Pediatric tic disorder is an involuntary, recurrent movement or vocalization with no apparent purpose. There are various forms of tics, mainly motor tics and vocal tics. In some children, the form of tics may change, such as blinking and shrugging, but after a while it changes to nodding, shrugging, and involuntary vocalizations. Clinical observation shows that most children with tics are sensitive, shy, out of sync, easily excited and agitated.
The main manifestations of tic disorder are brief, rapid, sudden, varying degrees of, involuntary movements. They begin with frequent blinking, eyebrow squeezing, nose sucking, mouth pouting, mouth opening, tongue stretching, head nodding, etc. As the disease progresses, the tics gradually diversify, alternating with shrugging, neck twisting, head shaking, leg kicking, hand shaking or limb twitching. The symptoms are often more pronounced during emotional stress or anxiety, and disappear after sleep.
Vocal tics are often explosive, with repeated vocalizations, clear noises and grunts, unclear individual syllables, inappropriate stress or constant obscenities. The symptoms of Tourette’s syndrome are fluctuating, progressive and chronic.
In addition to the complex symptoms of ADHD, there are many co-occurring disorders. Whenever coexisting disorders appear, especially the earlier they appear, the greater the likelihood that the condition will become complex and difficult to treat. It is important to detect and identify coexisting conditions in a timely manner, as treatment of coexisting conditions is the main reason for improvement.
Coexisting disorders are.
1, inattention and/or hyperactivity, impulsivity, mainly attention deficit hyperactivity disorder that is pediatric hyperactivity disorder. It is more common in boys.
2, obsessive-compulsive disorder, including a variety of compulsive ideas and behaviors, either alone or at the same time, persistently and repeatedly in thought and action, knowing that it is not right, but can not stop, never get rid of, sometimes very painful, self-harming behavior, such as biting the tongue, biting fingers, damage to the skin, disfigurement, etc., often leaving infections or scars, and even reveal the suicidal thoughts do not want to live, it is important to be highly vigilant to prevent accidents. It is common in girls.
3, conduct disorder and oppositional defiant disorder, both have anti-social tendencies, can not be ignored, many parents often mistakenly believe that these manifestations are not pathological, thought only stubborn temper and scolded to suppress, but the result is aggravated.
4, learning disabilities, is impaired cognitive function, mainly dyslexia and math difficulties, can seriously affect academic performance.
5, mood disorders, mainly depression and bad mood, adult-type alternating depressive mania can also be in children and adolescents.
Anxiety disorders, mainly fear and anxiety, such as fear of separation from relatives, fear of accidents to relatives, fear of school, excessive fear of strangers, fear of social interaction, and even daily worry about the future, anxiety, etc.
7. Autism and related disorders, including language disorders and Asperger’s syndrome, which is the same as autism.
8. Aggressive behaviors, such as unprovoked provocations, verbal abuse, and vandalism.
Due to the complex and painful condition, which is not self-controlled and has a recurrent and prolonged course, the quality of life of children with the condition is poor and is mainly due to various coexisting disorders rather than ADHD itself.
The causes of pediatric hyperacusis are not well understood, but are generally thought to be related to genetic, psychiatric, and somatic factors. Scholars at home and abroad have found that the incidence of the disease is significantly higher in relatives of patients with ADHD than in other populations after investigation. Studies of twins have also demonstrated a 56% consistency of the disease. Tic disorders can be triggered by excessive mental stress and shock. Somatic factors are commonly found in upper respiratory tract infections, inflammation of the nasopharyngeal cavity and pharyngeal conjunctiva, or discomfort in certain areas causing local irritation and discomfort, resulting in protective or habitual movements that become fixed. For example, blinking can be caused by inflammation of the conjunctiva or foreign bodies in the eye; frowning and forehead frowning can be caused by wearing too small a cap or unsuitable eyeglass frames. After the above causes are removed, the action itself has lost its rationality, but inert foci of excitation have been formed in the cerebral cortex and twitching action occurs repeatedly; due to imitation of other people’s bad action or physiological defects can also become habitual action and form this disease.
Predisposing factors of tic disorder.
1, perinatal factors: maternal pregnancy stress, hyperthermia, pre-eclampsia, obstructed labor, history of postnatal asphyxia, neonatal jaundice, cesarean section, etc.
2, Infection factors: upper respiratory tract infection, tonsillitis, mumps, rhinitis, pharyngitis, chicken pox, various types of encephalitis, viral hepatitis, etc.
3, mental factors: fright, emotional excitement, sadness, watching thrilling TV, novels and stimulating cartoons, excessive playing video games, etc.
4, family factors: parental tension, divorce, reprimand or scolding children, etc.
5, other factors: epilepsy, trauma, carbon monoxide poisoning, toxic indigestion, allergies, etc.
Research has shown that there are two main causes of the onset of tic disorder in children, one is internal, that is, genetic defects, experimental evidence that tic disorder has a tendency to family history. The main reason for this is the child’s poor lifestyle. Nowadays, many children love to eat fast food, drink Coke, watch TV and play with computers, which will have a great impact on the child’s brain and nerve development. With the development of society, the increasing pace of life, the family to the development of only child, the heavy expectations of parents, the pressure of learning, competition for higher education, the complex and changing social environment to children and adolescents brought different degrees of tension stimulation and psychological pressure . The lack of partners in the process of children’s growth, and many parents for safety reasons, control or even prohibit children and the outside world contact, in the long run children’s interpersonal skills are bound to be low, mental health is also not optimistic, which is extremely detrimental to their growth. In addition, the lack of playmates makes children more dependent on television and computers. Medical research has shown that watching television and computers for long periods of time can cause neurological deformities in the child’s brain, increasing the likelihood of tic disorders in children.
Prognosis of pediatric tic disorder: Before the 1970s, the disease was considered to be a lifelong disorder, but recent studies have shown that it is a genetically related developmental disorder with the potential for complete natural remission after adolescence and a relatively good prognosis. The disease tends to fluctuate from childhood to adolescence, with symptoms peaking in adolescence and improving significantly in early adulthood. According to statistics, about 1/3 of tic symptoms are completely relieved in adulthood; 1/3 of tic symptoms are significantly reduced; and another 1/3 of tic symptoms are still obvious. Compulsive behaviors, such as compulsive number counting, compulsive walking, and compulsive touching of objects, may occur in 48% of patients. In addition, a small percentage of patients may develop conduct disorder, which may lead to criminal offenses and may have a poor prognosis. Therefore, timely control of tic symptoms, reduction of somatic discomfort and psychological burden, correction of undesirable behaviors and undesirable emotions are significant for the prognosis of the disease and prevention of serious behavioral disorders.
Care of pediatric tic disorder.
1, daily care: to reasonably arrange the child’s daily life, so that life has a certain regularity, the daily work and rest time is relatively fixed, to ensure that the child has sufficient sleep time, to avoid excessive fatigue, tension or excitement and so on.
The best diet for children is to give nutritious and easy-to-digest food, eat more light vegetables and fruits with high vitamin content, and do not overeat. Try not to drink coffee-based drinks to avoid overexcitement, and try not to eat hairy seafood such as fish and shrimp, mutton, fried food, and spicy food. The scientific and reasonable arrangement of the child’s diet and living plays a very important role in improving the effectiveness of the treatment.
2, room environment: children’s room should pay attention to open windows and ventilation, suitable temperature, but most importantly, the environment is quiet, reduce noise. The child with polydactyly has central nervous system dysfunction, and if there is noise interference for a long time, it will aggravate the condition or induce twitching. Don’t play rock music or percussion loudly, but play some classical music, serenade and other slow, soft music locally. Make the child live in a relatively quiet environment, will be conducive to the recovery of the disease.
3, discipline: parents should not relax discipline because they are worried about their children’s illness, not spoiled. But we should pay attention to the way of discipline should be patient and persuasive education, not scolding or corporal punishment. Regarding game activities, do not let your child play video games or computer games, forbid watching some thrilling and scary movies or TV programs, and watch less or even no martial arts or gun battle movies to avoid the aggravation of tics induced by excessive mental tension. For children with obscene language, correct guidance should be given on the use of civilized language.
4. Schooling: Since the intelligence of children with polydactyly is generally unaffected, they can attend school normally, but care should be taken that the child’s study load is not too heavy. However, when the child’s tic episodes are particularly frequent, cannot be controlled with medication or accompanied by more serious behavioral problems, it is necessary to temporarily suspend school for a period of time, and then continue school after the clinical symptoms are significantly reduced or basically controlled.
5. Psychological care: First of all, parents, teachers and classmates should be explained and educated about the characteristics and nature of the disease, so as to gain the understanding of the whole society and the understanding and tolerance of the affected children. Parents in particular should take the initiative to cooperate with the doctor’s treatment, not to give special attention or reminders to the child’s twitching symptoms, and try to create a good character and maintain a stable mood. Use kind words, more praise and encouragement. Patiently understand the child’s psychological activities and never show impatience or anxiety.
Psychotherapy focuses on addressing the child’s emotional problems and other accompanying symptoms. Eliminate triggering factors, restore the child’s self-confidence, and prevent other psychological problems from occurring. Indirectly, it relieves the symptoms and plays a role that cannot be replaced by medication.
The child is ridiculed and mocked by peers for showing uncontrollable symptoms, resulting in low self-esteem, and is also affected by parents’ overly worried and anxious emotions, taking their illness too seriously and forming a psychological shadow. Parents should not be overly worried and nervous, have a more correct understanding of the disease, and extremely cooperate with the doctor in the treatment of the child.
As far as possible, do not talk about the unpleasant things of the child, and when the child makes a mistake, do not insult or beat, but carefully enlighten and patiently convince. To ensure the emotional stability of the child. It is important to get in touch with school teachers so that they can give more correct guidance and help from classmates. The aim is not to make classmates or people around the child discriminate against the affected child, to make the child feel that there is a warm and safe environment everywhere, and to make the child feel that there is a sense of joy in life, thus eliminating the inferiority complex and helping to relieve the tic symptoms.
It is recommended that the child try to do the following.
1. Establish confidence in overcoming the disease understand that their disease can be cured and proactively cooperate with parents and doctors in treatment.
2. Understand that their uncontrollable symptoms are caused by the disease and that others are understandable, do not have an inferiority complex, and take the initiative to interact with classmates to promote friendship.
3.When the tic condition is serious and affects the study and makes the grade drop, know that it is temporary and can be caught up or exceeded by redoubling the effort in the future.
4, avoid mood swings, watch less TV, do not play video games, do not watch horror movies, get along with classmates, and do not fight and brawl.