Functional tics

Hear from Dr Morvwen Duncan, an Honorary Clinical Psychologist at GOSH:

Tics are fast, repetitive muscle movements that result in sudden and difficult to control body jolts or sounds. These are very common in children of primary school age, are often harmless and do not require specialist assessment.

Motor and vocal tics, known as neurodevelopmental, or classic tics, usually start in childhood and if they last longer than a year a child could be diagnosed with Tourette syndrome. This affects 1% of children in the UK, around 70-80% are boys.

There are also functional tics which are involuntary physical movements. These can be anxiety driven and are more common in teenage girls.

A child or young person can have both classic tics and functional tics, but it is important to get a correct diagnosis as this will help guide the different treatment options and to gain a comprehensive understanding of the child’s needs.

Hear from Dr Morvwen Duncan, an Honorary Clinical Psychologist at GOSH:

At our specialist Tourette syndrome clinic we provide assessment, diagnosis, and intervention for young people with a whole range of tics.

For children with classic tics we offer medication, advice, and recommendations for behavioural interventions.

We also help young people with functional tics to develop strategies to help manage the underlying conditions that may be contributing to the tic-like behaviours and advise local Child and Adolescent Mental Health Service (CAMHS) on how to help.

Hear from Dr Holan Liang, a Consultant Child and Adolescent Psychiatrist at GOSH:

Since December 2020 we have seen a sharp increase in the referral of young girls with functional tics to our clinic. Clinicians at the Evelina London Children's Hospital also noted this increase.

Hear from Dr Holan Liang, a Consultant Child and Adolescent Psychiatrist at GOSH:

There are multiple factors, which either individually or in combination, could be causing this increase in functional tics.

A major factor is anxiety. We know that functional tics are related to anxiety, and that levels of anxiety have been understandably high during COVID-19 pandemic.

A high proportion of the young girls we see also had undiagnosed neurodevelopmental disorders, such as ADHD and autism.

There is a known relationship between tics and these conditions, but functional tics could now be increasing because of heightened anxiety.

ADHD and autism can increase anxiety, particularly if undiagnosed, as unsupported symptoms cause stress and it is well known that symptoms in girls are more likely to be missed by parents, teachers and clinicians.

There may also be a link with social media. Some of the teenagers we are referred display tics very similar to the ones exhibited by influencers with tics on TikTok. Watching these videos could be reinforcing these tic-like behaviours.

Hear from Dr Tara Murphy, a Consultant Paediatric Neuropsychologist and Clinical Psychologist at GOSH:

A psychologist or mental health practitioner will be able to advise on what treatment options are best for each child or young person.

Usually, the first step in treatment is to understand what the functional tics are, and how they change over time.

Once we understand more about the patient's tics, then we can help them start to adapt and change parts of their lives to cope and deal with these distressing involuntary movements and sounds.

This might include treatment for anxiety or trauma that is thought to be have triggered them, or looking at how to reduce actions that are maintaining or reinforcing the tics.

Hear from Dr Tara Murphy, a Consultant Paediatric Neuropsychologist and Clinical Psychologist at GOSH:

The first place to go for support will be your GP. They can then make a referral to the local Child and Adolescent Mental Health Service (CAMHS). Here, a range of health care professionals will be able to support and help those with functional tics.

Particularly complex cases may be referred to a more specialist team such as our team at GOSH.

• Additional information on functional tics can be found at Neurosymptoms.org, Tourettes Action, and Tourette Association of America.
• For further information on tics, please visit the NHS website.
• Access our recent research paper on the increase in functional tic presentations.