At what point is a childhood tic a sign of anxiety/mental health issues?

[usernamefromhell]

I've posted about this before (under a different user name), my DD (who is 7) seems to be prone to tics. She had a vocal/oral one about 18 months ago, which lasted about four/five months which has subsided, now she has one involving her hands which basically involves compulsive drumming of fingers on hard surfaces and is fantastically irritating (though I haven't expressed this to her).

I've read up a bit on this (including on here), and from what I've gathered tics are fairly common in children: there's not much to be done about them and most of them pass.

What concerns me is whether there's a point at which they should be seen as indicative of underlying mental health/anxiety/stress issues. As far as I can tell my DD is generally a happy child: we have a great relationship and she seems to enjoy life: she has her strops and tantrums like any other child. But nothing that overwhelmingly concerns me and she seems to be happy in life and at school.

But our lives are in many ways very stressful: I separated from her father three years ago and we're divorcing -- our relationship is reasonably cordial for a divorcing couple and she has a good relationship with him, but there are strains and she must pick up on this. He is also a fairly heavy drinker with a history MH problems although we are both careful to keep these things away from her. I work very long hours: I love my job but its stressful and takes up a lot of my time. In general I haven't picked up any particular unhappiness about any of these things, but I can't help wondering if these tics could be an outlet for stress which she doesn't feel she can express any other way.

I suppose I'm wondering whether I need to take this further with medical professionals/health visitor. On the one hand I'm loathe to go down the mental health services route if its not necessary and make her feel she has an "issue", particularly if there isn't much to be done about it and it will pass. On the other I don't want to ignore something which could be a warning sign.

Any thoughts? Anyone else been through anything similar?

Does school have a pastoral care person/emotional wellbeing team? They might be able to offer a space to talk for your daughter?

Have school said anything about her drumming her fingers? Is it just at home?

AIUI Tics are a stress outlet, so something may well be worrying her. Have you asked her how she is feeling about you and DH splitting? Do the tics seem to bother her (especially if it's also happening at school)? Do you get to spend good quality time with her daily so she knows there is time to talk through her day and any worries?

Aren’t tics just a stim, and not necessarily a sign of a mental health issue per se?

Shawshank no: when the previous tic was going on I mentioned it to her class teacher and she hadn't noticed it -- its much more noticeable when she's at home and when she's tired.

I've asked my DD about it a couple of times -- she says she can't stop doing it and wants to but otherwise doesn't seem overly bothered by it.

Her dad and I split when she was really small three and a half and she is pretty used to us being separated and in fact I don't know if she really remembers us living together. After he first moved out she used to ask if he could live with us again. More recently she seems more comfortable with him not living with us -- he stayed with us for a few days a couple of weeks ago and she seemed fairly relieved when he left.

We do have as much quality time as my time allows and we always have some "wind down" time to chat in bed etc. But the bottom line is my schedule is pretty mad.

flibberty there is a pastoral care person -- I might mention it when school starts again. I was on the point of going to the GP with the last tic when it disappeared.

itchy well this is exactly my point: there are clearly lots of tics which are nothing to do with mental health, I'm trying to figure out whether its just this or if there's something more to it.

As I said, I'm loathe to turn this into a MH/pastoral issue if its not -- I don't want to upset her or put more focus on it than is necessary. But I also don't want to ignore it if its a sign of something serious. I just don't have a good feel for whether its a MH issue or not.

I can hear how worried you are.

Thing is, there’s very little difference in how they’d be treated anyway, assuming you could get a firm diagnosis!

Tics and stims are REALLY common, it’s jsut that most are hidden carefully. I have a couple of tics which I’ve never discussed in real life and no one knows about as far as I know.

In any event, you are where you are. You didn’t cause this, and it’s just what she does, that’s all. X

One of my tics is the name of someone who embarrassed me decades ago, and I find myself muttering it when I feel crap about myself.

Another is a thing I do with my fingers when I really need a wee!

So, she's not ticking at school? Doesn't that mean she has some element of control over it? If she does control it at school I'm not sure it would be a tic as such but maybe something she does control and likes to do as she feels it relieves any anxiety (or energy?) she feels.

If it's not a problem at school I'm not sure school pastoral could help much. First step would be your GP if you feel it's a problem.

www.nhs.uk/conditions/tics/

My son had a series of tics from age 7-10. He is a happy boy but quite highly strung and fairly sensitive. His friends at school commented on his tics so he was aware of them but he really couldn't control them. I tried to normalise it for him and told him that it happens to loads of kids

Like you, I read up loads about it online and eventually took him to the doctor after he had a head flicking one for over a year. The doctor wasn't concerned and said he would grow out of it and that we shouldn't raise attention to it.

Thankfully he did grow out of it - he is now 13 and doesn't have any tics at all.

I would get her an appointment at the doctor to discuss it so that is on her record in case it gets any worse but really wouldn't worry too much at this age.

It is common to suppress tics in school, they then come out worse at home.

Tics are usually neurological rather than a mental health issue.

If two motor tics and one vocal tic have been present for 12 months then a diagnosis of Tourette’s would be likely. Tics can come and go and change often. Tics can also be things that look very deliberate and it’s sometimes hard to pick up.

Why haven't you considered the most obvious. Tourrets

zzzzzz that’s very interesting, especially the bit about compulsion. Now I don’t know if I’m ticking or stimming! It’s defo nothing I can control’

Don’t worry about it too much - as others have said, they are quite common. My daughter has had a few over the years that come and go. Seems ok at the moment (she is 12).

Could she be sensory seeking? Does it tie in with difficult times for her? Eg my son sucks his sleeves for weeks at the start of the school year.

My DS had a variety of different tics from age 5 to about 8. I informed school but his teacher said she had seen it all before over the years and not to worry - there was also another boy in the class with a different tic. His teachers after this did not even pick up on the tics. I think he managed to subconsciously control them at school but also I think I was hyper aware of them at home and always looking out for them. If he was tired or upset they got worse. He is now 17 and has no sign of them. I was very concerned at the time and consulted the GP on a number of occasions - advice was to ignore. It is hard to do this but definitely the best option at this stage.

My ds had this at the same age.
He was later diagnosed with Tourette’s.
Not to worry you of course. It may be just a nervous tic and disappear in time.
But I would just ask the gp for a referral anyway.
My ds is 17 now and a very bright and happy boy.

Not sure if its a tic or a stim and wasn't really aware of the difference -- it seems to have a compulsive element but its not something that causes her pain or for which the compulsion is so intense that it causes her distress. Maybe its a stim.

robojesus I have considered Tourettes. But as others have posted Tourettes is multiple tics at the same time, verbal and motor, and it generally is very noticeable and goes on for a long time. These are mild tics which take place for a fairly short amount of time and over which she seems to have some degree of control. It may be Tourettes but I don't think so.

Tics are a neurological issue and are not caused by stress or mental health issues- although stress can make existing tics worse. Tics can be 'categorised' as transient Tics, chronic tics or Tourettes (for a diagnosis of Tourettes, tics need to be present for more than 12 months and both verbal and motor tics need to be present). Regardless of what category the tics fall under the treatment options are the same - CBT/ medication. However medication is usually only recommended in very severe cases where quality of life is affected because the medication is not particularly effective in most cases and can carry some quite nasty side effects. Personally I would see the GP without her just to get it noted on her records in case things progress in the future but if she's happy and not overly bothered by her tics then leave her be - taking her to the doctors might make her think there's something 'wrong' with her. Childhood tics are very common and many children do grow out of them.

Zzzzz - yes you’re right.

I have had tics all my life I am 50 now. They come and go and change. As a child having anyone comment on it always made it worse, my mum used to tell me to stop but I couldn't.
Mine go if I am really busy or concentrating on something. They are worse around some people.
I don't think it's really to do with stress or anxiety although stressful situations can make it temporarily worse.
Things that need physical concentration like tai chi or yoga can make it stop.