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COVID-19 related increase in childhood tics and tic-like attacks
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  • Published on: 15 March 2021
    CAMHS seeing an increase in girls presenting with Tics
    • Uttom Chowdhury, Consultant in Child and Adolescent Psychiatry Dunstable Child and Adolescent Mental Health Service, Bedfordshire
    • Other Contributors:
      • Selin Aktan, ST4 CAMHS Bedfordshire

    We welcome this article by Heyman et al (2021) in last weeks Archives of Diseases in Childhood in particular the explanation of 'functional tic-like attack disorder'. In our community CAMHS in Bedfordshire, we too have noticed an increase in referrals or enquiries asking about medication and management of tics in young girls. In some cases the tics have started since lockdown in girls who are already being seen by CAMHS for other mental health issues such as anxiety or Autistic Spectrum Disorder. Although most of our patients report an increase in motor tics, we have also been made aware of vocal tics increasing. Normally the tics include noises such as clearing of the thorat or high pitched noises.
    In February this year we also cofacilitated a local support group for parents with children with Tourettes Syndrome (Beds, Herts and Bucks Parent Tourette Syndrome Group) with a view to understanding how they were coping in the pandemic. We were surprised to see that so many of the attendess had daughters with Tics and Tourettes and almost all said their daughters struggled with increase in anxiety and worsening of tics. It was interesting to hear that a number of boys with Tourettes coped better as there was lack of pressure from going to school and they were allowed more time with online gaming, although those with associated ADHD understandably struggled being confined to their homes. We would agree that the tics serve some sort of function in that it is an...

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    Conflict of Interest:
    None declared.
  • Published on: 8 March 2021
    Don't forget chorea

    Any new, sudden onset of tics or "tic-like" attacks should prompt consideration of Sydenham's chorea. The typical age range for Sydenham's chorea is 5-15yrs, with females more commonly affected, especially in adolescence, which fits with the group described [https://doi.org/10.1016/j.pediatrneurol.2009.11.015].

    Neuropsychiatric signs, such as emotional lability, obsessive-compulsive signs, anxiety, and attention deficit often precede the chorea but may mistakenly lead to a presumption of a functional disorder. It can be difficult for non-specialists to distinguish different kinds of involuntary movements, and this may explain why delayed diagnosis is common in Sydenham's chorea [http://www.dx.doi.org/10.1136/archdischild-2015-308693].

    The importance of establishing Sydenham's chorea as a cause is of course so that appropriate treatment can be given, including antibiotics and medication to control the chorea, but also to diagnose and treat co-existing rheumatic heart disease.

    Conflict of Interest:
    Chair of Sydenham's Chorea Association
  • Published on: 8 March 2021
    Excessive sensory stimulation causing dysregulation resulting in tic like disorder

    Have the authors consider the increased duration and nature of screen time as a trigger for these tic like disorders.
    This would have implications for both prevention and treatment.
    Is it correct that 'stress' as a trigger is one hypothesis only of functional symptoms that are not medically understood? Was there a comparison made for anxiety and stress is a matched group who did not developed these symptoms?
    It is likely that the increase in social media posts and searches for tic disorders and Tourette's reflects their increased incidence rather than is causative. While is possible that the 'validation' does prolong or maintain the episodes it may be preferable to isolation and exclusion.

    Conflict of Interest:
    parent of affected child- I am unsure if this counts as a competing interest- if that is the case-please do not publish this but can forward to authors if possible.
  • Published on: 7 March 2021
    Covid-19 and tics
    • Brian M Fabri, Retired cardiac surgeon Liverpool Heart and Chest Hospital

    I read with interest the article ‘Covid-19 related increase in childhood tics and tic-like attacks’ by Heyman et al. It would seem the me that the premise that such a high increase in the prevalence of tics and Tourette’s in adolescent females is related to pandemic related stress is somewhat too simplistic. Their conclusion would seem very plausible in those with a predisposition or vulnerability to motor and phonic tics but including all these new cases under the umbrella of just ‘anxiety’ appears dismissive of other potential aetiological factors. The temporal relation to the Covid pandemic cannot simply be attributed to the psychological effects of pandemic related stress. Have any of these kids been tested for Covid antibodies to confirm or exclude that they have not been infected, possibly asymptomatically. Perhaps even more importantly have they been investigated for the presence of anti- neuronal antibodies which would be indicative of a possible autoimmune link that might explain this sudden surge in tics/Tourette’s. This PANS type possibility needs to be fully evaluated before attributing this increase in new onset of severe tics and tic-like attacks as a functional manifestation of the Covid-19 pandemic.

    Conflict of Interest:
    None declared.