Tic Disorders and Tourette's Syndrome

Tics are sudden, repetitive movements or sounds that a person cannot easily control. In most children, they appear between the ages of five and ten. For many families the first reaction is confusion: a child starts blinking hard, clearing their throat constantly, or jerking their head, and no one is sure whether to worry or wait. The short answer is that tics are common, they are not a sign that something is fundamentally wrong, and most of them improve on their own as the child gets older.

But that is not the whole story. Some tics persist. Some get worse during stress, fatigue, or transitions. Some begin to interfere with school, with friendships, with how a child feels about themselves. And tics rarely travel alone. They frequently show up alongside ADHD, OCD, and anxiety, which means the tic itself may be the most visible part of a picture that includes other conditions the family has not yet identified.

When tics are causing distress, physical discomfort, or social difficulty, a psychiatric evaluation can help sort out what is happening and whether treatment would help. Not every tic needs medication. But every family dealing with tics that are affecting daily life deserves a clear understanding of what they are looking at and what the options are.

Signs and Symptoms

Tics fall into two categories: motor and vocal. Motor tics involve movement. Common examples include eye blinking, head jerking, shoulder shrugging, facial grimacing, and nose twitching. Vocal tics involve sounds: throat clearing, sniffing, grunting, coughing, or repeating words or phrases.

Tics can be simple or complex. A simple tic is brief and involves one muscle group or a single sound. A complex tic involves coordinated patterns of movement or more elaborate vocalizations. Complex motor tics might include touching objects in a particular sequence or mimicking someone else's movements. Complex vocal tics can include repeating one's own words or, in rare cases, involuntary use of inappropriate language.

Tourette's syndrome is diagnosed when both motor and vocal tics have been present for at least one year. The tics do not have to occur at the same time, but both types must be documented. Many children with tics do not meet the full criteria for Tourette's, and the distinction matters primarily for clarity, not because the treatment approach is fundamentally different.

Tics tend to wax and wane. There may be weeks where they are barely noticeable and periods where they intensify. Stress, excitement, fatigue, and illness can all make tics temporarily worse. Many families notice that tics are more prominent after school, when the effort of suppressing them during the day gives way to release at home.

The natural trajectory for most children is improvement during adolescence. By late teens, many children see their tics decrease significantly. But some do not, and adults with persistent tics often carry the condition quietly, having learned to mask or minimize it over the years.

How We Approach Tic Disorder Treatment

We start with the tics themselves: what they look like, when they started, how they have changed over time, and how much they are affecting your child's life or your own. We ask about the situations that make tics better or worse, whether the person experiences a premonitory urge before the tic occurs, and what other symptoms may be present alongside the tics.

That last part matters more than most families realize. Tic disorders are commonly associated with ADHD and OCD, and all three are seen together more frequently than any of them appear in isolation. A child whose primary complaint is tics may also be struggling with attention, impulsivity, or intrusive thoughts that have not been evaluated separately. Treating the tics without addressing what is traveling with them usually produces incomplete results.

"Tic disorders, ADHD, and OCD are genetically linked and show up together more often than most families expect. Getting all of them properly diagnosed, not just the most visible one, is what changes the trajectory."

Dr. Marshall Teitelbaum

Not every tic requires medication. When tics are mild and not causing distress, monitoring over time may be the right approach. When tics are physically painful, socially disruptive, or interfering with school or work, medication can reduce their frequency and intensity. The goal is not to eliminate every tic but to bring them to a level where they are no longer running the day. We monitor closely, adjust as needed, and revisit the plan as the child grows, because tic severity often changes with age and development.

What to Expect

Your first appointment is an in-office psychiatric evaluation. Dr. Teitelbaum will review your history, ask about your symptoms, and take the time to understand what is going on before recommending a treatment plan. For children and adolescents, a parent or guardian is part of that conversation.

Follow-up visits are scheduled based on your individual needs. When starting or adjusting medication, more frequent check-ins help us monitor your response. Once treatment is stable, visits are typically less frequent.

After your first in-office visit, telehealth appointments are available for patients located in Florida. An in-office visit is required at least every six months.

When to Seek Help

If your child's tics are causing physical discomfort, social difficulty, problems at school, or distress at home, a psychiatric evaluation can help determine what is happening and whether treatment would make a difference. If you are an adult whose tics have persisted or returned, the same applies. You do not need to have a diagnosis to call. You do not need to be in crisis.

For non-emergency questions about scheduling or whether our practice is a good fit, call us at (561) 630-8530.