4 Year Old Vocal Tics

[AbsMom]

My 4 year old daughter has been exhibiting vocal tics since she was very young - approx. 2 years old.  She would hum bit when watching TV.  It was just occasionally that she would do it and she had reflux as a baby so we figured it was due to that.  She continued to do it off and on, especially when reading a book to her at night at bedtime.  She would make the noise and seem to be very hyper.  Now, just recently, she has begun to click her tongue.  She doens't do these noises often, some times more than others.  I haven't noticed her making the noise when she is stressed out, she actually seems to make the noise more when she is watching TV or when reading her a book right before bed or playing. The thing is, we never noticed a "motor" tic.  Does that mean anything?  She has DX of apraxia.  She does very well in school, some behavior issues, likes to have things her way or will have a tantrum.  The tantrums do not last long and she is always sorry after.  We just kinda figured she's "strong willed".  I'm not sure if something else may be going on though now with this "new" noise.  Should I be looking for a motor tic as well?

[Kevin Kennedy, Ph.D.]

Self-soothing behaviors are usually quite unconscious, or automatic, for young children. But your concern is not unfounded, since children who display a behavior or characteristic of a neurointegrative sort may well display some other symptom as well. Be sure to talk about your observations with the pediatrician, and see if he thinks your daughter should be evaluated by a pediatric neurologist.

[AbsMom]

Hi.  Thanks for responding.  What made me think of tics was that it was repetitive, chaning, and she seems to be very hyper when she gets going with the noise.  For example, yesterday when she came home from pre-school she made the clicking noise like 8 to 12 times in 2 minutes.  I asked her "Why did you make that noise?" and shee seemed completely unaware she was doing it.  If it were self-soothing would she be aware of it?  Also, she has had some strange behavior lately.  The other day, she took off her shoes and socks and started to lick her feet!  I told her she shouldn't do that, feet are dirty ahd have germs.  I have seen her lick her finger then rub the wet finger on her arm or leg.  I'm not sure why she does this.  She is an only child so I tend to over-analyze things she does, but because of the DX of apraxia I worry she may have some other conditions as well (comorbidity)  - TS, ADHD, SDI.  and YES, I am a worry wart! Thanks for your help.  

[Kevin Kennedy, Ph.D.]

To be frank, it is not clear that the noises are actually tics. My sense is that they are self-soothing mechanisms for her vs tics in the strict meaning of the word. If they are tics, one would wonder about the co-existence of motor tics, but this does not sound like an emerging Tourette's Disorder situation. However, be sure to discuss this with her pediatrician.