Tics and Tourette Syndrome in Children: What They Are and What Helps

It started in the spring with blinking. Leo, who is seven, would screw his eyes shut several times a minute, especially in front of the television. By summer the blinking had faded, but now there is a sniff, and a little jerk of the head when he is excited. At dinner his grandmother says, "Leo, stop that," and he tries, his face tense, and then it bursts out twice as often. His mother has read so many frightening things online that she does not know whether to worry, ignore it or book a doctor. If you are in the same place, here is the reassuring part first: tics are common in childhood, most are mild, and many fade with time. This guide explains what tics and Tourette syndrome are, how they change, when to get them assessed, and what really helps.

At a glance

Tics are common in childhood. A 2012 meta-analysis in Pediatric Neurology found that about 3 in 100 children have a transient tic disorder, the most common kind, and the NHS describes tics as fairly common in childhood.
Tourette syndrome is less rare than many think. The CDC estimates that about 1 in 162 children has Tourette syndrome, and that around half of them have never been diagnosed. Boys are affected about three times as often as girls.
Tics usually ease with time. According to the American Academy of Neurology (AAN), tics are usually at their strongest between 10 and 12, and many children improve during adolescence.
Behavioral therapy works. In a landmark 2010 trial in JAMA, 52.5% of children who received a behavioral therapy for tics were much improved, compared with 18.5% of those who received support and education.
Other conditions are common. The CDC reports that about 83% of children with Tourette syndrome have at least one other diagnosed condition; the NHS names ADHD and obsessive-compulsive disorder (OCD) among the most frequent.

What it is, and what it isn't

A tic is a sudden, quick, repeated movement or sound that a child does not choose to make. The NHS divides them into motor tics, such as blinking, grimacing, nose wrinkling, shoulder shrugging or head jerking, and vocal tics, such as sniffing, throat clearing, coughing, grunting or repeating a sound or word. Some tics are simple and brief; others are longer sequences, like touching things or jumping.

Many tics come with a warning. The NHS explains that tics often start with an unpleasant feeling that builds up in the body, such as an itch, a pressure or a tension, until the tic releases it. Some children describe it as a feeling that something is "not right" until they have done the tic. Tics can sometimes be held back for a while, which is why a child can seem fine in class or at the doctor's and then tic a lot at home. That does not mean the tics are put on.

Doctors group tic disorders by how long the tics have lasted and what kind they are:

Provisional tic disorder: tics that have been present for less than a year. This is the most common kind, and many of these tics fade on their own.
Persistent (chronic) tic disorder: either motor or vocal tics, but not both, lasting more than a year.
Tourette syndrome: according to the NHS, both movement and sound tics, which started before the age of 18 and have been present for a year or more. The movement and sound tics do not have to happen at the same time.

Despite how it is shown on television, Tourette syndrome is not about swearing. Involuntary swearing does happen, but the NHS describes it as rare. Most children with Tourette syndrome have ordinary tics, such as blinking, sniffing and shrugging.

How it can look at different ages

Early school years (5 to 7): the NHS says tics typically first appear around the age of 5, and a CDC survey of parents found that tics were first noticed at about age 6 on average. Simple facial tics such as blinking, grimacing and nose wrinkling are often first, along with sniffing or throat clearing, which can look like a cold or allergy at first. Tics may last a few weeks or months and then disappear, sometimes replaced by a different one.
Middle childhood (8 to 12): this is when tics are usually most noticeable. They come and go in waves, often called waxing and waning: a busy month, then a quiet one. Old tics fade and new ones appear. Tiredness, excitement, stress and big changes such as a new school or class often make them worse, the CDC reports, while absorbing activities often make them quieter. This is also the age when other children start to notice and comment.
Teenagers: for most young people, tics become milder after puberty. A follow-up study reported by the CDC found that at age 18, almost half of young people with Tourette syndrome had been tic-free in the previous week, and only just over 1 in 10 still had moderate or severe tics. At the same time, teenagers are more self-conscious, and worries about tics, along with any anxiety, OCD or low mood, can matter more than the tics themselves.

The CDC reports that about 83% of children with Tourette syndrome have at least one other diagnosed condition, and that more than a third of people with Tourette syndrome also have OCD. ADHD and anxiety are also very common. For many families, these conditions cause more difficulty day to day than the tics, so a good assessment looks for them too.

Why it happens

The exact cause of tics is not known. The NHS explains that they are thought to come from differences in the parts of the brain that control movement, that they often run in families, and that genes are likely to play a part in many cases. It is common for a parent or other relative to remember having tics as a child.

Tics are not caused by parenting, by a child being nervous or spoiled, or by anything the family did. Stress, excitement and tiredness can make tics more frequent, but they do not create them. This distinction matters, because it means the goal is not to find someone to blame but to lower the pressure around the tics and teach the child skills.

How it is assessed

Who assesses. The first step is usually your child's pediatrician or family doctor. If tics are frequent, troubling or come with other difficulties, they may refer your child to a child neurologist or a child and adolescent psychiatrist.

What happens. Tics are diagnosed from their description and, ideally, from seeing them. According to the NHS, a short video can help, as long as you take it without drawing your child's attention to the tic, since that can make it worse. The doctor asks when the tics started, what they look like, how often they happen, what makes them better or worse and whether anyone in the family has had tics. A physical and neurological examination is usually enough; the NHS notes that tests such as an EEG, a brain scan or blood tests are sometimes used, mainly to rule out other conditions. The doctor should also ask about attention, worries, repeated thoughts or rituals, mood, sleep and school, because the AAN guideline calls for screening for these conditions.

What to bring. A short list of the tics you have noticed and when each started, a few notes about what seems to trigger or calm them, a discreet video if possible, school reports or teacher comments, and anything you know about tics, OCD or ADHD in the family.

Only a qualified professional can assess your child. Recognizing your child in this article is a reason to ask, not a conclusion. Many children with mild tics never need treatment, but a calm conversation with a doctor is worthwhile whenever tics worry you or your child.

Treatment: what the evidence supports

Understanding comes first. The European Society for the Study of Tourette Syndrome (ESSTS) recommends psychoeducation as the first step for every child, whatever the severity: clear information for the child and family about what tics are, how they change and what helps. The AAN also recommends education for teachers and classmates, which can improve how a child with tics is treated at school. For many children with mild tics, this, together with lower stress and good sleep, is all that is needed. The AAN notes that watching and waiting is a reasonable choice when tics are not causing problems.

Behavioral therapy for tics. When tics cause pain, embarrassment, problems at school or distress, the first-line treatment is a behavioral therapy called the Comprehensive Behavioral Intervention for Tics (CBIT), built on habit reversal training. The 2019 AAN guideline recommends offering CBIT as a first treatment option before medication, and the 2022 European ESSTS guideline recommends habit reversal or CBIT, and exposure and response prevention, as first-line treatments.

What CBIT involves. Over about eight sessions, a trained therapist helps the child:

notice the urge. The child learns to recognize the feeling that comes just before a tic;
use a competing response. The child practices a gentle, less noticeable movement that makes the tic hard to do at the same time, such as slowly stretching the arms down instead of shrugging, and uses it when the urge appears until it passes;
change the situations around tics. Together with the family, the therapist looks at what tends to make tics worse, such as certain times of day or reactions from others, and adjusts them;
relax. Breathing and relaxation exercises help with the tension that fuels tics.

The key difference from being told to stop is that the child is in charge: they learn a skill, choose which tic to work on and practice with support, with no pressure or blame.

The evidence. In the 2010 JAMA trial by Piacentini and colleagues, 126 children aged 9 to 17 with Tourette syndrome or chronic tics received either eight sessions of CBIT over ten weeks or supportive therapy and education. 52.5% of the CBIT group were much or very much improved, compared with 18.5% of the comparison group, and 87% of the children who responded still had the benefit six months later. Treatments for tics rarely make them disappear completely, the AAN notes, but they can make them much milder and less disruptive. Where no therapist is nearby, the AAN says CBIT may be delivered by secure video.

The place of medication. When tics are severe and behavioral therapy has not helped enough, or is not available, a doctor may suggest medication. According to the NHS, it can be used alongside or after therapy. This is a medical decision made together with your family, with the benefits and possible side effects explained, and the AAN guideline asks doctors to review regularly whether medication is still needed, because tics often ease with age. When ADHD, OCD or anxiety are present, treating them can make a big difference to daily life.

What helps at home

Don't comment, don't tell off. The NHS advises trying to ignore tics, not talking about them too much and never telling a child off for a tic, because attention can make them worse. When a tic happens, carry on the conversation as if nothing happened.
Talk about it calmly, at a quiet moment. Give your child simple words: "Tics are something your brain does on its own, a bit like hiccups. You're not in trouble, and they often get smaller as you grow."
Lower the pressure on the whole day. Regular sleep, plenty of physical activity and time for calm hobbies help many children. In a CDC survey, about half of parents said exercise or quiet hobbies made their child's tics better.
Prepare the people around your child. Ask relatives, coaches and teachers not to react to tics. With your child's agreement, ask the school to let them leave the room for a short break when tics are strong, and consider an age-appropriate explanation for classmates.
Give your child a short answer for questions. A ready sentence helps: "It's a tic. My brain does it on its own, like a hiccup. It doesn't hurt and you can't catch it."
Watch for teasing and for worries. A 2022 study of more than 51,000 US children found that 56.1% of children with Tourette syndrome had been bullied, compared with 21.6% of other children. Ask regularly how school is going, and take it seriously if your child seems withdrawn.

Myths and facts

"He could stop if he really wanted to." Tics can sometimes be held back for a short time, but they are not chosen, and the urge often keeps building until it is released. Telling a child to stop adds stress and self-consciousness, which, as the NHS notes, can make tics worse.

"Tourette syndrome means shouting swear words." Involuntary swearing does occur, but the NHS describes it as rare. Most children with Tourette syndrome have ordinary motor and vocal tics.

"Tics are a sign of an anxious child or something wrong at home." The NHS explains that tics come from the parts of the brain that control movement and often run in families. Stress and excitement can turn the volume up, but they are not the cause.

When to get help right away

Most tics are not an emergency. See a doctor promptly if:

tics start suddenly and severely, especially together with sudden obsessions, fears, eating changes or other big changes in behavior, for example after an infection;
a tic is causing pain or injury, such as forceful head jerking or hitting;
your child is being bullied, is avoiding school or is very distressed about the tics;
tics come with anger, low mood or self-harm, which the NHS lists as reasons to seek help.

If your child talks about wanting to die or you believe they are not safe, call your local emergency number and stay with them.

In one sentence

Tics are common, involuntary movements and sounds that usually come and go and ease after puberty; they are not anyone's fault, they get worse with attention and pressure, and when they do cause problems, behavioral therapy and support at school can help a great deal.

Sources

Centers for Disease Control and Prevention (CDC), "Data and Statistics on Tourette Syndrome", 2026
NHS, "Tics" and "Tourette syndrome", patient information
Knight T. et al., "Prevalence of tic disorders: a systematic review and meta-analysis", Pediatric Neurology, 2012
Piacentini J. et al., "Behavior therapy for children with Tourette disorder: a randomized controlled trial", JAMA, 2010
American Academy of Neurology, Pringsheim T. et al., "Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders", Neurology, 2019
European Society for the Study of Tourette Syndrome (ESSTS), Andrén P. et al., "European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part II: psychological interventions", European Child & Adolescent Psychiatry, 2022
Charania S.N. et al., "Bullying Victimization and Perpetration Among US Children with and Without Tourette Syndrome", Journal of Developmental & Behavioral Pediatrics, 2022

General information, not a diagnosis or medical advice. Only a qualified professional can assess a child.