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Global rise in adolescents with ‘tic attacks’ may be due to social media exposure

July 1, 2022

Coinciding with the COVID-19 pandemic, another global phenomenon has been observed — adolescents presenting with “tic attacks.”

Tourette syndrome experts from multiple continents have reported an influx of referrals from pediatricians and emergency departments of adolescents with disinhibited and involuntary complex movements, words and phrases.

In most cases, these adolescents did not have Tourette syndrome but rather a functional neurological disorder (FND) also called conversion disorder (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). The strong similarity of clinical presentations spanning a vast geographic area led these experts to speculate that social media videos shaped the symptoms (Pringsheim T, et al. Mov Disord. 2021;36:2707-2713, https://doi.org/10.1002/mds.28778), which some refer to as “TikTok tics.”

Is it Tourette or not?

Distinguishing the phenomenology of Tourette tics and FND tic-like behaviors can be challenging since there is some overlap.

Tic disorders are common in childhood. Many children have simple motor tics (e.g., blinking) or vocal tics (e.g., throat clearing). Usually, the diagnosis is clinical, and no diagnostic testing such as blood tests, EEG or brain MRI is needed. If tics occur sporadically, a diagnosis of provisional tic disorder is made, and clinical observation without any treatment often is advisable.

Some children meet criteria for Tourette syndrome, which include having tics for at least a year, with two or more motor tics and one or more vocal tics. Simple tics most commonly start before age 10. Treatment may be recommended when tics impair function at home, school or social settings, or cause pain or injury.

In the “tic-attack pandemic,” the clinical presentation differs. Onset occurs after age 10 years, usually in females. Early tics are large-amplitude arm movements (hitting self or family members) and odd/obscene words or phrases. In most cases, the diagnosis is FND.

How to talk with patients

When a pediatrician suspects a functional disorder may be the explanation for symptoms, it is helpful to introduce this to the teen early using simple, nonjudgmental language. Analogous to saying, “We need to figure out if the cause of your cough is asthma, an infection or other diagnoses,” the physician may say, “We need to figure out the cause of these jerking movements and vocal outbursts. It could be a form of Tourette syndrome, or it could be a functional illness.”

The pediatrician should further explain that Tourette syndrome is a neurological condition where children’s brains send signals to create movements or sounds called tics. Functional neurological disorder is a neurological condition where the brain sends signals that mimic a disease that the person doesn’t have — like tic attacks in someone who doesn’t have Tourette.

It is not advisable to equate FND with malingering. Instead, acknowledge the high levels of stress adolescents have experienced during the pandemic.

An accurate diagnosis made rapidly is critical to help the adolescent and family move forward. Most often, tests such as brain MRI are not needed or helpful. As this diagnosis can be challenging, referral to a pediatric movement disorder or Tourette specialist may be advised.

Management and treatments

A diagnosis of a functional neurological disorder (International Classification of Diseases-Tenth Revision-Clinical Modification code F44.4) is a component of the treatment. It is important to convey to the family that the diagnosis has recognizable, positive features and is not solely a diagnosis of exclusion. Education also is vital (see resources).

The following interventions may be considered:

  • Develop a specific back-to-school plan (staying home and avoiding schoolwork feed into and prolong symptoms).
  • Share a diagnosis letter with the school explaining the importance of keeping the adolescent at school with “tic breaks” as needed.
  • Treat any co-existing psychiatric or medical conditions.
  • Refer for psychological therapy to learn what stressors are driving the neurological symptoms and to implement “competing responses” — mental and physical strategies to mitigate and overcome tic attacks.
  • Advise patients to avoid social media. In the current “tic-attack pandemic,” strong circumstantial evidence supports the role of influential videos modeling tic-like behaviors.

Dr. Gilbert is a member of the AAP Section on Neurology.

Resources

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