Deal With Neurotic Twitching

Neurotic twitching, also called tics, are involuntary, repetitive and jerky movements that are difficult or impossible to control. They typically involve the head, face, neck and/or limbs. Neurotic twitching is fairly common during childhood and is often diagnosed as either Tourette Syndrome (TS) or Transient Tic Disorder (TTD) based on severity and duration of symptoms. The exact causes of tics are difficult to determine, but often related to nervousness, anxiety or adverse side effects from medications. Learning how to deal with nervous twitches is important, especially during childhood, so that there's a better chance of them getting better or disappearing.

Steps

Dealing with Neurotic Twitching

1. Be patient and don't assume the worst. If you see your child or family member twitching repeatedly, don't assume it'll become a permanent behavior. Instead, be patient and supportive of the person and try to understand how stress at home, work or school might play a role. In the vast majority of cases, twitches during childhood fade way within a few months anyway. On the other hand, a neurotic twitch that develops in an adult is less likely to resolve itself.
   • If a person has a neurotic twitch for a year or so, then TS is more likely, but it's still possible it might go away or become more mild and controlled.
   • Emotional, psychological and physical stressors are linked to most neurotic disorders. As such, observe your child's routine to understand their primary stressors and alleviate them if possible.
2. Don't get frustrated with diagnosing. There are no lab or brain imaging tests used for diagnosing neurotic twitches, so the cause can be a bit of a mystery in most cases. Try not to get frustrated or too concerned with neurotic twitches, particularly in children, because they commonly fade away after a few months or so. Research the topic online (using reputable sources) to get an understanding of the condition and how common it is among children.
   • Serious disorders that can cause neurotic twitching need to be ruled out by your doctor. They include attention deficit disorder (ADHD), uncontrollable movements due to a neurological disease (myoclonus), obsessive-compulsive disorder (OCD) and epilepsy.
3. Don't pay too much attention to it. Most doctors and psychologists recommend that family members and friends don't pay much attention to neurotic twitching or tics, at least at first. The rationale is that too much attention, especially if it's negative and involves disparaging remarks, can cause more stress and exacerbate the twitching. It's difficult to balance taking interest in someone's problem, but not going overboard with attention that feeds the problem.
   • Don't mimic the person's twitching in order to be funny or playful — it can make them more self-conscious or nervous.
   • If the twitches don't go away within a few weeks, ask the person what's bothering them. Repetitive movements, such as sniffing and coughing, can also be caused by allergies, chronic infections or another illnesses.
   • Deciding on treatment should depend on how disruptive the twitching is to the person's life, not how embarrassed you might be.
4. Consider some form of counseling or therapy. If the twitching is severe enough to cause social problems at school or work for a child or adult, then some form of counseling or therapy should be sought. Therapy typically involves a child psychologist or psychiatrist who uses cognitive behavioral interventions and/or psychotherapy. Over the course of multiple sessions, the child or adult should be accompanied by a close family member or friend for support.
   • Cognitive behavioral therapy includes habit reversal training, which helps to identify the urge to twitch or have repetitive behaviors and then teaches the patient to voluntarily combat them from occurring. Tics are often classified as "Involuntary" movements rather than involuntary ones, because the tics can be willfully suppressed for a period of time. However, this often results in discomfort that builds until the tic is performed.
   • Psychotherapy involves more talking to the patient and asking probing questions. It helps more with accompanying behavioral problems, such as ADHD and OCD.
   • Depression and anxiety are also quite common in people who develop neurotic twitches.
   • Most twitching can't be halted completely with therapy, but it can be made less obvious or forceful.
5. Ask your doctor about medication. There are prescription drugs to help control neurotic twitching and reduce the effects of related behavioral problems, but it depends if the condition is considered short term or long term, and if the person is a child or an adult. Drugs are not given to kids with TTD (temporary or transient tics), but are to those diagnosed with severe long-term TS. Psychotropic drugs change symptoms and behaviors, but they often have serious side effects, so discuss the pros and cons with your doctor.
   • Drugs that help control twitches by blocking dopamine in the brain include: fluphenazine, haloperidol (Haldol) and pimozide (Orap). Perhaps paradoxically, side effects include an increase in involuntary, repetitive tics.
   • Botulinum (Botox) injections paralyze muscle tissue and are helpful for controlling mild and isolated twitching of the face / neck.
   • ADHD drugs, such as methylphenidate (Concerta, Ritalin) and dextroamphetamine (Adderall, Dexedrine), can sometimes reduce neurotic twitching, but they can make them worse also.
   • Central adrenergic inhibitors, such as clonidine (Catapres) and guanfacine (Tenex), can increase impulse control in kids and help them to reduce their anger / rage.
   • Anti-seizure drugs used for epilepsy, such as topiramate (Topamax), can also help twitching in people with TS.
   • Unfortunately, there is no guarantee that any medication will help reduce the symptoms of a neurotic tic disorder. In order to reduce the incidence of undesired side effects associated with medication, dosing should start low and increase slowly up to the point when side effects appear then stop or decrease.

Distinguishing Tourette's from Transient Tic Disorder

1. Pay attention to age and gender. Neurotic twitching due to TS often begin between the ages of 2-15 years, with the average age of onset about 6 years of age. TS often lasts into adulthood, but it always starts at some point during childhood. TTD also starts before the age of 18 years, usually at 5-6 years old, but lasts less than a year in duration.
   • There's a lot of similarity between the two conditions with age of onset, but TS often begins a little younger because of its stronger genetic link.
   • Neurotic twitching that starts during adulthood is typically not diagnosed as either TS or TTD. The twitches must begin during childhood to be diagnosed TS or TTD.
   • Males are 3-4x more likely than females to develop TS and TTD, although females have higher incidence of other behavioral / psychological problems.
   • TS is hereditary and there is usually a genetic link between most cases.
2. Notice how long the twitching lasts. The duration of the neurotic twitching is the biggest factor for distinguishing TS from TTD. To be diagnosed with TTD, a child has to exhibit twitching (tics) for at least 4 weeks on a daily basis, but less than a year. In contrast, for a diagnosis of TS, the twitching must occur for more than a year. As such, some time and patience are needed to get a proper diagnosis.
   • Most cases of TTD resolve and go away within weeks to months.
   • Twitches that last around a year are called "chronic tics" until enough time passes to justify a diagnosis of TS.
   • TTD is much more common than TS — 10% of children develop TTD, whereas about 1% of Americans (kids and adults) are diagnosed with TS. In contrast, about 1% of Americans have mild TS.
   • About 200,000 are estimated to have severe TS (both kids and adults).
3. Take note of any tics. For a kid or adult to be diagnosed with TS, they must exhibit both at least two motor tics and at least one vocal tic in combination for over a year. Common motor tics include excessive blinking, nose twitching, grimacing, lip smacking, head turning or shoulder shrugging. Vocalizations can include simple grunts, repetitive throat clearing, as well as yelling out words or complex phrases. Numerous types of motor and vocal tics can occur in the same child who has TS.
   • In contrast, most children with TTD have either a single motor tic (twitch) or vocal tic, but rarely both at the same time.
   • If your child or family member only shows some sort of neurotic twitching, then it's likely they have TTD and it will resolve on it's own fairly quickly (weeks or months).
   • When repetitive words and phrases are spoken, it's considered a complex form of vocalization.
4. Observe the complexity of the twitching. TS varies from mild to severe in terms of repetitive twitching and vocalizations, and tends to involve more complex movements. Complex tics involve several body parts and rhythmic or patterned movements, such as head bobbing while sticking out the tongue, for example. In contrast, children or adolescents with TTD sometimes display complex movements, but not nearly as often as seen with TS.
   • The most common initial symptoms of both TS and TTD are facial tics, such as rapid eye blinking (single or both), eyebrow raising, nose twitching, lip protruding, grimacing and sticking out the tongues.
   • The initial facial tics that develop are often later added to or replaced by jerky movements of the neck, torso and/or limbs. A twitch in the neck usually jerks the head to one side.
   • Twitches from both conditions typically happen many times per day (usually in bouts or bursts of activity) almost every day. Sometimes there are breaks that may last a few hours or so and do not occur when sleeping.
   • Neurotic twitching often looks like really nervous behavior (thus the name) and can get worse with stress or anxiety and better when relaxed and calm.
5. Watch for associated conditions. A fairly reliable predictor of potential neurotic twitching behavior is whether or not the person has (or had) other disabilities, such as ADHD, OCD, autism, and/or depression. Serious problems in school with reading, writing and/or math may also be risk factors for developing neurotic twitching behavior.
   • OCD behaviors include intrusive thoughts and anxiety combined with repetitive actions. For example, excessive concern about germs or dirt might get associated with repetitive hand-washing through the day.
   • Approximately 86% of kids with TS also have at least one additional mental, behavioral or developmental disability, usually either ADHD or OCD.

Tips

• Neurotic twitching usually fades away and doesn't occur during sleep.
• TS has a relatively strong genetic link, whereas environmental factors (stress, abuse, diet) likely play larger roles with TTD.
• Research indicates that TS may involve brain abnormalities and either too much or not enough brain hormones called neurotransmitters — particularly dopamine and serotonin.

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Sources and Citations

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