Tics and Tourette syndrome

What are tics and Tourette syndrome?

Tics are sudden jerky movements such as eye blinking or shoulder shrugging (motor tics) or making sounds such as throat clearing or saying words (vocal tics). Tics often get worse if someone is feeling excited, nervous or stressed.

Tics usually start when a child is around 4 to 8 years old. Many children develop a tic, and these usually go away within a year. Most children with tics improve or even go away during the teenage years.

If motor or vocal tics last more than a year they have a chronic tic disorder.

If a child has both motor tics and a vocal tic, they may be diagnosed with Tourette syndrome.

Only about 10 percent of children with Tourette syndrome will develop a swearing tic.

Tics can sometimes be held in for a short time, but a lot children and young people cannot stop tics and may not be aware of them. The best advice for parents, carers and teachers is not to draw attention to tics.

Sleep and tics

Children and young people with tics and Tourette syndrome can have sleep disturbances, such as:

• difficulty falling asleep
• frequent waking at night
• difficulty getting back to sleep
• sleep walking
• sleep talking
• nightmares
• increased non-tic movements, such as tossing and turning in bed

These may not necessarily be due to tics, but the tics may make them worse.

Why is sleep so important?

It is important for children to get enough sleep as sleep supports healthy growth and strengthens their immune system. Better sleep can also help children to regulate their emotions. Poor sleep can lead to:

• poor memory and concentration
• difficulty in regulating emotions
• anxiety
• irritability
• grogginess or lethargy
• weight gain

Poor sleep can also lead to more tics.

Treatment

Some tips to improve sleep include:

• make sure that sleep time and wake-up times are the same each day
• a cool and dark bedroom
• not using screens at least an hour before bed
• a healthy diet and sleepy food will help
• reduce or eliminate sugar in the late afternoon or evening
• tackle worries in the day by setting talking around them in the morning
• medication can be given to help with problems sleeping. Ask your doctor for more information

Behavioural treatment for tics

The best treatment for tics is behavioural treatment. We may be able to help your child with one of these options:

• Habit reversal training (HRT)
• Exposure with response prevention (ERP)

Ask your doctor how your child can access these therapies if they are not offered.

Medication

Tics at bedtime or in the night can be difficult for young people with tics and Tourette syndrome. If your child’s sleep is very disturbed, we may have to consider medication.

Melatonin can be prescribed to aid sleep. Melatonin is a hormone produced by our brains in response to darkness and makes us feel sleepy. It is part of our body-clock so should be used as part of a good sleep routine.

If your child is under the care of a consultant for their tics or Tourette syndrome you should also tell them about the difficulties your child is having with their sleep.