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Could tics be connected to COVID?

Answered by Jerry Bubrick, PhD

Q My seven-year-old started displaying mild tics around age six. I read that ignoring them may help in cases where it's transient. It took time, but each of these tics mostly went away. Recently she tested positive for COVID, thankfully with mild symptoms. But now she's developed new, much more concerning tics. I can only imagine during school she is probably doing them very often. I feel the recent infection with the virus may well have triggered this, but obviously don’t know for sure. How concerned I should be? Are doctor visits warranted at this point? Is this likely to be with her forever?

There are reports coming out showing a correlation between having COVID and then afterwards developing tics, but it’s far too early in the data collection to be able to say what exactly is going on. More research needs to be done to understand if these tics are somehow related to the COVID infection or related to stress and anxiety that’s present before and after COVID, and so on.

It’s also true that your daughter is around the age that tics start developing, and even before COVID she showed signs that she was in the process of developing some sort of tic disorder.

So it’s hard to know if these new tics would have developed independent of the infection — your daughter may have been on that trajectory already.

The good news is that the cause doesn’t really matter, because there are very effective treatments for tics regardless, both from using medicine and from using therapy. You ask if doctor visits are warranted at this point, and I think they are. Even if these tics, like the previous ones, fade on their own, it’s never a bad thing to have skills to speed that process along and make the tics less impactful as well.

There is an evidence-based therapy for tics that is called CBIT, or the cognitive behavioral intervention for tics. CBIT helps kids learn more about their tics, including noticing patterns of when the tics might be more likely to happen and what they feel like. In particular kids learn to identify what we call the “premonitory urge” that they feel just before the tic occurs — like the feeling you get in your nose right before a sneeze. After they’ve noticed one of those urges, CBIT teaches kids how to replace the tic with a much less disruptive behavior until the urge passes. It also teaches skills for calming the body down, with the theory that a calm body is much less likely to tic than a tense body.

While it’s understandable to assume that your daughter has a lot of tics at school because she is having them at home, that might not be the case. Many kids are aware of the potential social repercussions that can come from tics, and they are actually pretty good at stopping them from coming out at school. This may actually result in more tics coming out at home afterwards. If you’re concerned, you might ask her teacher if they’ve noticed any changes. But be careful with how tics are discussed around your daughter because tics are very suggestible and drawing attention to them outside of a clinical setting can make them more likely to happen again.

Many kids do outgrow their tics by the time they become young adults. If your daughter learns strategies to effectively treat her tics, they’re less likely to get worse over time.