TikTok & Tics: Rise in Movement Disorder Documented on Social Media
Physicians are sounding the alarm on yet another health concern that may be exacerbated by the pandemic. Within the past year doctors have noticed a dramatic increase in teens experiencing the sudden onset of tics, or involuntary and uncontrollable sounds and movement.
This current tic phenomenon is primarily impacting teen girls, many of whom have no previous history of tics. That’s not typical for most tic disorders, such as Tourette syndrome. Tourette’s is a neurological movement disorder that is more common among boys and typically starts between ages 5 and 7 years.
Zelime Elibol, M.D., a pediatric neurologist with a special interest in cognitive and neurobehavioral disorders and director of Cook Children’s Tourette Syndrome Clinic, says the majority of tics observed in this current surge are called functional tics. Functional neurologic symptoms are not associated with any known neurologic cause. There is no structural damage to the brain or a lesion causing them, like in the case of a stroke or multiple sclerosis. Something is wrong, but it’s difficult to identify a physical cause, and it’s not likely to respond to typical medical treatments for tics.
An article published in the British journal “Archives of Disease in Childhood” in March, shed light on the issue. It detailed both an increase in tic symptoms during the pandemic among adolescents already diagnosed with tic disorders, as well as a sharp rise in the sudden and new onset of tic-like attacks among teenage girls. Pandemic stress and social media may be to blame, according to the article’s authors.
The piece highlights a recurring factor at play with this new set of functional tic disorders—the viral TikTok trend of showing one’s tic attacks. Views of #tourettes videos doubled between January and February 2021, and some teen girls report an increased consumption of these videos prior to onset of symptoms. Some also said they post videos of their own tic attacks and gain a level of support and attention from them, according to the article.
We sat down with Dr. Elibol to learn more about functional tic disorders and what parents and caregivers need to know about the recent rise in cases.
How common are tics in general?
About 25% of children will develop tics during early childhood, known as developmental tic disorders. The most common are called transient tics. They get them for a period of time, but they’re gone within a year. A much smaller percentage, about 1%, go on to have what we call chronic tics that last more than a year, often many years. Aside from developmental tic disorders, there are medical and metabolic disorders that cause tics. There are also medications that may cause tics as a side effect.
What are you seeing in your own practice right now related to functional tics?
We see functional neurologic disorder symptoms at times, meaning we see neurologic symptoms that contradict known patterns of disease and are often thought to have a psychological underpinning. They’ve always been around, but there is a notable increase right now. Specifically, what I’m seeing in my practice is a significant increase in explosive tics in otherwise healthy adolescents with a normal neurologic exam. So far, all of my functional tic patients are adolescent girls with symptom onset well after 11 years old and, by this age, 95% of Tourette patients will have already developed tics.
This is outside of the norm for typical tic disorders, like Tourette syndrome, which more often occur in boys between ages 5 and 7, and wax and wane over time. Some of the children I see with Tourette’s do have severe tics, but that’s a little less common. The tics in the girls I’m seeing right now are all very severe. I would describe them as tic attacks, where they have these sudden attacks of various and complicated vocalizations, curse words, body movements, sometimes hitting themselves and hitting others. They often are not waxing and waning, but sustained and so severe that they can’t go to school. There is a typical course, evolution and appearance for most developmental tic disorders. This current wave of functional tics I’m seeing does not follow that typical course and does not improve with tic medication.
What do you think has caused this increase in tic attacks?
Kids with functional neurologic disorders will sometimes deny that they are experiencing any type of psychological stress, but over time, they often recognize that something was, in fact, going on. They’ll return and say they were actually super anxious or even suicidal, and it started coming out in this physical way. There is an evolving theory behind functional neurologic disorders that a predisposing factor is an impairment in emotional processing and difficulty identifying one’s own internal emotional states.
I think the pandemic is playing a significant role in the increase. I’ve never seen it to this degree or had this many functional patients present to my clinic. We’ve seen an increase in mental health struggles like anxiety and depression, and I think it’s triggered an increase in functional neurologic disorders.
Have your patients referenced pandemic stress and restrictions as a trigger for their tics?
My patients don’t necessarily say that they’re stressed because of the pandemic, but when I ask them when things got worse, almost all of them say it’s all been within the past year. Most of them look back and give a history of some anxiety or depression in the past with significant worsening within the last year, including the onset of tic attacks. A lot of them will say they don’t want to go to school for whatever reason or that school is stressful for them and, when they go back to school, they’ll have tic attacks and end up back at home.
Do the patients you see for tic attacks report watching more TikTok videos of someone with tics prior to the onset of their symptoms?
The TikTok factor is new to me. More recently, I’ve been asking my patients if they’ve seen it and they say yes. They’ll also show me videos they’ve recorded of themselves having tic attacks. They’re not necessarily posting their attack on TikTok, but a number of them do say they have seen the videos.
How do you counsel these patients and their parents? What course of treatment do you advise?
The most important thing I tell parents is that I don’t think their child is faking it or that they are crazy. There is something going on, we just have to get to the bottom of it. I have a very long discussion with them about functional neurologic disorders—how the brain is not functioning correctly but there is nothing structurally wrong with it, like a lesion. We talk about why I have diagnosed their child with functional tics versus another developmental tic disorder, like Tourette Syndrome, based on their medical history and the evolution of their symptoms. It’s worth noting that you can have both Tourette’s and functional tics, so that can be difficult to tease apart, but the majority of the increase I’m seeing right now are kids that have no past history of tics.
Then, we talk about what we can do to help their child. Tic medications do not help children with functional tics. We need to address their child’s anxiety and underlying mental health issues, whether it’s with depression and anxiety medication, or therapy, or a combination of both. I will refer them to a psychiatrist or counselor, if they don’t already have one. I have also recommended a type of cognitive behavioral therapy for tics, called CBIT (Cognitive Behavioral Intervention for Tics), where they learn how to identify the things that trigger their tics and coping strategies such as relaxation and breathing techniques to help lessen their severity or stop them all together.
We’ll often work with schools to put a plan in place where the student can take a break or go to another room if they need to. But, we emphasize with the patient that this is not going to allow them to get out of their school work. They can take a break, but they need to return to class and complete their work. This is not a reason to go home for the day. It’s important that we have empathy and understanding for these patients and help them work their way through it, but also not allow the tics to keep them out of school.
I would also recommend to children and families to stop watching tic videos on social media. I don’t have a study where I can prove that watching these videos incites tics in others, but if you’re anxious and depressed and not processing your emotions, it’s going to come out in some way. If you are watching a lot of other teens showing their tics on social media and talking about their tic attacks, it makes sense that you might be influenced to release your stress in that way, too. Step away from social media for a while and focus on developing coping strategies for your stress and for managing your tics.