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Persistent (Chronic) Motor or Vocal Tic Disorder

Kathryn Patricelli, MA

What is Persistent (Chronic) Motor or Vocal Tic Disorder?

The symptoms of this disorder include:

  • single or multiple motor or vocal tics that have been present at some point during the illness, but not both motor and vocal tics.
  • the tics may come and go, but have been experienced for more than one year since the first tic occurred
  • the condition first appears while the person is under 18 years of age
  • the symptoms are not the result of effects on the body from a substance (such as cocaine) or another medical condition
  • the criteria for Tourette's Disorder have not been met.

Clinicians will also specify if the condition is:

  • With motor tics only
  • With vocal tics only

Tics are classified as either simple or complex and examples include:

  • Simple motor tics, which are sudden, brief, repetitive bodily movements that involve a limited number of muscle groups. This could include eye blinking, facial grimacing, shoulder shrugging, and head or shoulder jerking.
  • Simple vocal tics could include repetitive throat-clearing, sniffing, or grunting sounds.
  • Complex tics are distinct, coordinated patterns of movements involving several muscle groups such as the head and shoulders, or arms and legs.
  • Complex motor tics might include facial grimacing combined with a head twist and a shoulder shrug, sniffing or touching objects, hopping, jumping, bending, or twisting.
  • Complex vocal tics include words or phrases.
  • The most disabling tics include motor movements that result in self-harm such as punching oneself in the face or vocal tics including coprolalia (uttering swear words) or echolalia (repeating the words or phrases of others).

How common is Persistent (Chronic) Motor or Vocal Tic Disorder?

Tic disorders are common in childhood, but are typically temporary. They generally occur more often in male children than female children (from 2-4 times more likely).

While it can be a lifetime chronic condition, most children with this condition have the worst symptoms in the early teen years and then begin to improve later in the teen years and into adulthood.

What are the risk factors for Persistent (Chronic) Motor or Vocal Tic Disorder?

Research has found risk factors for this disorder that influence the tics being present and also cause them to be more severe. These include genetic factors, complications during pregnancy, older paternal (father's) age, lower birth weight, and a mother smoking during pregnancy.

Tics can be made worse by anxiety, being excited, being in stressful situations (taking a test, giving a presentation, etc.) or being very tired. Generally, children will have less tics when they are focused on a project or task and will have more when they are relaxing or are at home.

When seeing someone else making a gesture or sound, someone with a Tic Disorder often repeats the same sound or gesture. This can be seen by others as mocking or copying them, or that the person is doing it on purpose to be mean or silly. That is actually not the case - it's just part of the disorder.

What other disorders or conditions often occur with Persistent (Chronic) Motor or Vocal Tic Disorder?

Other conditions that often occur with this disorder include attention deficit hyperactivity disorder (ADHD), obsessive compulsive and related disorders, other movement disorders, depression, bipolar disorder, and substance use disorders.

How is Persistent (Chronic) Motor or Vocal Tic Disorder treated?

Because tic symptoms do not often cause the person's health to be worse or stop them from living their daily lives, most people will not need medication to stop the tics. There are medications available if the tics are interfering too much with the person's school or work activities. However, there is no single medication that works for everyone or that stops all tics. Each medication will also have some side effects, so the person may have to keep trying different ones to find something that works and doesn't cause problems that are harder to handle than the tics.

There are also behavioral approaches that have been used, including relaxation training and techniques (such as yoga or meditation), biofeedback (focusing your mind to control your body), and hypnosis. Habit reversal training, which works to help the person become aware that a tic may happen soon and then teaches them to do something else instead of the tic, has also be used. However, none of these methods have been thoroughly tested and are not considered proven approaches for treating Tic Disorders at this time.