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I've got Tics and terrified - please help me!

For years in A&E we've seen lots of children with tics. 10 years ago I had started using solution-focused therapy for a large range of situations and it worked particularly well. It certainly brought acute relief when children were distressed or in pain from the tics.

One of the most common we see is habitual coughs - a so-called vocal tic (sound with the mouth) rather than a motor tic (jerks or twitches or similar). It has always been boys and many had already been struggling with ADHD, autism or OCD. It's no real surprise that these children might struggle in lockdown - let's face it most people did. Interestingly we saw children in much more distress than normal and more of them. The biggest trigger seemed to be when lockdown or tiers were changing - particularly where the restrictions were being relaxed and weren't obviously logical or consistent.

And yet, out in the community this was not the bulk of the developing tics. Teenage girls having tics became a tsunami in lockdown. The Royal College of Paediatrics published an article on this big shift in their Journal Archives of Disease in Childhood - my comments above were in an article discussing this. I actually didn't see them - schools and GPs did. They were often very uncomfortable, embarrassed and worried about what might be wrong. I wish I could be there for every single one of them. I hadn't realised how difficult it is to access care quickly - particularly treatment rather than purely for a diagnosis. I want to get the word out that I can offer that.

The article talked also about TikTok videos and how tics had been portrayed. This caused a lot of controversy as to whether this brought out latent tics in those watching them. An emergency training session was set up with Sarah Dove via Eventbrite (who lives herself with tics) to look at this. She very much was clear that there should be no shame or hiding of tics. Being more visible can help society in general be more accepting and then supportive.

So what are they?

They can be vocal or motor (see above) and include coughs, throat clearing noises, lip smacking, words (and rarely in only 10% of cases, swearing) in verbal ones. The motor ones are often focused around the head and neck (which of course makes them very obvious) and can be jerks, or twitches for example. There is a build-up before they happen often and this is worse when stressed or when there aren't distractions (one potential explanation for the pandemic-related explosion). Tourettes Action gave that eye blinking example to illustrate the urge to tic. They can be painful because the same muscles repeatedly spasm.

How do you get it?

It seems to be a bit like migraines. There is a strong genetic component - sufferers very often have family members affected. Many people may develop the tendency to tic and never actually do it - we wouldn't ever know. It seems that if you inherit the tendency something then acts as trigger to reach a threshold for showing tics. The trigger may be a (usually viral) infection, stress, excitement or something else. Again we're not sure.

Some people will have tics which are very mild or at such a low level that they never look for medical help. Many people will have tics which become well established and yet still vary day to day - they aren't a fixed thing - which is good! We can work with that!

What can help?

Again similar to migraines, the problem is over-excitation in the brain. Unlike migraines medicines aren't even really in the toolbox.Often it's the simple stuff that makes the biggest difference. It's the eating regularly, drinking plenty of fluids, sleeping well, avoiding significant stress or extreme excitement. As with migraine sufferers I say that this is true - you still need to be able to live a meaningful life so that it's a balance.

Distractions and outlets really help. Many people suppress the tics, particularly in company or school and this takes incredible effort and constant concentration.

In terms of treatments there really aren't any medicines. Talking therapy can really help. Although many people are aware that they can suppress tics they may think that that intense effort is the only way. Solution focused conversations / therapy shows that they have quite a bit of control and just knowing that causes huge relief and gives real power back to them.

The approved treatments are around channelling the undesirable tic into something different and potentially less obvious or painful. These include a specific form of CBT. The beauty of the Solution Focused approach is that it is unique to you - it harnesses your resources and what you already know works rather than follows a set protocol into which you squeeze.

Most importantly, please get support. Through school, doctors (I would love to help you).

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