Tics and Tourette's: Assessment and Care for Children

Tics are common in childhood, and for many families the hardest part is not the tics themselves but the uncertainty: what they are, whether they will pass, what school should do, and when treatment is worth considering. This page explains how we think about tics and Tourette syndrome at Hunter Children's Clinics, and what actually helps.

What tics are

A tic is a sudden, quick, repeated movement or sound that is not rhythmic: things like blinking, facial movements, shoulder shrugs, sniffing, throat clearing or short vocal sounds. Tourette syndrome is diagnosed when a child has had multiple movement tics and at least one vocal tic, not necessarily at the same time, for more than a year, beginning in childhood. Where only movement tics or only vocal tics persist beyond a year, this is called a persistent (chronic) tic disorder, and tics present for less than a year are described as a provisional tic disorder.

Tics naturally wax and wane. They can fade for weeks and return, and they often change form over time. That pattern is expected, and on its own it is not a sign that anything is going wrong.

The urge that comes first, and why "he can hold it in at school" is a misunderstanding

Most tics are preceded by an urge: a feeling of tightness, stretch, tension or itching that is relieved by performing the tic. Clinicians describe an urge-tic-relief cycle, and it is why tics are sometimes called "unvoluntary" rather than voluntary or involuntary.

Children can often suppress tics for short periods, but this comes at the expense of mounting inner tension and is often followed by a rebound. Many children manage the school day with few visible tics, then tic much more once safely home. It is easy to misread this as evidence that a child could stop if they tried harder. It is the opposite: it is evidence of how much effort they have already been making. Asking a child to "just stop it" adds pressure and does not help.

What usually happens over time

Tics typically begin in the early primary-school years and are often at their most noticeable somewhere around ages 10 to 12. From there, most young people improve substantially through adolescence, and many reach adulthood with mild or no tics. A smaller group continue to have significant tics, which is one of the reasons proper assessment matters.

When tics need treatment, and when they don't

Not all tics need treatment. Where tics are not getting in a child's way, watchful waiting is an accepted approach, and there is no evidence that starting treatment earlier works better. What guides the decision is the impact of the tics from your child's and your family's point of view: discomfort, teasing, interference with school work, or distress. That is assessed properly, with your child's voice in the room.

Education comes first

The first and most useful intervention is understanding: for your child, for you, and for school. Knowing what tics are, how the urge works, and what usually happens over time changes how everyone responds, and support for teachers and classmates is specifically recommended. We help families explain tics at school so the pressure to suppress comes off, because that pressure is often the most impairing part of the picture.

Behavioural therapy is the first-line treatment

Where treatment for the tics themselves is needed, behavioural therapy comes first. The best-established approach is CBIT (Comprehensive Behavioural Intervention for Tics), which combines awareness training, learning a competing response to use when the urge arrives, and practical changes to the situations that make tics worse. It typically runs around eight sessions, has its strongest evidence in children about nine and older, with adapted versions used for younger children, and can be delivered by video where in-person options are not available. Exposure and response prevention (ERP) is a recognised alternative. These approaches ask real motivation and practice of a child, and we are honest with families about that.

Treating what sits alongside the tics

For many children, the tics are not the main event. ADHD co-occurs in a large proportion of children with tics, and often appears before the tics do. OCD and anxiety are also common companions. Clinical research is clear that these co-occurring conditions are often more impairing than the tics themselves, which is why our assessment always looks at the whole picture, not just the tics. Where ADHD, anxiety or learning difficulties are part of your child's presentation, treating those well often helps more than chasing the tics. See our ADHD service and our psychology team, including psychology assessment.

What treatment can and cannot do

We set expectations honestly, because the evidence requires it: treatments for tics infrequently result in complete cessation of tics. The realistic goals are fewer and less disruptive tics, less distress, and a child who understands themselves and is understood at school and at home. Alongside any treatment, the things that most support a good adult outcome are the ordinary powerful ones: strong friendships, real interests, and self-esteem that is protected rather than eroded.

Where medication fits

Medication is one option, usually considered where tics are causing significant difficulty, and generally alongside or after behavioural and educational approaches. Any medication decision is made individually with your paediatrician, weighing possible benefits against side effects, and reviewed regularly. Medicines can reduce tics for some children but do not stop or cure them.

Getting help

Assessment and care for tics and Tourette's at Hunter Children's Clinics is paediatrician-led, within our general paediatric service. A GP referral is required before a first appointment with a paediatrician; fees and referral details are on our fees and referrals page. If behavioural therapy such as CBIT is the right next step, we will talk you through the options for accessing it, including telehealth. Families sometimes ask where to access CBIT. Healthy Patterns (Laura Sales, a counsellor registered with the Australian Counselling Association and PACFA, with training in CBIT) offers CBIT online and in Newcastle. Medicare rebates do not apply. This is provided as information only and is not an endorsement. We can also talk with you about school support, and about connecting with other families, at your appointment.

Frequently asked questions

Does Tourette's mean my child will swear?
Almost certainly not. Involuntary swearing, called coprolalia, is present in only about 15 to 20% of people with Tourette syndrome. It is the thing most people picture, and it is the exception, not the rule.

Can my child stop their tics if they try harder?
No, and this is the most important thing to understand. Tics are usually preceded by an urge, a feeling of tightness or tension that is relieved by the tic. Children can sometimes hold tics in for a while, but only at the cost of mounting inner tension, and tics often rebound afterwards. A contained day at school followed by lots of tics at home is common, and it does not mean your child could stop if they tried.

Will my child grow out of tics?
Tics usually begin in the early primary years, are often at their most noticeable around ages 10 to 12, and for most young people improve substantially through adolescence, with mild or no tics by adulthood. A smaller number continue to have significant tics, which is one reason assessment and support matter.

Did we cause this?
No. Tic disorders are neurodevelopmental conditions. Research points to a mix of genetic and other biological factors. They are not caused by parenting.

This page is general information only. It is not a substitute for professional advice. Please speak with your GP, paediatrician or treating clinician about your individual child.