What is a Tic?
Repetitive, unintentional, purposeless and inappropriate movements and sounds are called tics. There are 2 types: Motor and Vocal. Motor tics; is associated with movement. Blinking, hand-arm movements, biting lips, shrugging shoulders, pursing nose, grimacing, raising eyebrows, etc.
Vocal tics are tics associated with a person's vocalization. Sniffing, coughing, clearing the throat, coughing, grunting, making various sounds, etc.
What are the Types of Tics?
In Transient Tic Disorder, tics occur continuously for at least four weeks and do not last more than 1 year. It is seen with one or more motor and/or vocal tics.
Chronic Tic Disorder is the coexistence of more than one motor or vocal tics in a person for at least 1 year. From time to time, motor and vocal tics may occur together. It does not significantly affect the person's functionality.
Tourette Syndrome is a chronic neuropsychiatric disorder that occurs in childhood and is characterized by motor and vocal tics. The necessary conditions for diagnosing Tourette Disorder are the presence of multiple motor and one or more vocal tics independently of each other for a period of more than one year, the period in which the tics are not observed is not longer than 3 months, and it begins before the age of 18 (APA, 1994: 63). -64). Unlike chronic and temporary tic disorders, it is seen together with behavioral problems. Tourette Disorder can also be considered as a more severe form of Chronic Tic Disorder.
What are the Causes of Tics?
Genetic and environmental factors are effective in the formation of tics. Research mainly examines the genetic and neurophysiological causes of tourette disorder and chronic tic disorders. Tics that occur due to organic reasons are usually permanent. Tics that occur due to psychological reasons are usually temporary. In temporary tics, the internal distress and problems experienced by the child and the sources of these problems should be identified. The child's social relationships, family relationships, and school life are evaluated and the problems experienced in these areas are solved. It should be noted. Punitive, condescending and comparative behaviors and attitudes cause the child's problems to increase even more.
Tics are generally leading and clear signs of internal tension and conflicts. They increase during stressful and tired times and disappear during sleep and rest (Dalery, 1980). When we look at the psychological factors that can cause tics, situations such as a person being anxious, nervous, restless or afraid can be seen.
What is the Frequency of Tics?
An increase in tics over time. or a decrease may be observed. The more people try to stop and suppress it, the more severe it becomes. Research indicates that the incidence is higher in children between the ages of 6-12 and mostly in boys. However, its severity may decrease with advancing age. In some studies conducted on this subject, it has been determined that obsessive compulsive disorder, learning disability, and attention deficit and hyperactivity disorder may accompany this disorder in children with tic disorder.
What are the Treatment Methods?
First, a medical evaluation should be made for the child by a neurologist. If there is an organic disorder causing the tic, it should be identified and treated first. After this, it is appropriate to undergo a psychological evaluation and receive support from the psychologist in areas deemed necessary.
Behavioral therapies are especially used in the treatment. It is possible to work with the child through behavioral therapies while the family is given training on this subject with expert support.
First, psychoeducation is given. Afterwards, the person is given the relaxation training he needs during the process. Studies are carried out to increase the child's awareness of his thoughts and feelings before his tics, and methods are determined to help him cope with the problems he experiences in a functional way.
Habit reversal training is given to eliminate behaviors such as nail biting, tics, and thumb sucking. The disorders experienced by the child are reviewed, the difficulties these tics cause in his life are determined, why he wants to get rid of these tics, and at what moments they cause problems. is detected. Afterwards, the person's awareness is tried to be increased by determining his/her emotions and behaviors before and after the tic. The person exhibits the problematic behavior in order to relax. Situations such as what is the underlying reason for feeling the need to relax, after what event or thought does the person feel the need to exhibit this problematic behavior are determined. Following awareness training, an opposing behavior is determined instead of the problematic behavior. Instead of the tic behavior, an opposite behavior is used. After identifying this alternative behavior, it is used to interrupt the habit or prevent its emergence. Relaxation exercises are also taught. Since it has been observed that tics increase in stressful, excited and anxious times, it can be helpful to benefit from simple relaxation techniques such as deep breathing, especially in stressful environments. The aim is to make the person gain a habit with the homework given afterwards.
As another method, in the intensive reverse practice technique, the person is asked to demonstrate each tic behavior he/she has intensively several times a day for a pre-determined period of time. Accordingly, the person repeats the tic intensely until conditioned fatigue occurs. Then, the patient is expected to rest and demonstrate an adaptive, alternative behavior - the behavior of not showing tics.
In addition to psychotherapeutic interventions, the person's family, school and social environment must first be informed about tics. This information and studies provide a significant reduction in tics and improve their academic performance and social skills (Prestia, 2003). Tics occur outside of children's control. Therefore, parents should not punish the child and focus on his behavior. Getting angry at the child because of his tics or drawing attention to his tic behavior creates pressure on the child, which may cause the tics to become permanent. Expecting the child to perform beyond his/her capacity is also among the reasons that increase the child's tics. It is important that the child does not experience any difficulties in this regard. Helps increase the child's sense of self-confidence Preliminary studies should be carried out.
If there is a neurological cause that causes the tic, this should be evaluated and treated first. If the situation that causes the tic is due to psychological reasons, goals determined for the person's needs and methods such as game therapy and behavioral therapy should be studied under the guidance of an expert psychologist. During the process, psychological treatment support is provided to the person along with training and counseling given to the family.
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