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Autism and Tics: Is There a Connection?

December 11, 2023

As you watch your autistic child twitch their nose and shrug their shoulders repetitively, you probably wonder about autism tics. Are they simply a form of repetitive behavior or something more complex? 

Many parents look for an autistic tics list that can help them better understand their child’s repetitive behavior. Unfortunately, no checklist could suit each child on the spectrum. There is much more to tic disorders than just facial twitching and shoulder jerks.

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What Are Tics?

Tic disorders are neurodevelopmental conditions that often emerge in childhood. They may be comorbid with attention deficit hyperactivity disorder (ADHD), autism, or obsessive-compulsive disorder (OCD).

A tic could be described as a brief-lasting movement or sound interrupting normal behavior. Tics are involuntary movements or vocalizations occurring suddenly and repetitively. Although the tic or behavior is usually repetitive, it is not rhythmic. 

Your autistic child may have ADHD or other comorbidities, which may confuse symptoms. This is why seeking an accurate diagnosis that considers the child’s history and coexisting conditions is important.

Repetitive behaviors, such as rhythmic hand waving in front of the face, are linked to autism spectrum disorders. They are often referred to as stereotypies.

The Diagnostic and Statistical Manual of Mental Disorders includes three types of tic disorders to help with diagnosis:

  • Tourette syndrome – a complex neurodevelopmental condition diagnosed when a child exhibits two or more motor tics and at least one vocal tic. Motor tics include actions like head twitching, blinking, and shoulder shrugging, while vocal tics involve sounds such as throat clearing, grunting, and yelling. 
  • Persistent (also called chronic) motor or vocal tic disorder – doesn’t require multiple motor and/or vocal tics. A single tic or multiple motor or vocal tics (but not both) is enough for a diagnosis.
  • Provisional tic disorder – according to DSM-5 criteria, it must happen before the child turns 18, and the child should never have met the criteria for Tourette syndrome or Persistent motor or vocal tic disorder.

Understanding Autism Tics

Autistic tics, also known as stimming or self-stimulatory behavior, are repetitive movements, sounds, or actions that individuals with autism spectrum disorder engage in.

These behaviors serve various purposes for autistic individuals and can vary widely from person to person. Autism tics can take various forms, including hand flapping, vocalizations, or specific routines, and are often confused with stereotypes.

But what are stereotypies? They can be distinguished from tics in that they are rhythmic and appear to be purposeless. Unlike tics, there’s no premonitory urge before or relief after their performance.

Furthermore, stereotypies usually have an earlier onset than tics. Stereotypies often appear before the child reaches age three, with tics mostly appearing when the child is around six years old.

Some common examples of autism tics are motor tics such as:

  • rocking back and forth,
  • licking lips,
  • flapping hands,
  • blinking.

Some common vocal autistic tics are:

  • grunting, 
  • repeating words or phrases,
  • yelling and screaming.

Even if you ascertain that the behavior is related to a tic disorder, you will still need a professional to determine whether the child has Tourette’s syndrome or another tic disorder. 

For accurate diagnosis and early intervention, provide your doctor with as much detail as possible about the onset and characteristics of the repetitive behavior.


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The Effect of Autism Tics on Adults and Children

People often describe a specific sensation before experiencing a tic. A study from ScienceDirect explored sensory phenomena reported by adolescents and adults with Tourette syndrome or Chronic tic disorder.

Common sensations before a tic include energy needing to escape, an inner sense of wound up, and overall tenseness. Participants noted that these sensations usually subside after completing a tic.

I remember suppressing a dry cough as a child in church. The urge to cough was intense, but the thought of letting it out in the silent, holy space was both horrifying and euphoric.

It’s challenging for a young child to cope with urges relieved through behaviors that may be frowned upon, especially in a school setting where differences can lead to teasing.

Studies show that children with Tourette syndrome face more bullying, victimization, and school challenges, including repeating grades.

While Tourette syndrome is the most severe tic condition, many childhood tics are temporary and often resolve without intervention in less than three months. Promisingly, behavioral interventions offer therapeutic potential for chronic tic conditions.

Tic Suppression

A 2019 study examined tic suppression in children with recent onset tics. The study was undertaken to determine whether the capacity to suppress a tic predicted the severity of tics in the future.

The study found that children who had tics for only a few months could suppress tics. Suppression was especially successful when children received an immediate reward. The study may be valuable regarding inhibitory control over tics in the early onset period.

Positive Outcome

Many studies highlight the importance of early intervention in conditions like Tourette syndrome, which may be comorbid in autistic children. A 2020 study conducted by Marquette University detailed the success of the Comprehensive Behavioral Intervention for Tic Disorders (CBIT) when it was adapted for use in young children.

Treatment and intervention may prevent the chronic course of tic symptoms, so parents should never downplay the role of interfering and repetitive behaviors as just another symptom of autism.

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FAQs

Q: Can autistic people have tics?

A: Yes, some people on the autism spectrum may have tics. Around 9-12% of autistic individuals may experience tics, according to a 2016 study.

Q: Are autistic tics the same as Tourette’s syndrome tics?

A: No, they are not the same. Although both involve repetitive behaviors, Tourette’s syndrome is a separate neurological condition characterized by motor and vocal tics.

Q: Can autistic tics improve over time?

A: Yes, with appropriate interventions and support, many individuals with autism can experience a decrease in the severity of their tics.

Q: When do autism tics start?

A:  Autism tics in children often appear during early childhood, typically between the ages of 5 and 10.

References:

The Premonitory Urge to Tic: Measurement, Characteristics, and Correlates in Older Adolescents and Adults, Behavior Therapy, 2014
https://www.sciencedirect.com/science/article/abs/pii/S0005789413000877?via%3Dihub

Premonitory urges located in the tongue for tic disorder: Two case reports and review of literature, 2019
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6656667/

Bullying Victimization and Perpetration Among US Children with and Without Tourette Syndrome. Journal of Developmental & Behavioral Pediatrics, January 2022
https://journals.lww.com/jrnldbp/abstract/2022/01000/bullying_victimization_and_perpetration_among_us.4.aspx

Impact of Tourette Syndrome on School Measures in a Nationally Representative Sample, 2018
https://pubmed.ncbi.nlm.nih.gov/29432328/

Phenomenology and Tic Awareness in Adults With Autism. Mov Disord Clin Pract. 2015
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178731/

Stereotypy in Autism: The Importance of Function
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598746/

Developmental Profile and Diagnoses in Children Presenting with Motor Stereotypies, 2019
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5120120/

Development and Open Trial of a Psychosocial Intervention for Young Children with Chronic Tics, 2020
https://epublications.marquette.edu/cgi/viewcontent.cgi?article=1518&context=psych_fac

Correlates and clinical implications of tic suppressibility, 2022
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8224814/

Tic suppression in children with recent-onset tics predicts one-year tic outcome, 2019
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733613/

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