UNC Health Talk

Tics Are Uncontrollable—and Completely Normal

Believe it or not, eye rolling isn’t always a sign of disrespect. It’s one of the most common tics that children can develop. Other common tics are blinking, coughing and throat clearing.

“A tic is an uncontrollable movement or noise,” says Steven Trau, MD, a UNC Health child neurologist and director of the UNC Clinic for Tourette Syndrome and Tic Disorders. “It’s very common—about 25 percent of children have tics.”

Tics are almost never harmful. However, they can make a child a target of bullying or teasing. Tics may hurt a child’s self-esteem and can sometimes cause depression. In addition, some motor tics can be physically painful.

“If a tic is actively bothersome to a child, then it’s time to talk to a doctor,” Dr. Trau says. “Otherwise, the best thing to do is ignore it.”

What Causes Tics?

The exact cause is not known, although tics seem to run in families.

“No one has found a gene connected to tics,” Dr. Trau says, “but if a parent has tics, there’s a 50 percent chance the child will, too.”

Some experts think environmental factors or inflammation can contribute to the onset of tics, which typically occurs between ages 4 and 6 but can happen earlier or later, Dr. Trau says.

“I explain to patients that there’s a structure in the brain that’s designed to keep some types of movements from happening,” he says. “When it’s not working quite as well, tics can come out.”

About 50 to 70 percent of the time, children with tic disorders also have attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) or anxiety.

“The circuits that control movement interact with the circuits in the brain that control and regulate emotions,” Dr. Trau says. “When they overlap a bit too much or too strongly, tics and psychological issues can come together.”

Tic Disorders and Tourette Syndrome

Tourette syndrome is the term used when someone has both motor and vocal tics that have lasted for more than a year. It is not an indication of severity.

Unfortunately, the syndrome has become the butt of jokes.

“Tourette syndrome has gotten a really bad reputation from TV and movies,” Dr. Trau says, “but rarely does someone with Tourette syndrome have coprolalia, or uncontrolled swearing. That occurs in fewer than 10 percent of children with Tourette syndrome.”

Boys are three times more likely than girls to have tic disorders and Tourette syndrome.

Treatment for Tic Disorders

Most of the time, no treatment is needed. In about a third of children, the tics go away. In another third, the tics become less frequent, or they come and go. For the remaining third, the condition may stay the same or become more pronounced.

Behavior modification tactics can help children recognize the uncomfortable feeling or urge to tic and channel that urge into a non-tic activity.

An ideal way to learn these tactics is through comprehensive behavioral intervention for tics, or CBIT. Unfortunately, COVID-19 precautions have delayed training for professionals, so CBIT availability is limited right now. However, there are online resources that can help families, Dr. Trau says, including materials from the Tourette Association of America.

Several medications can help lessen the number or severity of tics, although none of them cure the disorder.

“In many patients, the tics themselves aren’t actually severe enough to cause issues,” Dr. Trau says. “However, a patient’s ADHD, OCD or anxiety can be quite severe. It’s very important in taking care of these patients to evaluate and help address both the tics and non-tic symptoms.”

Communicating About Tics to Others

Some tics cause physical pain. They can also cause emotional or psychological distress if the child is embarrassed or treated poorly by others.

Often, the best thing teachers, friends and parents can do is ignore the tics. That may be easier, though, if the adults and other kids understand the condition.

“Most teachers are wonderful,” Dr. Trau says, “but I know of at least one case where a teacher sent a child to the principal’s office for rolling his eyes. She thought he was being disrespectful, but he couldn’t control it.”

Dr. Trau recommends that parents send a letter to the child’s teachers and other school officials explaining the child’s diagnosis. Parents also can help their child find words to explain the condition to their friends, such as, “I have a medical condition, and I cannot control my tics. We can ignore them and keep playing.”

“You can even make a wallet-sized card that the kid can carry around if the child gets tired of explaining,” Dr. Trau says.

Ready-made cards can be downloaded from the Tourette Association’s website, explaining, “Why do I act this way? Because I can’t control it. … I am grateful for your understanding and empathy.”

The Bottom Line: Only Act if the Child Is Struggling

“It’s all about the kids and how they are doing,” Dr. Trau says. “If the child is not affected, then ignore it. If things get worse or the tics start bothering the child, then contact your pediatrician.”

Pediatricians may refer patients to the UNC Clinic for Tourette Syndrome and Tic Disorders for evaluation and, if appropriate, an individualized plan that might include CBIT, medications and addressing co-existing conditions.


Does your child have tics that interfere with his or her quality of life? Talk to your pediatrician. If you don’t have a pediatrician, find one near you.