Tics are repeated and involuntary movements. They can happen with several conditions, including ADHD.
Childhood tics can be subtle and missed by parents, caregivers, and educators. They can also be obvious, and sometimes disruptive.
You may have noticed unusual behaviors in your child with deficit hyperactivity disorder (ADHD), like excessive blinking or nose wrinkling.
Or maybe a classroom teacher was the first to spot the tics. This is often the case, since school can cause feelings that make tics more severe, such as:
Once you’re aware that your child has tics, you may wonder why, and what to do next.
If you have a child with ADHD who’s experiencing tics, it may seem like it’s the ADHD that’s causing them. But the more likely culprit is an undiagnosed tic disorder.
Tic disorders aren’t part of ADHD, although the two often occur together. They also aren’t a sign of ADHD. This is why many children with ADHD do not experience tics whatsoever.
When ADHD occurs with a tic disorder, signs of ADHD generally show up before tics. This is why ADHD is often diagnosed first, and may appear to be causing tics.
Previous speculation was that the medication used to treat ADHD may contribute to tics. A 2015 review of 22 studies, involving over 2,000 children, concluded that psychostimulant medication does not increase the risk for new tics or worsening of existing tics.
Studies show that about
Tourette syndrome (TS) is one such condition. TS is a neurological disorder characterized by both motor and vocal tics that usually start when a child is between 5 and 10 years of age. For a diagnosis of TS, a child must have had both types of tics for more than 1 year.
TS tics typically start in the head and neck region and may progress to other areas of the body. They become more pronounced during adolescence then often fade in early adulthood, although sometimes they remain or even worsen.
Other tic disorders that occur with ADHD include:
- persistent (chronic) vocal or motor tic disorder (either vocal or motor tics — but not both — for at least 1 year)
- provisional tic disorder (motor, vocal, or both types of tics, for less than 1 year)
The differences between the tic disorders are the types of tics that occur, and how long the person has had them.
In fact, there’s a strong connection between TS, ADHD, and a third condition: obsessive-compulsive disorder (OCD).
TS, ADHD, and OCD share an important neurological characteristic: disinhibition, which is the inability to control behavior that’s considered inappropriate.
Impulsivity is a disinhibition characteristic of people with TS. People with TS also tend to experience hyperactivity and inattention, much like those with ADHD. When these traits meet the required level for an ADHD diagnosis, TS and ADHD exist together.
Much like the way people with OCD are often driven to perform specific rituals to ward off intrusive thoughts, some people with TS have a similar experience. They need to perform their tics in a certain manner or for a specific number of times, to relieve an urge or sensation.
ADHD and OCD aren’t the only conditions associated with tic disorders. For example, TS can also occur with:
- learning disorders
- conduct disorders
- oppositional defiant disorder (ODD)
- sleep disorders
- social skill deficits
- sensory processing issues
It’s important to note that while ADHD and tic disorders, like TS, may co-occur, they don’t cause one another. What ADHD and TS may cause, however, is anxiety. Or, conversely, anxiety can increase ADHD symptoms and tics.
Similar to people with tic disorders, autistic people often engage in repetitive behaviors, but these behaviors are called stims. The main difference between stims and tics is that stims are usually voluntary and done to self-soothe. Autistic people with TS, on the other hand, experience tics.
Tics are abrupt muscle twitches, so they can appear in many different forms or areas. Common tics include:
- head and shoulder movements
- facial activity like grimacing and blinking
- sounds such as throat clearing, sniffing, and grunting
You can tell a movement is a tic if it happens more often than is typical, or if it’s out of context with a situation. For example, eye rolling is a fairly expected response to specific stimulus. But if eye rolling happens repeatedly without being a reaction to something, it may be a tic.
Tics fall into two categories: motor and vocal. They can be simple or complex.
Simple motor tics include:
- head jerking
- eye movements
Complex motor tics include:
- object touching
- hopping or jumping
- combined movements, like facial grimaces with head turns
Simple vocal tics include:
- throat clearing
Complex vocal tics include:
- repeating one’s own words or phrases
- repeating the words or phrases of others
- using vulgar or inappropriate language
On rare occasions, tics can cause self-harm. An example is hitting or punching oneself.
People who experience tics describe an urge or impulse to perform the tic. The urge usually persists until the tic occurs.
Some tics are sensory in nature. This means that the person with the tic experiences a sensation in a specific location. The tic eliminates this sensation. The relief is only temporary, and the sensation returns, so the tic is repeated.
It’s usually a good idea to mention any new developments to your child’s doctor when you visit. Whether you should schedule an appointment just to talk about tics depends on several factors.
- Are the tics bothering your child?
- Are they disruptive?
- Do they interfere with learning, friendships, or daily functioning?
- Do they create a safety issue?
If the answer is yes to any of the above questions, your doctor can help you and your child find solutions to minimize the impact of tics.
Tics often improve with age. According to
There are several treatment options for tics, but your doctor might suggest a wait-and-see approach. If tics are mild, the medications for treating them can have side effects that are more severe than the tics themselves.
If treatment is a priority, there are several approaches that have been successful:
- habit reversal therapy
- exposure response prevention
A thorough evaluation to identify any co-occurring conditions is important since these variations in diagnosis can affect treatment. For example, certain types of ADHD medications work better than others for tics.
Lifestyle modifications can improve the experience of someone dealing with tics. For instance, reducing stress and anxiety triggers can help, as well as prioritizing a consistent sleep schedule and proper nutrition.
If you’re the parent of a child with ADHD and tics, learning as much as you can about the co-occurrence of the two conditions can help you support your child.
Children are very aware of parent perceptions. Practicing acceptance and understanding may improve your child’s self-confidence and reduce any stress they may feel about their tics, which, in turn, may help to reduce them.