When should medical treatments be considered for tic disorders?

When should medical treatments be considered for tic disorders?

OVERVIEW

Tic definitions and diagnoses have been described in the previous two posts. Tics are common among children. And not all children with tics require treatments. The goal of this post is to describe occasions when medical treatments should be considered.

DO WE NEED TO TREAT?

Some children have mild tics. They are referred to medical specialists because family members, teachers, or primary physicians become concerned about the new-onset of abnormal movements and/or sounds that are tics. But often the child is unaware of the new movements or sounds (or unconcerned about them). When tics are mild and do not affect daily activities, medical treatment is not needed.

WHEN TO CONSIDER TREATMENT

Tics can be severe, and when they are, treatment should be considered. The following situations are examples of when to consider seeking treatment.

Tics cause pain

Certain stretching movements with tics, especially involving the neck and shoulders, can cause pain or discomfort. Treatment should be considered whenever tics are thought to produce pain.

Tics affect daily activities

Both motor and vocal tics can be disruptive in a classroom (or other) environment. Motor tics can interfere with daily activities and sports. Vocal tics can impair the pronunciation of words. If tics impair normal daily activities, treatment should be considered.

Tics affect social functioning

Young children might not be aware of their tics or they might not be concerned by them, even when the movements or sounds are quite noticeable to others. Usually, treatment is not necessary when the patient is not concerned. However, when tics draw negative attention from peers or cause the individual to avoid social situations because of embarrassment, treatment may be helpful.

Comorbidities are present

In a previous post, comorbidities were defined as additional medical conditions that are commonly present with the primary condition. Common comorbid conditions with tics include attention deficit-hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and depression. It is common for a patient with tics to have at least one comorbid condition.1 When present, these conditions may warrant treatment, although treatment of the tics themselves may or may not be necessary.

The specific types of treatments for tics will be discussed in the next post.

References

¹Hirschtritt ME, Lee PC, Pauls DL, et al. Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette’s syndrome. JAMA Psychiatry. 2015;72:325-333.