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Ask the Mental Health Expert Archives 2001-2004

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Transient Tic Disorder

Q. I have a 3-year-old son who has developed a motor and phonic tic within the last few months (blinking and sniffing). He has been seen by a pediatric neurologist who has diagnosed him with Transient Tic Disorder.

She has not given us a prognosis however, as she says it is very much a "wait and see" approach. There is no family history of Tourette's or OCD. He is neither hyper nor attention deficit. I have read that the prognosis is generally quite good for children who develop either a vocal or a motor tic between the ages of 6 and 8. What about a 3 year old with both a motor and vocal tic? Any input would be greatly appreciated.

A. I can imagine how nerve-racking it is to feel that all you can do is "wait and see" what happens with your son's problem But, based on my unsuccessful attempt to locate solid research in the area of tic disorder outcomes, your child's pediatric neurologist may be on the mark.

The problem is, in order to answer your question scientifically, we would need data on hundreds if not thousands of 3-year-olds who have developed motor and vocal tics. We then would need to follow all the transient tic cases--by definition, those of less than a year's duration--and determine what percentage had converted, at the end of a year's time, to a chronic tic disorder, or to Tourette's Disorder.

To the best of my knowledge, there are no such large-scale, long-term studies providing that sort of data. (In fact, most transient tic disorders begin after age 5). But we do know that if episodes of transient tic disorder (TTD) recur, there is usually a reduction in frequency and severity of symptoms over the years.

On the other hand, let's assume, for discussion's sake, that your son's tic problem did not go away on its own, after a year, and was re-classified as a chronic tic disorder. In about two-thirds of cases, chronic motor or vocal tic disorders end during adolescence. Even in Tourette's Disorder, severity of tics tends to wane after the mid-teens, in most cases. Furthermore, we are increasingly developing new and more effective behavioral and pharmacological treatments for tic disorders, if they become too disruptive. Fortunately, most cases of TTD do not even require treatment.

In the mean time, if you are not satisfied with the information you have been given, you may want to obtain a second opinion from a pediatric psychiatrist who specializes in tic disorders. Dr. Barbara J. Coffey, of the Tourette's Unit at McLean Hospital, Belmont, MA, may be able to advise you further on this.

If your child's behavior seems unduly disruptive or upsetting to him (or you), you may also want to consult a pediatric psychologist or neuropsychologist, to see if some behavioral strategies would be helpful. I do hope all turns out well for you and your son.

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December 2003

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