My daughter's tic

As both a parent and a therapist, I am familiar with the duality of grappling with the fear and anxiety of the unknown while also turning to my own professional skill set, tools, and knowledge. I have been here a few times since occupying the chair of a scared and grieving NICU mom nearly eight years ago.  
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One of my daughters, a beautifully vibrant, silly, and sweet almost eight-year-old is a worrier who recently developed a simple vocal tic.  Though the exact cause of tics is unknown, they are often stress-related. I’d say our household, along with many others, experienced a good-sized dose of stress these past couple of years. The therapist in me reflected on the amount of stress my daughter has faced these past two years by simply being a kid during a global pandemic.  She experienced most of kindergarten, a formative year for socialization, virtually.  She learned how to log into a Google meet classroom before learning how to write lowercase letters. The laundry list of pandemic-induced lifestyle changes that directly impacted her seven-year-old world seems endless.

The parent in me wanted all the answers to all the questions flooding my mind: how do we get her tic to go away? Will the severity and frequency increase?  Will this impact her self-image? I had to stop and pull out my therapist toolbox. I reframed my thoughts, reminded myself to breathe and to take it one day at a time. Taking it one day at a time includes educating myself on tics and writing this blog. The pandemic has taken a toll on children’s mental health and my daughter is no exception.

What is a tic?
The American Psychiatry Association defines tics as sudden, recurrent, and non-rhythmic movements (motor tics) or vocalizations (phonic or vocal tics). Tics can be either simple or complex.

• Simple tics: sudden and fleeting tics using a few muscle groups (e.g. nose twitching, blinking, or throat clearing.)
  
• Complex tics: coordinated movements using several muscle groups (e.g. facial grimacing, hopping, or repeating words or phrases)
  

How are tics diagnosed?
It is always a good idea to inform your child’s pediatrician at the onset of a suspected tic. A detailed description or a video may be all they need to diagnose. If there is indication for a specialist consult, they may refer to a neurologist. A diagnosis will help determine which type of tic your child has:
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• Provisional: the most common affecting up to ten percent of children during their early school years. The good news is that this type goes away on its own in less than a year.
  
• Chronic: tics lasting one year or more
  
• Tourette’s Syndrome: both vocal and motor tics for more than a year
  

How are tics treated?
Evidence-based treatment options include psychoeducation, behavioral therapies, and medication. Your child’s pediatrician will help identify the best treatment option for your child based on age, symptom severity, and resource availability.

‍Behavioral Therapy
‍Seeking specialized behavioral treatment is seldom needed if a tic is mild and not disrupting your child’s day-to-day activities. If a tic is more severe, these behavioral therapeutic interventions though not a “cure” have proven successful in reducing tic severity and frequency.

Comprehensive Behavioral Intervention CBIT:  gain awareness of the tic, the premonitory experience (urge), and make behavioral changes to lessen the tics
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Habit Reversal Therapy (HRT): implement a competing response to prevent the tic from occurring

Exposure and Response Prevention (ERP): learn to manage and suppress the tic without a competing response

‍Nutritional Supplements
‍After reading about a clinical study* out of Spain, and running it by my daughter’s pediatrician, I’ve added a children’s magnesium gummy and vitamin B(6) to her daily vitamins and have seen a significant reduction in the frequency and severity of her vocal tic.

‍Management: Ignore the tic and provide support
‍The ignoring part may be difficult at first but it does get easier.  Ignoring the tic is crucial as drawing attention to the tic increases anxiety and will likely exacerbate it. Calling it out is like taking a neon green highlighter and making it all that more visible to your child.

Tics can worsen with anxiety, stress, frustration, fatigue, and even boredom.  Here are some tips that have helped my daughter on her journey:

1. Age-appropriate education: set aside time to educate your child about tics. Knowing that what their body is doing has a name can provide a big sense of relief.
   
2. Mindfulness: learn stress reduction techniques. Square breathing, kids yoga, the feelings wheel are all great ways to learn the importance of being present and learning they are not their feelings.
   
3. Fun and stimulating activities: as we find ourselves returning to a sense of pre-pandemic normalcy my daughter is looking forward to trying Jiu-Jitsu and joining a Girl Scout Troop.
   
4. Sleep: create the best environment for a goodnight’s sleep
   
5. Distraction: if your child has awareness of their pre-tic sensation, have them pick a distraction gadget to use at this time. My daughter had fun picking out several “pop-it” bracelets and has at times successfully suppressed her tic by turning to “popping” when she feels the urge.  
   
6. Support: communicate with your child’s support network including teachers and extended family members so that they are all on the same page.
   
7. Love: continue being the loving, supportive advocate that you are.
   

As my daughter’s number one cheerleader, I will continue to support and search for creative ways to help her with this diagnosis. This tic does not define her. Though I hope and pray that her tic falls under the provisional category, both my mom and therapist brain know that kids are resilient and my daughter is no exception.  

‍Resources:
‍Tichelper.com
Tourette.com

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Citations

1. García-López R, Romero-González J, Perea-Milla E, Ruiz-García C, Rivas-Ruiz F, de Las Mulas Béjar M. Estudio piloto sin grupo control del tratamiento con magnesio y vitamina B(6) del síndrome de Gilles de la Tourette en niños [An open study evaluating the efficacy and security of magnesium and vitamin B(6) as a treatment of Tourette syndrome in children]. Med Clin (Barc). 2008 Nov 22;131(18):689-91. Spanish. doi: 10.1157/13129113. PMID: 19087826.