Children and Tics: What Parents Should Know

People of all ages can experience repeated involuntary movements called tics, but they are most prevalent in children. Nearly one quarter of all children experience this genetic disorder that becomes most visible in school-aged children.

Common motor and vocal tics include:

  • Blinking
  • Shoulder shrugs
  • Neck twitches
  • Throat clearing or sniffling
  • Coprolalia, involuntary and repetitively utters obscene words

All tics tend to wax and wane in severity and frequency. The tics themselves can also change over time, says Dr. Mary Zupanc, chair of neurology and the director of CHOC Children’s pediatric comprehensive epilepsy program. This means that a child with simple childhood tic disorder can have repetitive eye blinking during one point in time, and during another phase, can have irregular but repetitive shoulder shrugging, and later, intermittent head twitching.

children tics
Dr. Mary Zupanc

Childhood tic disorders are very common in young children. It is a “spectrum disorder,”  with some children having only intermittent, isolated tics, and having multiple motor and vocal tics. If these tics last greater than one year, the diagnosis is Tourette’s syndrome, which is simply a more severe form of childhood tic disorder.

Preserving Self Esteem

“Tics alone will not hurt a child, but we certainly want to preserve a child’s self-esteem, and not allow them to be embarrassed by their tics. Vocals tics can be especially problematic in the school setting,” says Dr. Zupanc. “Often times, the biggest treatment of tics is reassurance to the child and family, in addition to providing education on when it is appropriate to suppress a tic or not. Family and child counseling are often important, so that the child maintains his or her self-confidence.”

Treatment Options

Medication may be recommended in some severe cases. Pediatric psychologists who have training in behavioral modification can help children learn to suppress a specific tic.

Tics often disappear around the time of adolescence in many cases of childhood tic disorders and Tourette’s syndrome, although there may be concurrent co-occurring health challenges that are more problematic, Dr. Zupanc says. Learning disabilities, attention deficit hyperactivity disorder, obsessive compulsive disorder, and oppositional defiant disorder frequently appear in tandem with either childhood tic disorder or Tourette’s syndrome.  These co-morbidities may require medications for effective treatment.

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Meet Dr. Anjalee Warrier Galion

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Anjalee Warrier Galion, a pediatric neurologist and sleep specialist.

Dr. Anjalee Warrier Galion
Dr. Anjalee Warrier Galion

Q: What is your education and training?
A: I attended the University of Medicine and Dentistry of New Jersey- New Jersey Medical School, and completed my residency in pediatrics at University of San Francisco, Fresno.  During my academic year, I worked for Walter Reed Army Institute of Research to help identify a vaccine for malaria. My second day was September 11, 2011, and it was an amazing, humbling, and scary experience to be a part of the military for this day. My first fellowship was in pediatric neurology at the University of California, Irvine (UCI), and my second fellowship was in sleep medicine at the University of California Los Angeles- Cedars Sinai Sleep Medicine Fellowship.

Q: What are your administrative appointments?
A: Assistant clinical professor at UCI, assistant program director for the UCI child neurology residency program, chair of the junior faculty leadership council, and co-chair of the sleep workgroup for the National Autism Treatment Network.

Q: What are your special clinical interests?
A: Sleep disorders in children with neurologic diseases such as epilepsy and autism, as well as sleep and cognition.

Q: Are you involved in any current research?

A: Evaluation of efficacy of specific sedative hypnotics in children with Autism spectrum disorder, and Identification of sleep architecture and pathology in children with epilepsy.

Q: How long have you been on staff at CHOC?
A: Four years.

Q: What are some new programs or developments within your specialty?
A: CHOC is one of the few, if only, hospitals in the country doing combined long-term video EEG as well as polysomnography (sleep study).  This allows us a very unique opportunity to look at the brain activity and pathology in sleep. Multidisciplinary sleep clinics involving psychology and pulmonology are also unique. Also, identification and treatment of a variety of pediatric sleep disorders including all types of insomnia, narcolepsy and parasomnias, such as sleepwalking, sleep talking and night terrors.

Q: What are your most common diagnoses?
A: Insomnia, narcolepsy, sleepwalking (or somnambulism).

Q: What would you most like patients and families to know about you or your division at CHOC?
A: We treat all types of sleep-related disorders and are providing state-of-the-art care for children with sleep disorders. It is estimated that more than 30 percent of children have sleep-related disorders, and improvement in sleep is essential for learning and cognition. Research suggests improved sleep supports optimal athletic performance as well. If there is any concern for a sleep-related disorder we are happy to help evaluate these children.

Q:  What inspires you most about the care being delivered here at CHOC?
A: We treat every child with the highest level of care and the physicians genuinely care for the patients and our community.

Q: Why did you decide to become a doctor?
A: I had been interested in neuroscience since I was a Howard Hughes fellow at the University of Maryland, having done work in spinal cord regeneration. I heard a talk in my first year of medical school about pediatric neurology and haven’t looked back since.

Q: If you weren’t a physician, what would you be and why?
A: If I was not a physician I would mostly likely be a PhD working in the field of neurobiology and sleep medicine. Both my parents were PhDs and I grew up hearing about fascinating advances in the world of science, so I have been drawn to science and research from a young age. For quite a few years I was strongly considering becoming a professional flute player. I was fortunate enough to travel through Italy with my youth symphony and performed around the country in orchestras, but science drew me in by the time I was in college.

Q: What are your hobbies/interests outside of work?
A: I enjoy hosting parties and events for family and friends. Our family enjoys traveling and spending time together.

Q: What have you learned from your patients?
A: The best part about working with pediatric patients is that you are constantly reminded to enjoy life and be grateful for every day. The smallest things can make a child happy, like playing with a light-up toy or seeing bubbles, and it is a great reminder to take pleasure in all the simple things around us every day.

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Meet Dr. Andrew Mower

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Andrew Mower, a pediatric neurologist. Dr. Mower attended medical school at St. George’s University School of Medicine, completed a residency in pediatrics at Maimonides Medical Center, and another residency in child neurology State University of New York Downstate. He completed a fellowship in clinical neurophysiology at Columbia University. Dr. Mower sits on CHOC’s quality improvement committee and is part of CHOC’s ancillary and diagnostic services. He has been on staff at CHOC for two years.

Dr.Andrew_Mower_0699_2

Q: What are your special clinical interests?
A: Epilepsy and epilepsy surgery

Q: What are some new programs or developments within your specialty?
A: Stereotactic EEG for epilepsy surgery

Q: What are your most common diagnoses?
A: Epilepsy and headaches

Q: What would you most like community/referring providers to know about you or your division at CHOC?
A: We take on the most challenging epilepsy cases to search for cures, and, if not, at least an improvement in the child and family’s quality of life. We work together as a team to use all of our expertise to help the child and family.

Q:  What inspires you most about the care being delivered here at CHOC?
A: I feel that we offer families hope when hope had been abandoned before.

Q: Why did you decide to become a doctor?
A: I decided to become a doctor to help people in need. I chose neurology as my specialty because I had a fascination with the nervous system and wanted to break misperceptions that little can be done for patients with neurological problems.

Q: If you weren’t a physician, what would you be and why?
A: Farmer. I love the accomplishment of creating a garden and growing produce.

Q: What are your hobbies/interests outside of work?
A: Gardening, running and hiking

Q: What was the funniest thing a patient told you?
A: “I don’t eat apples, doctor.”

“Why?”

“Because they keep the doctor away, and I like you, Dr. Mower.”

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Test your Brain IQ with this Brain Awareness Week Quiz

At what point does a headache become cause for concern? How rapidly and when does your child’s brain develop? The brain is a complex organ, and sometimes, it produces almost as many questions and it does thoughts (which is about 70,000 per day). To celebrate Brain Awareness Week, take this fun quiz to see how much you know about the brain:

  1. True or False- If kids and teens have headaches, they should automatically be referred to a specialist.
  2. True or False- A newborn’s brain is smaller than an adult’s brain.
  3. True or False- The most active time for brain development is during puberty, when adolescents are rapidly growing and changing.
  4. True or False- The brain is the most complex organ in the human body.
Dr. Mary Zupanc
Dr. Mary Zupanc, CHOC’s neurology division chair, and director of CHOC’s comprehensive epilepsy program.
  1. False- Headaches can occur for a number of reasons and are usually not a sign of a serious medical condition. Before seeking a referral to a neurologist from your pediatrician, first try:
    • Getting enough sleep
    • Drinking plenty of water
    • Eating regular, well-balanced meals
    • Exercising regularly
    • Stress relieving methods such as yoga or meditation
  2. True- At birth, a baby’s brain is one-quarter of the size of their mom or dad’s brain. It will double in size by their first birthday, and eventually weigh three pounds when it’s full grown.
  3. False- The period between birth and two years old is a very active time for brain development. Until puberty, brain development will use up almost half of the body’s daily energy intake. However, brains won’t fully develop until closer to age 25.
  4. True- The brain powers the nervous system, which affects and is affected by all the other systems in your body (cardiovascular, endocrine, gastrointestinal, and immune systems). It has 100 billion neurons- cells known as the gray matter which process information.

Learn more about the CHOC Children’s Neuroscience Institute, where pediatric specialists are providing expert care at the only pediatric neuroscience hospital in the region.

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Preventing and Treating Concussions

CHOC Children’s multidisciplinary team of concussion experts can help prevent and treat concussions, as well as help patients ease back in to school and sports. Careful supervision is essential for young persons with concussions, since their brains are still developing.

In this episode of CHOC Radio, Dr. Sharief Taraman, a pediatric neurologist, Dr. Jonathan Minor, a sports medicine specialist, Jenn Ahlswede, a speech language pathologist, and Mollee Oh, a physical therapist and rehabilitation supervisor, discuss:

  • SCAT3, an assessment tool parents and coaches can use immediately after an incident occurs
  • The film “Concussion,” and how concussions affect kids and teens differently than adults
  • Recommendations for cognizant and physical rest periods after sustaining a concussion

Hear more from CHOC experts in this podcast.

CHOC Radio theme music by Pat Jacobs.