TICS & TOURETTE SYNDROME
Tics are sudden, repetitive movements or sounds that are difficult to control. While many children and young people experience tics at some point, for some individuals these persist and may be diagnosed as Tourette syndrome or a chronic tic disorder. At The Lotus Psychology Practice, we offer evidence-based psychological support to help children, adults and families understand tics, reduce their impact, and improve day-to-day functioning.
Understanding Tics & Tourette Syndrome
Tics are involuntary, rapid, and recurrent movements or vocalisations. Tics typically begin in childhood and are at their worst in teenage years. For 80% of people, they have very few tics through into adulthood. Common motor tics include eye blinking, shrugging or head jerking, and common vocal tics may including sniffing, throat clearing or whistling. Although rare, some people may experience complex tics, that include coprolalia and copropraxia (swearing vocal or motor tics).
Tic disorders are a neurodevelopmental condition, and refer to a spectrum of movement disorders:
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Transient Tic Disorder –motor or vocal tics that last for a short time, often under a few months. This is very common, affecting 10-20% of children. If you visit a nursery you will see lots of young children experiencing small blinking or sniffing tics.
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Chronic Tic Disorder – motor or vocal tics that persist for more than 1 year, which is less common, affecting 5% of people.
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Tourette Syndrome – multiple motor and vocal tics present for at least 1 year.
Diagnosis of Tic Disorder or Tourette Syndrome
It is important that tic-like movements are appropriately assessed to ensure an accurate diagnosis and to rule out other possible causes.
While most tics are part of a primary tic disorder, similar presentations may occur in:
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Neurological conditions
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Functional neurological presentations
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Medication side effects
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Other movement disorders
An initial assessment through a GP, paediatrician or psychiatrist is recommended.
Tics & Co-Occurring Conditions
Tourette syndrome and tic disorders frequently co-occur with other neurodevelopmental and mental health conditions.
Common co-occurring conditions include:
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Attention Deficit Hyperactivity Disorder (ADHD), affecting approximately 50–60%
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Obsessive Compulsive Disorder (OCD), affecting approximately 30–50%
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Autism Spectrum Condition (ASC), present in approximately 10–20%
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Anxiety disorders (around 30–40%)
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Depression and low mood, particularly in adolescence and adulthood
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Learning differences or additional educational needs
In many cases, these co-occurring difficulties have a greater impact on day-to-day functioning than the tics themselves. A formulation-led approach allows us to move beyond labels alone, developing a holistic and clinically meaningful understanding that can guide effective, individualised support.
Psychological Therapies for Tics
The European clinical guidelines for Tourette syndrome and other tic disorders recommend at first, a thorough assessment of tics, as they can often co-occur with other neurodevelopmental conditions such as attentional difficulties (ADHD), autism spectrum disorder (ASD), obsessive compulsive disorder (OCD) anxiety, depression and low self-esteem.
Following a confirmation of a tic diagnosis, the first line intervention is psychoeducation - to learn about tics, what causes them, the typical course of tics and how to explain tics to other people. If the tics are causing an impact on a persons life, behavioural therapies are indicated as a treatment for tic disorders and Tourette syndrome. They have been found to reduce tic severity, tic-related impairment and to improve quality of life, and are as effective as medication for tics. Behavioural therapies for tics include:
The research into HRT began as far back as the 1970’s. The first stage of HRT is to become more aware of the ‘tic alerts’. You then create a ‘tic blocker’ (known as a competing response), an action which makes it impossible to let the tic out at the same time.
Habit Reversal Training (HRT)
CBiT expands on HRT, and is made up of 6 key parts:
1. Psychoeducation: learning all about tics, and what your individual triggers are.
2. Self Awareness: learning how to recognise those ‘tic alert’ or urges.
3. Relaxation Skills
4. Social Support
5. Habit Reversal Training
6. Competing Response (Tic Blocker)
Comprehensive Behavioural
Intervention for Tics (CBiT)
ERP involves learning to tolerate the premonitory urge without performing the tic, helping to reduce the urge over time.
Exposure & Response Prevention
(ERP)
Our Approach at The Lotus Psychology Practice
At The Lotus Psychology Practice, our team of HCPC registered Psychologists have specialist experience in supporting children, adolescents and adults experiencing tics. We take a collaborative, formulation-led approach to therapy, which guides a structured, evidence-based and personalised treatment plan.
Prior to your first appointment, you will be asked to complete standardised and validated questionnaire measures, which are used to inform the assessment. A comprehensive psychological assessment is completed across the first two sessions. This helps us to develop a shared understanding of your current difficulties. Following an assessment, you will receive a full report, which includes individualised recommendations and resources, as well as an agreed therapeutic plan and individual goals.
Based on the assessment, we will agree the most appropriate therapeutic approach, tailored to you. Psychologists are trained across multiple therapeutic modalities, and the approaches are integrated based on an individuals unique needs. All therapies at The Lotus Psychology Practice are informed by scientific research and are and in line with National Institute for Health and Care Excellence guidelines.
Functional Tics
In recent years, there has been increased recognition of functional tics, which differ from neurodevelopmental tic disorders such as Tourette syndrome.
Functional tics are understood within the framework of functional neurological disorder (FND) and are typically associated with differences in how the brain controls movement, rather than a neurodevelopmental tic condition. Research indicates that functional tics often have a more sudden onset, typically in adolescence or early adulthood, and may present with more complex or severe movements or vocalisations.
They are also more commonly associated with:
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Anxiety and emotional distress
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Functional neurological symptoms
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Reduced family history of tic disorders
Functional tics are genuine and involuntary, and can be highly distressing and impairing. Importantly, they require a different clinical formulation and treatment approach compared to Tourette syndrome, which is why accurate assessment is essential.
Behavioural Therapy Group for Tics and Tourette Syndrome
Tics and Tourette syndrome can affect many aspects of a child's life, including confidence, friendships, participation in school and emotional wellbeing. While tics are common, specialist support can be difficult to access, with many families facing long waits for intervention.
The Lotus Psychology Practice is developing a specialist psychologist-led behavioural therapy group for children and young people with tics and Tourette syndrome.
The programme is being developed by Dr Morvwen Duncan, Lead Clinical Psychologist, who has extensive experience working with children and young people with tics, including within the National Tic Service at Great Ormond Street Hospital. Dr Duncan has also been involved in international research collaborations, exploring new ways to support young people with tics.
Who is the Group For?
The group is designed for children and young people who:
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Have tics or Tourette syndrome
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Feel that their tics are affecting daily life, school or confidence
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Are motivated to learn new ways of managing tics
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Can participate in a small supportive group environment
What Will Children Learn?
The European clinical guidelines for Tourette syndrome and other tic disorders recommend that following a confirmation of a tic diagnosis, the first line intervention is psychoeducation - to learn about tics, what causes them, the typical course of tics and how to explain tics to other people. Drawing on evidence-based approaches including Comprehensive Behavioural Intervention for Tics (CBIT), Habit Reversal Training (HRT) and Exposure and Response Prevention (ERP). Young people in the group will then be supported in recognising premonitory urges, identify triggers to tics, developing competing responses and behavioural strategies to manage tics. We know that stress and anxiety can exacerbate tics, and our group will teach young people tools to manage anxiety, and to build confidence. The group provides a safe environment where children can meet others with similar experiences and learn from one another.
Why Choose The Lotus Psychology Practice?
Led by a Lead Clinical Psychologist with experience in the National Tic Service at Great Ormond Street Hospital.
Evidence-based behavioural interventions informed by CBIT, HRT and ERP.
Specialist expertise in Tics and co-occuring conditions such as ADHD, Autism and anxiety/low mood.
Small group format with opportunities for individualised support.
Parent involvement throughout the programme.
Outcome-focused and grounded in current clinical research.