The diagnosis and treatment of tic disorders in children has become difficult due to the lack of public understanding, awareness, and attention to tic disorders in children.
Many parents and teachers do not consider childhood tic disorder to be a disorder, believing that the child is merely misfit, emotionally unstable, irritable, troublesome, active, disobedient, and deliberately disruptive. This is a misconception. Childhood tic disorder is a disorder, not just an involuntary twitching of a certain muscle group.
Childhood tic disorder is a common psychological behavior disorder in children, with an average age of onset of 6-7 years old and 90% of cases starting before the age of 10. Tic disorder in children is a genetically related developmental disorder with an onset associated with genetic factors, neurotransmitter imbalance, psychological and environmental factors. Most scholars believe that there is some biological alteration in brain function with neurotransmitter changes.
The first symptoms of tic disorder in children can manifest as motor or vocal tics, which can occur sequentially or simultaneously. It usually starts from the face, gradually progresses to the head, neck and shoulders, and then spreads to the trunk or extremities; facial tics are manifested by involuntary blinking, squinting, frowning, opening the mouth, extending the tongue, pursing the mouth, crooked mouth, and wrinkling the nose. The head, neck and shoulder twitches were characterized by head nodding, head tilting, head shaking, head turning, neck slanting, shoulder shrugging, etc. The upper limb twitches were characterized by hand rubbing, fist clenching, hand shaking, arm raising, etc. The lower limb twitching was manifested as kicking, leg extension, leg shaking, foot stirring, etc. The torso twitches are characterized by chest, abdomen, and waist bending. Vocal twitching can also occur, repeatedly emitting animal-like grunts, hums, throat clearing, etc., and even involuntary cursing.
It is easily triggered by infection or leads to aggravation, which is aggravated by stress, anxiety, shock, overexcitement or overexertion.
Childhood tic disorders often occur as co-morbidities with pediatric ADHD (ADHD), obsessive-compulsive disorder (OCD), learning difficulties, sleep disorders, mood disorders, and self-injurious behavior. These co-morbidities are usually the source of functional impairment in TD patients, adding to the complexity and severity of the disorder, and can affect the healthy development of the child’s learning, social adjustment, personality and psychological qualities, while adding more difficulties to treatment and management.
Many of the child’s psychological and behavioral behaviors and tics can be improved, and the child’s cognitive functions can be improved (including the child’s attention, comprehension, learning ability, etc.). Some children with Tourette’s disorder require medication to control the child’s tics and improve brain function.
Treatment of childhood tic disorders requires the cooperation of the school, hospital, and family. Because children with Tourette’s disorder may have some problems in peer relationships, teacher-student relationships, learning, self-esteem, etc.; school teachers need to go to the right guidance for children, teachers need to give feedback to parents and doctors on the child’s performance after medication, etc.; children at home to observe and record changes in the child’s condition, communicate with teachers and doctors in a timely manner; protect the child’s self-esteem and encourage the child more; in short, in the child’s Tourette’s disorder In short, teachers, parents and doctors should cooperate with each other in the treatment process of children’s tics.
Psychological treatment of tic disorders.
Integrated Behavioral Intervention Therapy (IBIT).
Integrated Behavioral Intervention Therapy is a highly structured treatment approach that generally involves eight sessions once a week for 10 weeks; it consists of three important components: 1) training the patient to be more aware of tic symptoms; 2) training the patient to engage in behaviors or alternative behaviors in the direction of the tic (reversal) when there are signs of tics; and 3) changing daily activities in a way that helps reduce the occurrence of tics.
Comprehensive behavioral intervention therapy
Relaxation therapy – abdominal breathing exercises
Cognitive-behavioral therapy.
Cognitive-behavioral therapy is a structured, short-course, cognitively oriented psychotherapy approach developed by A.T. Beck in the 1960s that focuses on the patient’s irrational cognitive problems and changes psychological problems by changing the patient’s perceptions and attitudes toward self, people, or things. The goal of treatment is not only to address the external manifestations of behavior and emotions, but also to analyze the patient’s thinking activities and coping strategies to identify and correct the wrong perceptions.
Example: Have the child stand in front of a mirror for 5-10 minutes and observe his movements so that he can understand how his tics start and what kind of symptoms they are. You can have him record the number of twitches as he observes.
Have the child make slow, identical movements to the mirror to the tics. For example, for a child who blinks, slowly close his eyes, hold them for 5 seconds and then slowly open them, for a child with a facial twitch, slowly unfold a smile, stop for 5 seconds and slowly recover, for a child who shakes his head slowly tilt his head to one side, stop for 5 seconds and then slowly turn to the other side. Do this for 5-10 minutes a day, with parental guidance in the beginning.
Children find their own problems, children learn to move are to give timely encouragement to the child. And encourage the child to persevere. Try.
Medication for tic disorders in children.
It is usually 1-3 years, or even longer. It takes some time for the medication to be adjusted from the starting amount to the appropriate therapeutic dose (including the choice of the type of medication, the dosage according to the weight of the individual human body differences, etc.), which may take 1-3 months, and the effect of early treatment is usually visible at 3-6 months, mainly in the form of improvement of symptoms, such as various combinations of twitching relief. The symptoms of this disorder tend to alternate repeatedly, fluctuate significantly, and are susceptible to a variety of factors, such as: stress, emotion, shock, etc.; short courses of treatment, the condition tends to recur or worsen after discontinuation of medication.
Tic disorder in children was considered a lifelong disorder in the 1970s, but recent studies have shown that the disease has the potential for complete natural remission until after adolescence, with a relatively good prognosis.
Appendix: Identification of tic disorder and epilepsy