Is it Transient Tics of Beginning of TS

[Izzi126]

I have posted on the child behavior forum but only got one response which although was an approachable response still left me with what is going on with my six year old daughter.  She is a bright, active, social, funny and very happy child.  Seemingly she is moving through her milestones normally.  However she has since birth always seemed to have a nervous condition of sort.  She has been a thumb sucker since birth.  With sucking her thumb she would always been doing something with the other hand, holding her throat - as she moved on ito being a toddler, she started sticking her finger in her eyes, lefting the lid and going as far as the first joint of her index finger, than stroking her nose until it was red and soar, than it was the belly button - which has a callis on it as we speak.  However about six months ago she had a cold and than after it was gone she still made noises with her throat, I brought her to the doctor and they said kids do this sometimes and for her action give her a reaction like a sip of water, never mentioned anything about tics, so we did and within six weeks she stopped.  About 2 months later she started with a kissing sound (a new vocal tic).  This happen around the time we started riding her about sucking her thumb and that she should stop.  Thumb sucking was chronic along with whatever her other hand was always doing.  A couple of days after the kissing sound she started making these arm bends (motor tics)out to her side extended with her hands in front of her chest.  While this seemed quite voluntary, I couldn't be sure.  I asked her several times over the course of two weeks and she originally said her arms hurt and now  she didn't want to talk about. Now about 1 week later the arm bends and kissing are still present but the arms are in a different position.  This can be up to 4 or 5 times in a minute, 20 to 30 times in an hour and sometimes only once an hour.  It has almost been one month now and she is still doing it.  It seems more chronic under stress, definitely whenever she is being reprimanded. I don't notice it while watching TV, she does it while I read to her or she is doing homework.  She does it right from wakening in the morning but not in her sleep.  I have ask her teacher, they said they have notice the kissing noise but she has stopped sucking her thumb in class, however they didn't notice the arm bends, she said she really isn't looking for it and I shouldn't worry that my daughter is one of the smartest in the kindergarten class and is social and has progressed over the school year.  Is this the beginning of TS or just Transient Tics.  If anybody has any experience I would like to hear from you or perhaps if you have TS how did it start.  She does have her own agenda at times and doesn't follow direction at home very well, but at school I don't get any complaints from the teacher.  I am so worried this is going to turn into something worse, especially with these motor tics I notice, however they don't seem like any of the ones I read about.

[b0101]

Hello doctor ,
i would like to know how i could contact u as i also stay in mumbai and would like to talk to u about my son

from b0101

[Abhijeet Deshmukh, MD]

Hi.

Well, the anxiety that we discuss here is a bit different from what we. as adults think to be. Pioneers of psychology and psychoanalysis have described the "anxiety" in a different aspect.

Humans are basically animals to start with. Since we have a society structure, a culture, the reshaping of children starts from day one of birth (or even before that, if some recent research are to be believed). If you know the concept if the Id, Ego and superego, described by Sigmund Freud, you will find it easy to understand.

The id is the natural instinct. Suppose a 2 year old likes a toy which belongs to some other child. Whatever happens, the child can not be persuaded by "reasoning" to not "grab it". You can not explain the concept of "ownership" at this age. We often have to either hide the toy or give in. Why does this happen? The reason is the "id". It is strong. The role of "ego" is to control the "id". The ego develops slowly and steadily.

If the "id" is not satisfied, what increases is the anxiety. Adults relieve this anxiety by using what are called as the "ego defense mechanisms". A very valid and real example of this is the attraction adults have towards those of the opposite gender. The "id" says "go and grab him/her". The "ego" controls the "id" and says, "this may not be a good idea, id! You’ll probably get beaten up. Wait for some time and see if the person likes you. Or .... You’ll get better". The anxiety is taken care of by reasoning! That's what adults do. We reason, intellectualize, rationalize, project, displace, suppress and repress. (You will enjoy reading Sigmund Freud).

This is the nature of the anxiety in children. They are growing up. And growing up is a very painful process. They are faced with new rules and regulations at every corner.

Ran out of thoughts..... :)

[Izzi126]

Your post this time was very interesting to me.  Habits to reduce stress - behavior.  That is interesting facts to throw into this mix.  I may better understand your meaning of anxiety now and related behavior.  Needless to say, I am keeping watch, journalizing and letting her know she is loved and that thumb sucking or arm movements do not effect our love.  We are also trying not to take too much attention to the movements.  I will follow-up with the neurologist but I am not quite ready yet, because since there really is not need for medication at this time and all my findings indicate that this behavior or tics or TS can improve over time, I think I will take a wait and see approach right now, especially since it may be a form of anxiety release because of her history with thumb sucking and all the other things she has done since birth along the way.  Thanks for your reassurance.

[Abhijeet Deshmukh, MD]

Hello.

I am glad you visited the pediatrician.

The eye blinking may or may not be present. Actually, the tics can be varied. The tics are indeed usually jerky movements. But they may not be very rapid.

Some kids form 'habits'. The habits may be an action, a thought, a way of speaking or even the way they sleep. These 'habits' are intended to reduce anxiety. Most kids outgrow such behaviors. So there isn't much to worry about in the long run. What is more important that she should realize that her behaviors are not bad, but she needs to alley her anxiety in more socially accepted ways.

Regards

[3gmom]

I was so glad to find your post and hopeful that you are finding some peace as you search for answers.  I have noticed in the last several weeks 2 different "tics" that my daughter has started.  She is 7, and she originally started making a noise with her mouth - I didn't know how to explain it, but when I read your "kissing" description, that seemed to be the best fit.  I tried to get her to stop - I thought maybe one of her friends at school did it too and she was copying them.  She got better about it, but now over the last 1.5 - 2 weeks she has started shrugging her shoulders.  I am embarrassed to say it absolutely drives me crazy.  I decided to approach it in a more loving manner with her and just gently remind her to relax her shoulders etc.  

Now I have looked up some things online and realized that there really isn't anything I can or should be doing about it for that matter.  I am feeling really sad and scared right now - not sure if this will go away quickly or turn into TS or something.  

She is shrugging her shoulders ALOT within a short period of time, and while I don't want to obsess about watching her, I feel that I need to continue to get a good sense of the frequency, duration etc. so that I can talk to her doctor about it.

I guess what I'm mainly looking for at this point is some moral support as I plan on talking to her pediatrician about it soon.

Thanks in advance for any response you might have.
3gmom

[Izzi126]

Thank you for your post.  The arm movements have not reduced and the thumb sucking has continued because we have told her if she needs to suck her thumb because she is stressed out than to do it, so I am assuming she feels it is okay.  I am very stressed to not be able to realize what is going on.  We did visit with the pediatrician and she has referred me to a neurologist.  She has indicated upon first impression, that there seems to be a lot of activity going on, however based on the 7-8 cases seen in the office, most children have a jerking motion to their movement when it is seen in the body of a child.  My daughters movements are quite refined and no jerking at all, while her first thoughts may lead her to TS or tics, she has some doubt because of the style movement.  My daughter had also indicated at the visit that these premonitor feelings she gets are also in her legs and she needs to bend each leg, something I had not noticed.  She told me to monitor the situation and not to feel that it was an emergency to visit with the neurologist but to follow up.  All her vital signs and mental state was quite normal to the doctor and told me that my daughter seemingly was quite normal despite to activity that was going on with her arms.  I can try and find a way to capture this on video.  Does a child with TS or tics make the movement at the moment of waking, because she starts as soon as she wakes.  I must admit though when anything of stress or reprimand is going on the movements are present immediately.  Also it seems that my daughter doesn't have the typical movements that I hear people taking about, most people talk about eye blinking.  Thanks for your help.

[Abhijeet Deshmukh, MD]

Hello b0101.

Your son probably has Tic disorder (Tourette's syndrome). Can he control the tics voluntarily for some time? Vocal tics are quite characteristic of Tourette's syndrome.

The discussion with Izzi126 mentions "Tics", but the word is used for the ease of communication. We are trying to figure out if her daughter has tics or anxiety features manifesting as repeated movements. And to tell you, I am having a tough time at it!!

Regards

[Abhijeet Deshmukh, MD]

Hi.

How is your daughter doing? Have the arm movements reduced? And what about the thumb sucking?

There's a member on the Neurology forum who has captures her 7 months old daughter's movement disorder/seizure and uploaded it on the YouTube.com. Can you somehow manage to do a similar video and post it for some time on the net? Your description itself has given a good picture, but seeing the video will give more insight.

Regards

[b0101]

My son is 8, and also has tics. He started at the age of 6 with blinking of his eyes. Then he started moving his arms and now is on vocal tics since last 3-4 months. Is he suffering from TS. Will he outgrow this . He is academically a bright child .

[Izzi126]

Thanks for your reponse.  No we don't have behavioral problems, I was just using that as a "for instance"  I think the issue was that we have been worried to reprimand her in any way to cause more stress on her.  She basically overall is a good well behavoried, especially at school and if she is over someone's house if we are visiting. My only issue with her is that sometimes more times than others, at home she is slow to follow instructions (has here own agenda), and doesn't know how to settle down unless you raise you voice, but I don't get that complaint from her teachers - they tell me she has progessed over the school year to listening and following instructions to her age level. The kissing sound has actually almost disappeared, I barely hear it once or twice a day recently if at all anymore.  My daughter in my opinion is quite spoiled.  She is an only child and doesn't want for much.  TV and Computer in home room (only educational games - no internet set-up), takes ballet, roller skating lessons, swim lessons. Has a expensive two wheel bicycle and the list goes on.  I am having trouble realizing what would cause her stress beside loud discussions between me and my husband.  We both are not on the same page with rules for her.  He has his set, I have my set - so I think that may be confusing to her - but causing stress and anxiety, we have tried recently to be more aware of that.  I have used your advise and reassured her of our love whether she does the tics or not whether she sucks her thumb or not.  In fact I think recently since I told her that she is starting to suck since I have given her my approval to suck again.  however I don't see the tics going away - they seem more relaxed and she has two types of arm movements.  If you ask her she will do them for you and still insistance that she needs to do it because he arms become tight.  I asked her if she would stop what would happen - she said her arms would hurt.  I also have been journizing and have noticed now that I can almost 99% of the time predict when she is going to do them, but most times it seems to be is when she is using her thought process.  example.  I am entering a room and there are people there I need to say hello (arm movements), I have said hello and am going to sit down at the table and begin to eat with them (arm movements)...something like that.  Anyway I wish I truly knew what was going on. I told her last night there is nothing that she can not come to me with that me and her have girl power together and we can resolve anything that is bothering her (she kind of tunes me out).  Okay anything else you can share with me, is appreciated and I am working on your methods each day.

[Abhijeet Deshmukh, MD]

Hello.

Tics can occur even more frequently than your daughter has. Let's work on it slowly and steadily. I hope the kissing sounds do not increase now. Reward her for that.

If she feels a tightness in the arms which has to be relieved by the actions, it does suggest anxiety and that she is probably concerned. But she does not say so. This is a paradox. I would like you to observe and concentrate on one basic aspect, the anxiety.

Why do you keep her in time outs? Are there any other behavioral problems? Time outs may not be appropriate for al behavioral problems. If the time out is for the "tics", she may be interpreting it differently.

Let me know.

Regards

[Izzi126]

I had a few questions, I am trying to follow your approach, however for the sake of discussion let's go ahead and call this behavior "tics"  how often does one tic in an hour, because it seems that my daughter tics at leat 30-40 times in an hour if not more - most of the day. I have asked her if she is aware of her movements and she has told me yes, it doesn't bother her and she doesn't know why she does it.  Her arms fell tight and she needs to stretch them so that the tightness goes away.  I have recently told her it doesn't matter if she sucks her thumb or not, I love her just the same and I would like it better if she stopped the movements.  She told me that it is her body doing this. Our difficulty is that we are all working around on pins and needles because we don't want to reprimand or scoll her or upset her because it seems when we do that it makes the movements more chronic.  If I was to bring her to a doctor - where should I start first.  I am keeping a journal, I am reassuring her of our love, and trying to spend more time with her one on one.  I have spoken to all of her teachers in school, they also have noticed the movement and said that her personaility nor her academics have change she is in the upper level of all her classes.  By the way the kissing sounds have slowed down a lot.  I don't know anymore when to put her in a time out when not to.  Any more advance would be very welcome. Are your a neurologist, or family doctor?

[Abhijeet Deshmukh, MD]

Hello.

It is a difficult task to diagnose behavioral / movement problems in children, especially when one has not seen the child. Most instances of apparent abnormalities are actually variations of normal behaviors.

There is a need of looking at the big picture. You can identify the anxiety provoking situations or events. Working towards them will help a lot.

Please monitor little Miss. .....'s academic progress closely. She will be facing an increasingly difficult curriculum over the next few years. This is a difficult phase. She will need constant encouragement. I am sure both of you will provide her with plenty of it.

Regards

[Izzi126]

Thank you so much for your answer, I had tried to post on the medical forum, but it is always unavailable.  You sound very well versed, can you tell me what type of doctor you are, I don't see anything in your profile.  I totally appreciate your response and it has answered a lot of questions, most of the answers I have received are telling me it is TS.  We are very reassuring parents and are very close with our daughter.  My husband about two months ago suffered a major job loss and it has effected the entire household and I am sure my daughter has picked up on this and is probably cause for more anxiety for her, along with us pushing for her to stop sucking her thumb.  She is fully aware of her tics and they don't seem to bother her at all.  Each day they seem to be changing though in description however still with the arms bending.  Your post does make a lot of sense.  Yes, she is very disappointed about having to stop sucking her thumb.  Each day after school - which she is trying hard not to suck in school, she ask me if it is alright if she sucks because she tells me she really likes to.  Just this morning I told her that if she needs to suck in school to go ahead because it is not worth stressing out about.  So let's see how things go.  You don't know how much you have really relieved my anxiety at this point.  The post below yours tells me to sick medicine attention, so I am sort of confused but since you are a doctor - I will take you advise - since this behavior really has been since birth and she is doing really well socially and these tics seem not at all to cause her any distress.

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
This does indeed seem to be a case of tics. The child has vocal as well as (perhaps) a motor component.
I suggest that you show the child to a qualified neurologist, who would perform a detailed neurological examination, and brain imaging to confirm or refute the diagnosis. Treatment would be planned depending on the results.
One comforting fact is that most children outgrow the tics as they grow older. So you can expect the symptoms to become milder as time goes by, and hopefully disappear totally.
You can read more at the following links.

http://en.wikipedia.org/wiki/Tourette_syndrome

http://www.emedicine.com/MED/topic3107.htm

Please feel free to post any additional queries/questions you may have. All the best!

[Abhijeet Deshmukh, MD]

Hello.

I would like to add some points here. Your present concerns appear to be a possibility of Tic disorder. And the fact that your daughter has continued thumb sucking for a long time is probably bothering you. I can understand your concerns as Tic disorder can be really difficult to cope up with.

After going through the symptoms, the questions that arise are -
1. Does she have Tic disorder?
2. Is it Stereotypic Movement Disorder?
3. Is this behavior "within normal limits”?

I would like you to think of the third option, too. Let us find out why she may not have the first two conditions.

How do we come to a conclusion that a child is suffering from Tic Disorder (Tourette's syndrome)?

Your daughter's age is appropriate for the start of Tic disorder. There have to be phonic and/or motor tics, which are sudden and repetitive. The child can suppress the tics on instruction, but not for long. And one of the most important indicators is that the child is significantly distressed by the tics. I would like to inform you that this factor was earlier used as a mandatory feature for diagnosis of Tourette's disorder. But since some children have all the typical signs but not the distress, this feature has been removed fro the criteria for diagnosis. But we still observe that almost all the children do tell that they have a problem due to the tics.

Does your daughter have distress? I guess she will say "no". This is a big hint. A child who has tics will try to suppress the tics on instruction. And even though she has started the kissing sounds recently, there are other behaviors as well, which were present since birth.

More importantly, she does not have a significant impairment in social and school environment. In fact, she is a bright kid.

Let's try to find out if she may have the Stereotypic Movement Disorder (SMD).

A child with SMD also has repetitive movements which "interfere with normal activities of daily living". Thumbs sucking is a major symptom. The symptoms of SMD do start before the age of 2 years. Your daughter may seem to fit in the diagnosis of SMD. But she does not have SMD. This is a common diagnostic problem. Children are often misdiagnosed as having either Tic disorder or SMD, when in fact, they do not have a "disorder".

This brings us to the third option. What if her behaviors are normal?

There is a pattern in your daughter's behavior. It starts right from the birth. She has been sucking her thumb. This was a natural activity for her. She never expected anyone to tell her to stop it! And when asked to do so, she was disappointed. The behavior have changed and added some more features. All this suggests that she is reacting to the environment, most probably in a normal way.

Her age is at the upper limit of normal allowed range for thumb sucking. Most children are expected to stop thumb sucking by the age of 5 years. According to a study, there are close to 9% children who may continue thumb sucking beyond 6 years.

Thumb sucking is a way of expression. The child expresses its anxiety and distress through thumb sucking. The inner anxiety is relieved. Newborns and infants have no other way to explore the world. They learn by mouthing objects. They explore the environment by mouth. This may continue for a long time.

Your daughter is anxious. She is trying to tell you something. She needs reassurance. The arm movements are part of her expression of anxiety. You will need to relieve the anxiety. If the anxiety is relieved from external sources (like reassurance and love from parents) the Tic like movements are not needed!

Looking at the fact that she does not have much problems in school, you will need to look back and reflect upon your relationship with her. She is probably reacting to something unwanted in the relationship. I won't say it applies to you, but the common factor is parents' control. The child may not like to be controlled after a particular age. Your daughter is entering an age where she needs to assert herself.

Again, this does not apply to you in particular, but I would like to make a point. This concerns all parents including me. We, as adults, have our own distresses. We unknowingly transfer our distress on to our children in the form of expectations and demands. We need to be aware of this and make a conscious effort to save our child from the burden of our own distress.

You are a concerned and loving parent. I applaud your awareness about your daughter's problems. What your daughter needs from you are a few words of reassurance. You could express it to her in words like "We love you for what you are", "we would like it if you don't do this (arm movements, for example), but please do not think that our love will be any lesser if you still do it". This will probably help in the long run.

There is no need of any testing. Just give her some time and your patience.

Regards

[syndismilez]

Hi,
I have a son that at. 6 years of age was Dx with TS. He is now 13.
You sure are describing some of the things I have been through.
His first Dr. told me to give it a year or two to see if the tics stopped.
His were constant sniffling, eye grimmacing, he twirled my hair. These all
waxed and wained. He could go a few months with nothing. Then he started making
loud peeping noises and would turn around in circles while he walked!  Poor kid.
So I switched Drs and the new one recognized it immediately. He was sent for
an MRI to rule out anything terrible. And the Dx was Ts.
telling him to stop the behavior would just make it worse.
Its is a hard to live with syndrome, but my son is at the top of his class!  Plus he is very musically gifted!  There is some evidence that children with TS have abilities greater than the average child!  Of course I'm not prejudice! :)
feel free to message me anytime!  I hope I can help!  
Cyndi