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"Tics" and Tourette Syndrome
Q: My grandson is four years old. He is quite precocious and highly verbal. For the past six months to a year, he has been exhibiting some odd body movements and noises. At first it was just clearing his throat. But now he will inhale, throw back his head and lift his arm and one leg. Each behavior lasts for about a month, then he starts a different set of movements. For a while he made mumbling sounds while we read to him, and that was very nerve wracking. Each thing he does starts out simply and quietly, but gets much more aggressive as the days go on. He started with clearing his throat when he had the sniffles, but then advanced on to gasping, clearing, coughing, and uh-hemming. I have suggested he be checked by a pediatrician, but my daughter has not been concerned until recently. They have no medical coverage because she is a college student with no help from the father. If this is something to be alarmed about, I will pay for the doc's fees. Please let me know.
A: I think your grandson should definitely be evaluated by his pediatrician. It may be that the movements that you describe are benign behavioral changes, but they sound like they may be "tics." Tics are recurring, involuntary movements or vocalizations. The most common types of motor tics are: Eye- blinking, grimacing, or neck twisting. Vocal tics can include throat clearing, coughing, sniffing and grunting. Tics can also be more complex than this and involve more detailed movements or sounds.
Tics can begin as early as age 2, but are most common in middle childhood, ages 8 -12. They are very common, and can affect from 5 to 10 % of children. They are about three times more common in boys than in girls.
The cause of tics is not really understood. Rarely, they can be a sign of a neurological disorder. They tend to run in families, and it is well known that certain medications can produce tics. Psychological factors are also felt to play a role.
Most tics will last for a short while and then go away, and generally no treatment is required. There are some children who have more significant and prolonged tics (greater than 1 year), and these children may have what is called Tourette syndrome, a disorder in which the tics are severe, frequent and can interfere with daily activities. Tourette syndrome is a lifelong disorder, though it often improves in adolescence or adulthood. There are medications that are available to manage severe tic disorders, and a number of behavioral treatments can produce significant improvement.
Thus I think it is important to have your grandson see his pediatrician, first to sort out whether the behaviors you mentioned are truly tics, and next to determine a plan for managing them if they are tics.
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Shari Nethersole is a physician at Children's Hospital, Boston, and an instructor in Pediatrics at Harvard Medical School. She graduated from Yale University and Harvard Medical School, and did her internship and residency at Children's Hospital, Boston. As a pediatrician, she tries to work with parents to identify and address their concerns.