Transient Tic Disorders: Signs, Symptoms, & Treatment

What Is Transient Tic Disorder?

Transient tic disorder, now referred to as provisional tic disorder (PTD), is a condition where a person experiences either single or multiple types of tics that last for no more than a year.¹ It usually develops in young childhood (under age 6) and may worsen prior to adolescence. Boys are more likely to experience PTD than girls.²

As transient tics may come and go considerably throughout a child’s development, it can be challenging to understand how common PTD is; some estimates suggest that either motor or vocal tics may occur in approximately 3 in 1000 school-aged children and may decrease in prevalence as children age.^1,2

Transient (Provisional) Tic Disorder vs. Tourette Disorder

While transient (provisional) tic disorder is diagnosed for unanticipated motor movements or vocalizations lasting less than a year, individuals with a Tourette disorder (TD) diagnosis are typically impacted for longer. TD requires that both multiple motor and one or more vocal tics have occurred and that the symptoms persist for longer than a year. More simply, TD is thought to be a more chronic disorder, with more individuals likely to seek treatment.

Tic disorders are best thought of as existing on a continuum, with transient or provisional tics occurring at one end of the spectrum and Tourette Disorder occurring on the other end. Some research has suggested that children with provisional tic disorder have been found to have a later age of onset than children with TD.³ Other differences between diagnoses have been suggested, including that children with PTD may have both lower rates of vocal tics and a lower severity of motor tics than individuals with chronic tic disorders.²

What Causes Transient (Provisional) Tic Disorder?

Research on family studies of individuals with tic disorders finds that they are often common in families, suggesting that PTD can have genetic causes.² Twin studies are commonly used to understand better whether certain diagnoses have genetic underpinnings, and such studies suggest that there is a strong genetic predisposition for tics among first-degree relatives.⁴

Additional research into the origins of tic disorders suggests that environmental exposures in utero may direct the severity of tics as well as how resistant they are to treatment.⁴ Specific risk factors identified include maternal smoking or drug use during pregnancy, older paternal age, low birth weight, and obstetrical complications.^1,5 It should be noted, however, that more research is needed prior to making any definitive claims regarding the causes of tics.

Symptoms of Transient (Provisional) Tic Disorder

Transient (provisional) tic disorder involves either single or multiple occurrences of tics and can involve either motor or vocal tics (or both). As the disorders are defined, differentiating PTD from TD by simply observing tic expression is not possible – the key to knowing the difference depends on their course and history.

Common examples of transient (provisional) motor tics include:

• Eye blinking
• Shoulder shrugging
• Head jerking
• Nose or lip twitching
• Facial grimacing

Common examples of transient (provisional) vocal tics include:

• Sniffing
• Throat clearing
• Grunting
• Humming
• Barking

How Is Transient (Provisional) Tic Disorder Diagnosed?

Transient (provisional) tic disorder is most likely to be diagnosed by primary care providers (e.g., pediatricians) or mental healthcare specialists. Professionals who may be unfamiliar with the diagnosis of tic disorders may overlook these symptoms or attribute them to other types of problems, like vision or speech impairments. Thus, it is important to seek a diagnosis from a provider with specialized expertise.

When diagnosing a tic disorder, a doctor or healthcare professional will likely ask you or your child a series of questions about the onset, frequency, severity, and level of impairment of tic symptoms. They may also use a standardized measure to capture this information, such as the Yale Global Tic Severity Scale (YGTSS).⁶

Criteria for a transient (provisional) tic disorder diagnosis includes:¹

• Single or multiple motor and/or vocal tics
• Tics have been present for less than 1 year since first tic onset
• Onset is before 18 years
• Tics are not attributable to the physiological effects of a substance or another medical condition
• Criteria have never been met for Tourette’s disorder or persistent motor or vocal tic disorder

Treatment for Transient (Provisional) Tic Disorder

Because transient (provisional) tic disorder is time-limited, it is not commonly addressed as a target for intervention. Doctors should only pursue treatment if symptoms are severe and/or significant enough to cause distress to the child or impact their social development. However, for most individuals with PTD, ongoing monitoring is most indicated to determine whether they may ultimately meet the criteria for a different, more chronic diagnosis.

Treatment options for PTD include:

Behavioral Therapy for Transient (Provisional) Tic Disorder

Behavioral treatments such as the comprehensive behavioral intervention for tics (CBIT) are considered a first-line treatment for tic disorders.⁷ It involves several components, including 1) teaching individuals to become more aware of both their tics and their urges to tic, 2) teaching individuals to engage in competing behaviors when they feel the urge to tic, and 3) making changes to the environment that may be helpful in reducing the frequency of tics.

Large clinical trials have established that more than 50% of the individuals who receive CBIT training have meaningful reductions in tic severity.⁷ CBIT, in many ways, incorporates components of habit reversal therapy, which involves operant conditioning and mass trial practice to create new patterns of behavior.

Medication for Transient (Provisional) Tic Disorder

Though medications often have side effects, there have been studies that show medications can be useful in reducing the severity of tics.⁸ Typically, there are several classes of drugs that are efficacious in suppressing tics, although there have been substantial placebo responses in studies that have evaluated their effectiveness.

Medications used to treat PTD include:

• Alpha-2-agonists: Alpha-2-agonists, such as Clonidine and Guanfacine, have been shown to have moderate efficacy for tics and are frequently prescribed first.
• Dopamine-blocking agents: Dopamine-blocking agents, also referred to as antipsychotic medications, such as haloperidol, pimozide, and fluphenazine, have also been demonstrated as being efficacious in clinical trials. However, these have frequent and unfavorable side effects.
• Atypical antipsychotics: Atypical antipsychotics such as risperidone or aripiprazole can be prescribed, though their side effect profile can also be problematic.
• Benzodiazepines: Benzodiazepines, like Clonazepam, have been used with some success at tic suppression and have been noted to be particularly useful for individuals who have co-occurring anxiety disorders.

Prognosis for Transient (Provisional) Tic Disorder

As transient (provisional) tic disorder is by definition time-limited, the prognosis for those individuals meeting the criteria for PTD but do not eventually receive a diagnosis for a more chronic tic disorder is quite good. If the tics go on to become more chronic, data suggest that some individuals may continue to experience them into adulthood (though the frequency and severity may be somewhat diminished).¹ A small percentage of adults continue to experience severe or worsening symptoms throughout their lives.

When to Seek Professional Support

Individuals may elect to seek professional help for tics, regardless of the frequency and severity of the symptoms. Often, support-seeking occurs when there are social consequences to engaging in tic behavior, such as bullying in schools. If important settings or events are being avoided due to concern about ticcing in public, it may be time to consult with a professional.

As with any type of treatment, individuals should talk to their providers to weigh the relative risks and benefits of intervention against the expected outcomes. An online therapist directory can provide a list of providers with expertise in this area.