groups involved with this type of tic disorder.

Tourette syndrome is the most severe form of tic disorder. This disorder may begin in early childhood, starting as simple motor tics and progressing after one or two years as vocal tics. This may be a life-long condition, with a prevalence of approximately 1:2,000. This is a genetic disorder and may have up to four components: motor tics, vocal tics, obsessive-compulsive behavior and attention deficit hyperactivity disorder (ADHD). Not all of these components are present at the same time. Stress and anxiety may exacerbate the symptoms.

The treatment for this disorder depends on the classification. The Transient type should be followed clinically since this is a diagnosis of exclusion. Undue parental attention can reinforce tics, whereas ignoring them may diminish their occurrence. Many tic disorders improve or resolves spontaneously over time. For Tourette syndrome, psychotherapy and behavior management, as well as biofeedback, relaxation therapy and hypnotherapy have been tried. Also, medications such as haloperidol and clonidine have been used.

Habit reversal training
(HRT) is a behavioral treatment program that was developed to address a wide variety of repetitive behavior disorders, including tic disorder. It consists of five components:
  • awareness training
  • Competing response training
  • Contingency management
  • Relaxation training
  • Generalization training
These components are intended to increase tic awareness, develop a competing response to the tic, and build treatment motivation and compliance. HRT is based on the presence of a sensation occurring before a tic. HRT involves replacing a tic with a competing response when a patient feels a premonitory urge building. The competing response is a more comfortable or acceptable movement or sound.

HRT reduces the severity of vocal tics, and results in enduring improvement of tics when compared with supportive therapy. HRT is not yet proven nor widely accepted, but large-scale trials are ongoing.

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