Tics in Autism: Why They Happen & What to Do About Them

Children with autism commonly experience tics, which can be confusing for parents who may be unsure what to do about them. In autism, tics may appear as sudden movements or sounds like blinking, throat-clearing, or shoulder shrugs, often linked to stress, anxiety, or sensory needs.

This article will help bring some clarity and information by delving into the nature of tics in autism, explaining what they are, how they are presented, and what support strategies parents can use for their children.

We will also discuss the most common types of tics, causes, and management strategies. By the end of the article, parents will know how to differentiate tics from stimming, when to consult a professional, and how to establish a good support system for their child.

What Are Tics in Autism?

Tics are brief, fast, frequent, nonperiodic, nonrhythmic motor movements or vocalizations. They can manifest as either motor tics, which are physical movements, or vocal tics, which are sounds or words. Motor tics include eye blinking, nose twitching, or shoulder shrugging, and vocal tics include sounds such as throat clearing or sniffing.

It is crucial to note that tics are distinct from other repetitive behaviors that are commonly seen in autism, such as stimming. While tics and stimming consist of repetitive movements, tics are involuntary and are characterised by an urge that precedes their performance, but stimming is a purposeful, voluntary self-soothing or self-regulating behavior.

The Connection Between Tics and Autism

Research shows that tics are more prevalent among individuals with autism compared to the general population. Studies have quoted between 9-12% prevalence of tics in the autism population. 

• Autistic individuals may also meet the diagnostic criteria for tic disorders, which include: Provisional Tic Disorder (tics lasting less than a year)
   
• Chronic Motor or Vocal Tic Disorder (tics lasting more than a year) 
  
  
• Tourette Syndrome (both motor and vocal tics for over a year). 

The presence of tics in your child does not necessarily mean they have a tic disorder, but it does suggest that their tics need help and support. Tics are thought to result from differences in brain regions that control movement and sensory processing, especially the basal ganglia, thalamus, and frontal cortex. The brain areas that are involved in autism can help explain the common co-occurrence of the two conditions.

Common Types of Tics in Autistic Children

There are a few different types of tics, which can be broken down into motor and vocal tics. Simple motor tics include small, brief movements that are limited to one muscle group. Some examples of simple motor tics include eye blinking, nose twitching, facial grimacing, head shaking, and shoulder shrugging. These movements are short and occur multiple times daily and may be more noticeable when the child feels tired or anxious. 

Complex motor tics are more elaborate, may appear meaningful and coordinated, and involve more than one muscle group or a sequence of movements. The list of examples of complex motor tics includes jumping, repeatedly touching objects, smelling hands or the environment, and performing repeated gestures or poses. These tics can be more obvious and sometimes interfere with daily activities. 

Simple vocal tics are brief sounds that do not make up words, such as throat clearing, sniffing, coughing, humming, or other repetitive noises. Like simple motor tics, these vocalizations can increase during times of excitement or stress and often occur spontaneously. 

Complex vocal tics involve more elaborate sounds or speech, such as repeating words or sounds, imitating others’ speech (known as echolalia), and making unusual noises such as animal sounds or exaggerated tones. These vocalisations can sometimes cause social stigma, but are an important aspect of understanding the child’s unique way of expressing themselves. 

Why Do Tics Happen?

The development of tics is associated with neurobiological factors that increase the activity of specific motor circuits. Although a child may be aware of a tic urge, the actual tic act is outside of their conscious control. The more someone tries to prevent a tic from occurring, the more stress they experience, and the stronger their tics will be when they allow themselves to engage in the behavior. 

During periods of heightened internal states, including anxiety, excitement, fatigue, or sensory overload, children tend to experience more noticeable or frequent tics. Autistic children may experience increased tics from the intense sensory stimulation that loud noises, bright lights, and crowded spaces produce. The combination of physical exhaustion with emotional anxiety and fatigue can increase the intensity and frequency of tics. 

Research indicates that tics serve as automatic defense behaviors that help children cope with their internal stress levels. Children develop tic behaviors to enable them to manage uncomfortable physical sensations or pressure, although they often lack awareness about this connection.

Once caregivers understand this link, they should establish calming environments to ease stress while helping their children self-regulate.

Recognizing the Difference: Tics vs. Stimming

Both tics and stimming produce repetitive movements or sounds that occur because of factors such as sensory overload, stress, or excitement. The main difference between tics and stimming lies in their voluntary nature.

Specifically, while tics occur involuntarily, stimming happens purposefully for self-regulation and comfort. Tics mainly occur in people with Tourette syndrome, but stimming appears more frequently in individuals with autism spectrum disorder and attention deficit hyperactivity disorder. 

Another difference lies in the presence of a premonitory urge. This is an anticipatory feeling that typically precedes tics but does not occur before stimming. Tics often bring relief directly after completion, but stimming serves to regulate or maintain focus. 

Misinterpretation of tics as stimming or vice versa may lead to inappropriate responses. Tics typically are managed with behavior therapy and/or medication as needed, while stimming may involve sensory integration strategies. Discriminating between these behaviors allows for appropriate therapy and school support.

When to Be Concerned About Tics

Typically, tics that do not interfere with daily activities are usually harmless and do not require direct intervention. However, further investigation becomes necessary when tics become frequent and disruptive to the child’s life.

For example causes of concern could be if tics appear more than once per hour during the entire day, if they create disturbances that prevent a child from performing important activities such as speaking, reading, writing, eating or sleeping, or if they cause your child to feel both tired and frustrated while attempting to control these involuntary movements. 

You should consult a healthcare provider when any of the mentioned concerns receive a positive response. The evaluation of tics may not necessarily result in an intervention, as the investigation may conclude it is not necessary.

However, information is power, so ruling out the need for intervention will help your child and you feel confident in your course of action.    

The presence of specific warning signs indicates when professional evaluation is required. These include: 

• Your child is in pain or physical harm from tics that cause neck jerking or head hitting, or result in muscle soreness from forceful movements.
   
• Tics lead to social withdrawal and school or public embarrassment, and relationship problems with peers and bullying incidents.
   
• Your child expresses negative feelings about their tics because they perceive themselves as different or do not understand their situation.
   
• Severe or complex tics that emerge suddenly should be evaluated because they might be linked to neurological or psychological conditions. 

A healthcare professional will determine whether further assessment or therapy should be initiated. Unchecked, secondary symptoms can develop from the constant movements, such as muscle soreness, headaches, and fatigue, as physical complaints. Tics sometimes make it difficult for children to perform basic actions such as eating safely and walking properly. 

These situations warrant a closer look from a neurologist, who can evaluate the neurological basis of the tics, or a behavioral therapist, who can offer strategies to reduce the impact of tics through non-medication interventions like Comprehensive Behavioral Intervention for Tics (CBIT).

Supporting a Child with Tics

The first step requires establishing an environment that shields the child from feelings of shame. When children are asked to stop ticking or receive negative attention because of their tics, they can experience increased stress, which in turn can lead to worsened tic symptoms.

Instead of criticizing or drawing attention,  you could say to your child something like, “Your body has automatic tics, and that is normal for your body. You’re not doing anything wrong.” Children will gain increased self-assurance and show fewer symptoms of anxiety if they feel calmer and understood.

For a child, hearing somebody else describe the physical experiences in their body can also help with their own understanding and acceptance.  Your words should use language that matches your child’s understanding and age level.

Simple language for young children should state: “Your brain sends signals to produce body movements and sounds. You can’t control them, and that is okay”. Explanations for older children may include more specific terms to help deepen their understanding. 

Encourage your child to ask questions and express how they feel about their tics. Children who understand their experiences become more capable of managing their symptoms. Children’s tics tend to draw people’s attention whenever they appear in classrooms or public areas.

Your child needs self-advocacy skills to develop explanations for specific situations. You can help by developing basic phrases that your child can use in everyday situations, such as: “My body experiences something known as a tic. These are a part of my body’s normal functioning.”

If your child is shy, is not comfortable, or is too young to advocate, you should communicate their needs to teachers, caregivers, or their peers. People need to understand that tics function automatically without any need for correction or discussion.

Request adjustments in the classroom when needed by asking for noise-cancelling headphones, along with movement breaks and seating placement in less distracting areas. 

The strength and occurrence of tics tend to grow more severe because of stress, together with fatigue and high levels of stimulation. Creating a peaceful and structured home environment helps reduce the factors that trigger tics. Some practical strategies to help children manage their tics include:

•  Keeping daily routines consistent.
  
  
•  Offering sensory-friendly spaces or quiet time.
  
  
•  Encouraging physical activity and downtime.
  
  
•  Practicing deep breathing, stretching, mindfulness, and other self-regulatory techniques. 

Therapy and Management Options

CBIT has been proven effective through numerous research studies for tic management. In CBIT therapy, children receive improved tic awareness while learning competing responses as replacement behaviors to decrease their tics. The structured and empowering approach of CBIT gives children tools to handle their symptoms without punishment, so they can learn how to control their tic symptoms. Family members also reported feeling hopeful due to progress when working with trained CBIT therapists. 

Occupational therapy (OT) also shows benefits for children who experience tics involving large body movements and who struggle with coordination, muscle tone, and fine motor skills.

Occupational therapists teach children effective motor control techniques, which has a knock-on effect, helping them grow stronger in daily living, self-help help and fine motor skills. Occupational therapists identify the sources of sensory triggers and help develop self-regulation strategies for when these triggers arise. 

Medications can serve as an alternative solution only after other interventions fail to deliver sufficient relief and the tics are causing bodily or mental harm. A neurologist or psychiatrist will assess the child and discuss the potential medication options.

Before using any drug, children with their families need to assess both positive effects and adverse reactions with the assistance of their healthcare provider. Parents should ask questions regarding any concerns about changes in their child’s behavior after medication.

Finally, respecting neurodiversity is an essential requirement for developing an ethical and practical treatment plan. Neurological differences, such as tics, must be recognized as brain variation patterns that do not require treatment as fixable medical problems. The approach promotes self-acceptance alongside empowerment and focuses on individual strengths over challenges.

The child’s support system needs to adapt its methods to meet personal requirements and preferences so that the goals focus on improving life quality, self-esteem, and comfort rather than just reducing observable symptoms.

Frequently Asked Questions About Tics

Q. Will my child’s tics get worse over time?

A. Tics often wax and wane. Some children outgrow them during adolescence, while others manage them more effectively with support.

Q. Do tics mean my child also has Tourette’s Syndrome?

A. Not necessarily. Many children with tics do not meet the criteria for Tourette Syndrome.

Q. Should I point out or correct my child’s tics?

A. No. Correcting or drawing attention to tics can increase anxiety and make tics worse.

Q. Can stress management help reduce tics?

A. Yes. Calming routines, sensory breaks, and emotional regulation strategies often help reduce tic frequency.

My Perspective as a BCBA

As a BCBA, I have worked with autistic children with tics. The first step in the successful management of the tics was to distinguish them from stimming during the assessment process.

While stimming behaviors could be more easily redirected, tics were generally more pervasive. Once I had made this distinction, my treatment plans were focused on ensuring the child was given frequent access to different types of breaks to help physical and emotional regulation.

Collaborating with occupational therapists helped share and discuss successes we were having and coming up with the best interventions. 

The most important lesson I learned when working with children with tics is that drawing attention and putting effort into suppressing them usually has the opposite effect. Accepting that they are a part of your child and working on addressing the cause is much more effective. With this, I encourage parents to help their child feel accepted and focus on fostering a calm and inclusive environment.

Conclusion

Many autistic children experience tics as a normal occurrence in their lives. The occurrence of tics may be confusing or disruptive at times, but they should not be feared or shamed.

With appropriate knowledge, support, and guidance from professionals, your child will thrive. It’s important to remember that acceptance should be prioritized above correction, and comfort should be emphasized over conformity.

Advocating for your children with knowledge and compassion will help your child find their confidence to be themselves.

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