Tics are short abrupt movements or sounds that a person does repeatedly and are difficult to control. Some common tics include blinking, shoulder shrugging, facial grimacing, head jerking, mouth opening, snorting, sniffing, coughing, and squeaks. Some tics are more complex and can involve moving multiple parts of the body or saying whole words or phrases.

Tics typically start in early childhood and increase in severity towards adolescence. For many people with tics these then reduce in late adolescence and may resolve by early adulthood, though a proportion will continue to have tics in their adult life.

Many young children (particularly boys) may have one or two tics for a brief period that then go away by themselves. A tic disorder is diagnosed when tics have been around for over a year, and if there are both movement and sound tics then this may be Tourette Syndrome.

Some people with tics are not particularly bothered by them, but for others they can cause pain, interfere with tasks, or cause embarrassment. Where tics are interfering with day-to-day life treatment may be appropriate.

Other areas of difficulty are very common in Tic Disorders and Tourette Syndrome. People with tics are more likely to have anxiety, OCD, and other mental health problems. They are also more likely to have neurodevelopmental differences, such as ADHD or autism spectrum conditions.

Although tics may be the most visible difficulty, they may not be the problem causing the greatest impairment or distress, and sometimes treatment for other problems should be prioritised over treatment for tics.

Research tells us that both medication and behavioural therapies can reduce the frequency and intensity of tics and their interference in day-to-day life, although neither offer a cure.

There are no NICE guidelines for treatment of tics and Tourette Syndrome. European Guidelines state that where psychoeducation (learning about tics and Tourette Syndrome) is insufficient, behavioural therapies are recommended as a first line of treatment for both children and adults with tic disorders.

Behavioural therapies for tics are a psychological intervention designed to increase a person’s abilities to hold their tics in when they want to. There are a number of different behavioural therapies including Habit Reversal Therapy (CBIT is a version of this) and Exposure and Response Prevention. Treatment normally involves weekly appointments and daily practice between sessions.

OHSPIC can offer behavioural therapies for tics where the following apply:

• The person already has a diagnosis of Tourette Syndrome or a chronic tic disorder.
• The person’s tics are causing difficulties and they want to have treatment for them.
• The person can practice techniques regularly between appointments.

We do not offer general assessment for tic disorders or Tourette Syndrome and their co-morbidities. Your GP should be able to refer you to a local service such as CAMHS, Paediatrics, or Neurology for this.

We are happy to offer treatment for tics to children, young people, and adults with a range of comorbidities, but do not offer treatment for the comorbidities themselves, except where they are a condition OHSPIC offers treatment for separately and where commissioners have funded this.

There are a range of local and national services which offer diagnosis and support for neurodevelopmental conditions, and which offer treatment for mental health conditions. Your GP can advise you on what services are available in your area.

OHSPIC does not have a multi-disciplinary team and cannot offer urgent or crisis support. We do not offer medication prescription or review. In some circumstances it is better for all treatment and care to be provided locally by a multi-disciplinary team.

We do not offer assessment or treatment of Functional Tics. There is not yet clear evidence on whether behavioural therapies are helpful for these, and treatment is often better held in a multidisciplinary team. Again, we would advise you liaise with your GP with regards to local services, or talk to your CAMHS team, Paediatrician or Neurologist if you are under one of these.