In our study of children whose tics began just over the past few months, I have encountered several parents who have been hesitant to have any discussion at all with their child about the tics. Here are my thoughts on the subject.
Behavior therapy experts recommend creating a “tic-neutral environment.”1 In part, this means that parents, teachers and others don’t reward or punish the tics. For instance, it won’t help the child to hear “stop it!” all day. So losing that kind of talking about the tics is a good idea. Also, it’s true that “tic talk” can worsen tics–for the moment, while you’re talking about them.2 But “these effects quickly disappear once the topic of conversation shifts away from tics.”3 In fact, self-monitoring of tics may even decrease tic severity slightly.3 The real question is whether talking about the tics helps or not in the long term.
Some of our best evidence is that talking about the tics is an essential part of CBIT (Comprehensive Behavioral Interventions for Tics), which is one of the best-proven treatment for tic disorders.3 Over the course of 2-3 months, CBIT helps the child learn strategies for reducing the severity of the tics. Identifying the tics is one of the first steps in CBIT. Since CBIT helps tics and involves talking about them, we know talking about tics isn’t a problem in the long run (and may even help).
Besides, most children are aware of their tics, even if they don’t talk about them, and they must wonder sometimes what it’s about. Having someone safe to discuss the tics with may help them realize that Mom and Dad aren’t freaking out about it.
So how do parents broach this topic with their child? I’d recommend a setting without other children for a first discussion, and just asking, “hey, you may have noticed that you do this a lot [demonstrate the tic]. Is that bothering you at all?” Then stop talking and listen for a while. If they say they don’t know what you’re talking about, or that they don’t want to talk about it, you can end the discussion with, “OK, well, if you ever want to talk about anything like that, I’m here for you.” With this question, you have some of the information you need to decide whether to seek treatment for the tics; namely, whether or how much the symptoms are bothering the child. (Of course, information you don’t need to ask about can also be important, for instance, if tics are clearly interfering with school or social life.) If on the other hand, your child is eager for information, this gives you a chance to discuss a doctor visit, or to browse the Tourette Association of America web site together.
And remember, you don’t have to know everything to do a good job with this conversation. After all, you cared enough about your child to read this post!
- Walkup JT, Mink JW, McNaught KStP, eds. A Family’s Guide to Tourette Syndrome. Bloomington: iUniverse, Inc., 2012. p. 139.
- Woods DW, Watson TS, Wolfe E, Twohig MP, Friman PC: Analyzing the influence of tic-related talk on vocal and motor tics in children with Tourette’s syndrome. J Appl Behav Anal 2001; 343(3):353-356. doi: 10.1901/jaba.2001.34-353
- Capriotti MR, Himle MB, Woods DW: Behavioral treatments for Tourette syndrome. J Obsessive Compuls Relat Disord 2014; 3(4):415-420. doi: 10.1016/j.jocrd.2014.03.007