It started with blinking, which the pediatrician attributed to allergies. Then throat clearing that went on for two months. Then a shoulder shrug. Now there is a head movement, and a teacher has asked whether he is doing it on purpose, and he is starting to notice other children noticing.
Tic disorders are far more common than most parents realize — transient tics affect a substantial minority of children at some point — and almost everything the average adult believes about them is wrong.
What a tic actually is
Tics are sudden, rapid, recurrent movements or vocalizations. Motor tics include blinking, facial movements, shrugging, head jerking, and more complex sequences. Vocal tics include throat clearing, sniffing, grunting, and occasionally words.
Tourette's syndrome is diagnosed when both multiple motor tics and at least one vocal tic have been present for more than a year, with onset before age eighteen.
The feature that most explains the experience is the premonitory urge: an uncomfortable building sensation — pressure, itch, tension — that the tic relieves. Most children describe it as needing to sneeze, or an itch that must be scratched.
That is why tics are described as semi-voluntary. A child can often suppress one for a while, and doing so requires effort and produces mounting discomfort, usually followed by a burst of tics when the effort stops. It is not a choice in any meaningful sense.
The coprolalia myth
Popular culture has attached Tourette's to involuntary swearing. In reality this affects only a small minority of people with the diagnosis — roughly one in ten.
The myth causes real damage. It makes families terrified of a diagnosis that in most cases involves blinking and shrugging, and it means children with visible tics get treated as if they are about to do something outrageous.
What makes tics worse
Understanding this helps parents stop doing the two things that hurt most.
Tics increase with anxiety, excitement, fatigue, and — critically — attention to the tics themselves. They often decrease with absorbed concentration, which is why many children tic less while playing an instrument or a video game and more in the twenty minutes afterward.
Two consequences:
Telling a child to stop makes it worse. Every reminder directs attention to the tic, which increases the urge. Parents who ask "what was that?" fifteen times a day are, without meaning to, driving the frequency up.
Suppression at school produces an explosion at home. Many children hold it together all day at enormous cost and then tic constantly from the moment they walk in. Parents interpret this as the child being able to control it and choosing not to at home. The reverse is true — home is where the effort finally stops. That is a sign of safety, not manipulation.
Waxing and waning is normal
Tics change. They come and go, one replaces another, they worsen for months and improve for months, often with no identifiable cause.
This unpredictability leads to a great deal of false attribution — a diet change, a supplement, a new routine credited with an improvement that was going to happen anyway. Be cautious about concluding anything from a few weeks.
The general trajectory is encouraging: tics typically peak in early adolescence, around ten to twelve, and improve substantially for most people by late adolescence or early adulthood.
Treatment that works
Not every child needs treatment. If the tics are not causing distress, pain, or impairment, education and reassurance may be all that is required.
When treatment is warranted, the first-line behavioral approach is CBIT — Comprehensive Behavioral Intervention for Tics. It has good evidence and typically runs around eight sessions. It involves:
Awareness training — learning to recognize the premonitory urge before the tic.
Competing response — a physically incompatible voluntary movement performed when the urge appears, held until the urge subsides. For a head jerk, for example, gently tensing the neck muscles.
Function-based intervention — identifying and modifying the situations that reliably worsen tics.
Importantly, CBIT does not suppress tics through willpower. It works with the urge rather than against it, and it does not produce the symptom substitution that people sometimes worry about.
Medication exists for severe cases and is generally reserved for tics causing pain, injury, or significant impairment, given side-effect profiles.
Treating what accompanies it is often the most important part. Most children with Tourette's have at least one co-occurring condition — ADHD and OCD are the most common, and anxiety is very frequent. For many families, the ADHD or the anxiety is causing considerably more difficulty than the tics, and treating those improves everything, including the tics.
School matters enormously
The social experience is usually harder than the tics. Practical steps:
- Educate the teacher, and with the child's consent, the class. Peers who understand generally respond well; the cruelty usually comes from confusion.
- Permission to leave the room briefly to release tics reduces the suppression burden dramatically.
- Extra time on tests, since suppression consumes working memory.
- Never call attention to tics publicly or discipline a child for them.
- Consider a 504 plan, which many students with Tourette's qualify for.
What parents can change today
Stop commenting on tics entirely. No corrections, no "are you okay," no sighing. Attention feeds them.
Do not let siblings imitate or tease. Explain it plainly to the whole household.
Let your child decide who to tell. Some want it explained to their class; some are mortified by the idea. Their control over the narrative matters.
Watch for anxiety and depression. The bigger risk in adolescence is usually social withdrawal and low mood rather than the tics themselves.
Manage your own distress somewhere else. Children read parental anxiety accurately, and a parent visibly worried about tics increases them.
Who to involve, and in what order
We work with children from age three and adolescents, including neurodivergence-affirming support, anxiety treatment, and parent coaching, at our east valley office on E Russell Road, our northwest office on N Durango Drive, and by secure video anywhere in Nevada. We are in network with most major insurance plans, and Nevada Medicaid covers children's behavioral health.
A pediatric neurologist should be involved for diagnosis and for any medication questions; behavioral treatment and support for the anxiety and social impact happen alongside that.
The tics are not the main problem
For most children, tics improve on their own by adulthood. What tends to persist is what grew around them — the shame, the anxiety, the belief that there is something wrong with them.
That part is entirely preventable, and it is mostly a matter of how the adults around them respond. If your family is in the middle of this, book an appointment.