Q. I am not sure if what my 10-year-old son does is a nervous tic or not. Ever since he was a toddler, he would shake his hands and feet when he was happy and excited. Now that he is 10, he still shakes his arms when he is happy. It has toned down a bit but it is definitely something that he doesn't even realize he is doing until you point it out to him and then he stops. I would like to help him stop as kids are beginning to make fun of him. Is this some kind of tic?

A. I can't say without examining your son--but what you describe sounds more like a habit to me. In the first place, so-called motor (as opposed to vocal) tics usually involve isolated, small muscle groups--not entire limbs. So, for example, a facial tic might involve a slight twitching of the mouth or raising of the eyebrow. Second, tics are usually present more or less throughout the day, to some degree, though the frequency certainly can vary with the degree of the patient's anxiety, relaxation, etc. For example, in Tourette's Disorder--which involves vocal and motor tics--tic frequency may increase during periods of anxiety or social stimulation (Silva et al, J Child Psychol Psychiatry. 1995 Feb;36(2):305-12). So, it would be unlikely that a true tic would be expressed only when a child is happy and excited.

Finally, the fact that your son is able to stop this behavior once you point it out to him sounds atypical for a bona fide tic disorder. If your son is otherwise a healthy, happy, well-adjusted, ten-year old, it's not clear to me that you have much to worry about. Of course, you can gently encourage him to act more maturely if his arm-shaking really creates major social problems for you or him, and reward him with verbal praise when he behaves appropriately. He could simply grow out of this. But if the problem persists or worsens, talking to your pediatrician would be a good move.

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January 2004

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