Sunday, January 22, 2017
Tic Disorders in Children
Tic disorders can be simple or complex. Simple tic disorders can be eye blinking or facial grimaces. Complex ones are usually involving motor groups and produce tapping, echolalic speech, multiple motor habituated movements, etc.
Statistically tics are more frequent in boys than girls. The common age for onset is about 5-6 years of age. Tics are known to “peak” between ages 8-12 and then decrease during adolescence. Very few (although some) tic disorders persist into adulthood.
50% of the children have a diagnosis of ADD/ADHD, the remaining group may have an Oppositional Defiant Disorders, OCD, etc., and others have a mixed bag of some or no pre-existing conditions.
Often tics are a result of an (early) hyper-sensitivity to touch and/or vestibular stimuli. Sensory integrative therapy can help the child cope with sensory discomforts.
Tics are considered a release from an “urge” and can be brought on by anxiety, either social or academic or both. Tics can resolve independently but that is usually a waxing and waning process that is consistent and not a “sure thing”.
Occupational Therapy may initially increase tic responses because the therapy focuses on the tics and the child becomes even more aware of the actions relating to the tic. However as coping skills are increased this diminishes over time and assists with tic resolution.
Additionally Cognitive Behavior Intellectual Therapy (CBIT) can help by helping the child recognize the triggers for the tic episodes and then use relaxation to reduce their onset and/or duration.
Relaxation exercises are useful and this can include deep breathing exercises, at home yoga techniques, music etc.
Social anxiety may trigger tics as the child is feeling the urge to do a specific motor action but is afraid of demonstrating this in the presence of peers for fear of their reactions.
Occupational Therapy is most helpful in teaching the child a new behavior to replace the tic with one that is both relaxing and socially acceptable. OT can help the child replace the tic , not control them since trying to control them may increase their frequency. In OT the child is taught techniques that will help habituate positive sensory accommodations and reactions that decrease stress reactions and the need to utilize “tic actions”.
The OT can help the child learn relaxation and decrease stress with motor activities and actions as well as teaching some techniques that are “below the radar” such as the use of fidgets, muscles tightening and relaxing, etc.
It is also important to consider other resources and a full psychosocial assessment may provide additional valuable information.
Susan N. Schriber Orloff, OTR/L FAOTA