Quick Answer
Tics generally first appear in childhood between the ages of 5 and 7 years old. The exact lifespan of a tic is variable, as tics tend to wax and wane over time. However, research indicates that tics follow a natural course, beginning in childhood, peaking in severity during preadolescence, and improving for many individuals in late adolescence and early adulthood. While some children will outgrow their tics completely, about 30% of individuals continue experiencing tics into adulthood in some form.
What are tics?
Tics are sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations. The two main categories of tics are:
- Motor tics: these involve physical movements like blinking, shoulder shrugging, or grimacing.
- Vocal or phonic tics: these involve sounds like throat clearing, grunting, or repeating words or phrases.
Tics can range from simple to complex. Simple motor tics involve one group of muscles, while complex motor tics involve coordinated movements using multiple muscle groups. Simple vocal tics may include sniffing or throat clearing, while complex vocal tics include repeating words or phrases. The majority of tics start out simple and may evolve into more complex tics over time.
Tic disorders
When tics persist for more than a year and have a waxing/waning symptom course, it is diagnosed as a chronic tic disorder. Examples include:
- Provisional tic disorder: tics last less than one year
- Persistent (chronic) motor or vocal tic disorder: tics last more than one year
- Tourette’s syndrome: multiple motor tics and at least one vocal tic lasting more than one year
Tic disorders are more common in males than females. Tic disorders tend to first present in childhood with the average onset between 5-7 years old. Tics wax and wane in severity and frequency over time. Many individuals with chronic tic disorders experience a peak in severity during preadolescence, followed by an improvement in tics in late adolescence and early adulthood.
Lifespan and course of tics
The exact lifespan and longevity of tics is variable among individuals. However, research indicates that tics tend to follow a natural course:
- Childhood onset: Tics typically appear first between ages 5-7 years old.
- Waxing and waning course: Tics fluctuate in severity and frequency over weeks and months.
- Peak in preadolescence: The worst tic symptoms often occur between ages 10-12 years old.
- Improvement in adolescence: Many individuals experience a subsiding of tics in late adolescence.
- Remission in adulthood: By early adulthood, tic symptoms resolve fully for about 70% of individuals.
- Persistence of tics: About 30% of individuals continue to experience tics into adulthood in some form.
- Waxing and waning course continues: Among the 30% with persistent tics as adults, the waxing and waning symptom course continues.
Below is a graph summarizing the typical lifespan and timeline of tic disorders:
| Age | Tic Severity |
|---|---|
| 5-7 years | Tics first appear |
| 10-12 years | Peak tic severity |
| 13-18 years | Improvement in tics |
| Early 20s | Tics resolve fully for ~70% of individuals |
| Adulthood | Tics persist in ~30%, but improve from peak severity |
In summary, tics emerge in early childhood, reach maximal severity in preadolescence, improve in adolescence, and commonly remit by early adulthood. While tic disorders are chronic conditions, the symptom severity fluctuates over time.
Factors influencing lifespan of tics
Research has identified various factors that may influence the course and longevity of tics over an individual’s lifespan:
Gender
Tic disorders are more common among males, at a male to female ratio between 2:1 to 4:1. However, the natural improvement of tics in adolescence that occurs for many individuals happens similarly in both genders.
Type of tic disorder
The category of tic disorder may impact symptom duration.
- Provisional tic disorder involves shorter symptom duration (less than 1 year) by definition.
- Chronic motor and vocal tics may last many years.
- Tourette’s syndrome involves multiple tics types lasting more than 1 year.
Individuals with Tourette’s syndrome may be more likely to experience persistently severe tics for longer compared to other disorders.
Severity of tics
People with more severe tics may be less likely to experience spontaneous remission before adulthood compared to milder cases. However, tic severity often improves even if tics persist.
Age of onset
Earlier age of onset, especially before age 5, predicts longer tic duration through adolescence and into adulthood.
Presence of co-occurring conditions
Co-occurring conditions like ADHD and OCD are common with tic disorders. The presence of multiple co-occurring conditions may be associated with longer tic lifespan and impairment.
Psychosocial stress
Stress, fatigue, anxiety, and certain social situations can transiently worsen tics. Effective coping skills may help manage fluctuations.
Genetic factors
Genes likely play a role in tic disorders. Family history of tics or related disorders may be associated with tic persistence and severity.
Can tics go away and come back?
It is possible for tic symptoms to fully remit for a period of time and then return. Among the approximately 30% of individuals whose tics persist into adulthood, the waxing and waning, fluctuating symptom course continues throughout life. Periods of remission can last for weeks, months, or even years, followed by recurrence of tics.
Factors that may trigger the re-emergence of tics after a remission period include:
- Stress
- Fatigue
- Illness
- Anxiety
- Excitement
- Life changes
- Hormonal changes
Even if tics resolve for a long period, the underlying neurological susceptibility remains. Tics may recur because of various contributing factors. The cyclical course emphasizes the importance of managing stress and maintaining healthy coping strategies and routines.
Do tics ever completely go away forever?
For many individuals, tics do completely resolve forever at some point. Research suggests:
- About 70% of people experience full, lifelong remission of symptoms by adulthood.
- Tics resolve by early adulthood for the majority of teenage patients.
- Only around 30% of patients continue experiencing chronic tics into adulthood.
Complete tic remission is more likely if:
- Tics were milder in severity
- Tics first emerged after age 10 years old
- There are no co-occurring conditions like OCD or ADHD
However, there are individuals whose tics persist at some level across their entire lifespan. While waxing and waning over time, their tics never fully resolve.
It is difficult to predict at the onset who will experience lifelong tic persistence versus complete remission. The overall odds are in favor of tic resolution prior to adulthood. Monitoring symptom course over time can help better estimate prognosis.
Managing chronic tic disorders
For patients with chronic tic disorders lasting into adulthood, treatment focuses on managing symptoms. Recommended approaches include:
Medications
Medications that may help control tics include:
- Alpha-agonists like clonidine or guanfacine
- Antipsychotics like risperidone or aripiprazole
- Botulinum toxin injections for localized tics
Behavioral interventions
Behavioral techniques to reduce tic severity include:
- Cognitive behavioral therapy (CBT) with habit reversal training
- Exposure and response prevention (ERP)
- Relaxation strategies and biofeedback
- Stress management
Support and accommodations
Supportive measures to improve daily functioning and coping include:
- Psychoeducation about tic disorders
- Classroom accommodations
- Workplace accommodations
- Joining support groups
With a combination approach of medications, therapy, and support, the symptoms of chronic tic disorders can often be successfully managed.
Conclusion
In conclusion, the exact lifespan and duration of tics is variable between individuals. Onset is typically in childhood with a waxing and waning symptom course. Many individuals experience peak severity around 10-12 years old, followed by substantial improvement by late adolescence. Overall, about 70% of people achieve complete, lifelong tic remission prior to adulthood. For the approximately 30% of patients whose tics persist into adulthood, the disorder becomes chronic but tic severity often improves from the worst preadolescent peak. Factors like gender, tic severity, and genetics may influence the course and longevity. Although challenging, chronic tic disorders can often be managed with medications, behavioral interventions, and support strategies. More research is still needed to better understand predictors of tic remission versus persistence across the lifespan.
