https://www.gosh.nhs.uk/wards-and-departments/departments/clinical-specialties/department-child-and-adolescent-mental-health-dcamh/the-tic-disorder-service/functional-tics/
Functional tics
Since December 2020, we have seen an increase in the referral of young girls with functional tics to our Tourette syndrome clinic.
Hear from our specialist team of psychologists and psychiatrists about this rise in functional tic presentations:
- What are the differences between Tourette syndrome, classic tics and functional tics?
- What types of tics do we treat at GOSH?
- What have your team observed over the COVID-19 pandemic?
- What explanation is there for the recent surge in functional tic presentation?
- What treatments are best for people with functional tic presentations?
- Where can people go for support and treatment for functional tics?
What are the differences between Tourette syndrome, classic tics and functional tics?
Hear from Dr Morvwen Duncan, a Clinical Psychologist at GOSH:
What are tics?
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.
What is Tourette syndrome?
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.
What are functional tics?
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.
What types of tics do we treat at GOSH?
Hear from Dr Morvwen Duncan, a 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.
Treatment for classic tics
For children with classic tics we offer medication, advice, and recommendations for behavioural interventions.
Treatment for functional tics
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.
What have your team observed over the COVID-19 pandemic?
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.
What explanation is there for the recent surge in functional tic presentation?
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.
Anxiety as a contributing factor in 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.
Other undiagnosed conditions
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.
Social media as a contributing factor in tics
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.
What treatments are best for people with functional tic presentations?
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.
Understanding the tics
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.
Where can people go for support and treatment for functional 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.
Further information
- 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.