Persistent (Chronic) Motor Tic Disorder in Children and Adolescents

ICD-10 code: F95.1

Persistent (chronic) motor tic disorder (MTD) is part of a cluster of diagnoses called the motor disorders.  Motor disorders are a group of psychiatric conditions that include:

  • Developmental coordination disorder
  • Stereotypic movement disorder
  • Tic disorders

Motor disorders are a group of psychiatric conditions that affect the ability to produce and control bodily movements.

Motor disorders may involve developmental delays and deficits involving fine and gross motor functions. Developmental coordination disorder is characterized by deficits in the acquisition and execution of coordinated motor skills and is manifested by clumsiness and slowness or inaccuracy of performance of motor skills that cause interference with daily living. Stereotypic movement disorder includes patterns of repetitive and seemingly driven yet purposeless motor behaviors. Examples of such behaviors include movements of the head, body, and hands that are developmentally abnormal. Tic disorders involve sudden, rapid and recurrent, non-rhythmic motor movements or vocalizations. Such motoric or vocal manifestations are observably involuntary.

Several types of tic disorders can be distinguished in DSM-5.  These are as follows:

  • Tourette’s disorder
  • Persistent (chronic) motor tic disorder
  • Persistent (chronic) vocal tic disorder

Tourette’s disorder is characterized by the presence of multiple motor tics and one or more vocal tics.  Persistent (chronic) motor tic disorder is characterized by the presence of single or multiple motor tics and the absence of any vocal tics.  Persistent (chronic) vocal tic disorder is characterized by the presence of a single or multiple vocal tics and the absence of any motor tics.

Tics can be simple (of short duration) and can include motor behaviors such as eye blinking, shoulder shrugging, or movement of the extremities, or vocal behaviors such as throat clearing, sniffing, and grunting.  Complex tics are of longer duration (on the order of seconds) and may include combinations of motor or vocal behaviors.  Complex tics may involve imitating another person’s motor or vocal behaviors, sexual or obscene gestures (copropraxia) or utterances (coprolalia), or they may be apparently nonsensical combinations of motions and/or vocalizations.

Because many individuals experience one or more tics at some point in their lives, a tic disorder is diagnosed only when the tics persist for one year or longer.

What is persistent (chronic) motor tic disorder?

The exact prevalence of MTD is unknown; however, persistent tics are believed to affect 0.05 – 3% of children and adolescents.  Tic disorders typically have an onset around age 5 – 7, with symptoms often remitting by early adulthood.  However, earlier ages of onset have been observed.  To be diagnosed with MTD, the tic(s) must be present for one year or longer.  

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Understanding Persistent (Chronic) Motor Tic Disorder

MTD can range from mild to severe.  In severe cases, the tics can cause musculoskeletal pain or injury.  Social isolation or bullying can also occur, particularly in adolescence.  Children with tic disorders often experience other psychiatric disorders, including attention deficit/hyperactivity disorder, obsessive-compulsive disorder, and separation anxiety disorder.  Adolescents with tic disorders are more likely to experience major depressive disorder, substance use disorder, or bipolar disorders.  

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How is persistent (chronic) motor tic disorder treated?

MTD is treatable. In the case of mild MTD, treatment may not be necessary and the tic(s) may remit spontaneously.  However, in the case of moderately or more distressing or impairing tics, treatment can be helpful.

Published treatment recommendations for children and adolescents with tic disorders are available from the American Academy of Child and Adolescent Psychiatry and the European Society for the Study of Tourette Syndrome (ESSTS) Guidelines Group (Pharmacological Interventions and Behavioral Interventions).

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