By Patrick J. McGrath, OC, PhD, FRSC
Question:
My seven-year-old son has mild tics: expiratory grunts, snorts, eye blinking, and shoulder movements. I pay little attention to them. Most people don't notice his tics but they are obvious to his father and I. His teacher found the tics very noticeable at the beginning of the school year last year but hardly noticed them as the year progressed. He seems to have more tics in the evening or when he is anxious.
When he is with others, he sometimes grunts or snorts and it is not pleasant. His older sisters complain or tell him not to be gross. I understand that his tics will likely increase as he approaches adolescence. How should we help him deal with tics in public? I don't want his friends to tease or bother him because of tics. I don't think they even notice his tics that much; it just seems like the same snorting that kids with allergies do. Should we tell him that he has tics? We've never discussed them with him so as not to draw attention to them.
This is an inherited thing as I have tics (mostly finger movements) and my father and brothers have the same grunting and eye blinking tics as my son, not that anyone has been diagnosed.
Dr. Pat responds:
You are right not to make a fuss about his tics. What you are doing is working well. If his sisters get too cruel, you may want to speak to them. But his dealing with his sisters is good training for dealing with others.
You may want to talk to your son before his tics get worse or he begins to worry about them. Since his uncles and grandpa tic, he will probably see tics as normal. He also knows that they have done OK.
At about age eight or nine years, children with tics can notice when a tic is coming. With practice and support, tics can be changed or delayed. For example, your son might learn to recognize when a grunt is coming and then stop it or change it into a more acceptable throat clearing.
You may want to talk to your family doctor about his tics. People with frequent, severe tics may be diagnosed with Tourette syndrome. In this condition, the basal ganglia (an area of the brain that links movements with thinking) is involved. Dopamine, a neurotransmitter, is important but it is unclear how. Genetics play a role but several different genes are involved and the exact mechanism is unknown.
Boys are much more likely to have Tourette syndrome than girls. Some people with Tourette syndrome also have attention deficit problems, strong urges to repeat behaviours, or repeated intrusive thoughts (called obsessive compulsive disorder, OCD).
The website for the Canadian Tourette Society is http://www.tourette.ca.
The major problem with having tics is the response of others. With your support, he will likely do very well.
For more information, see "Ask Dr. Pat: What is Tourette syndrome and how is it treated?"
Patrick J. McGrath OC, PhD, FRSC is a clinical psychologist and a researcher. He is Professor of Psychology, Pediatrics, and Psychiatry at Dalhousie University and Vice President - Research at IWK Health Centre in Halifax. He is also the CEO of the Strongest Families Institute, which provides mental health care to families across Canada.
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