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My daughter has facial and hand tics, but not Tourette's. What causes this?

Writer: Ron J. Steingard, MD

Clinical Expert: Ron J. Steingard, MD

Q My daughter, who is almost 12, has suffered on and off since she was 7 from different types of facial and hand movement tics. They go away for a while and seem to return when she is stressed. They become more severe when she is tired. She does not have Tourette's Syndrome or any trace of strep virus. What is this caused by?

It’s possible that your child may have what we call “motor tics” without having Tourette’s Syndrome. Tourette’s is diagnosed only when you have chronic occurrence of both motor and vocal tics. But there are transient (lasting less than a year) and chronic forms of motor tic disorders that occur without vocal tics. The most common age of onset for the development of motor tics is from 6 to 7, although, in some individuals, they can begin earlier or later. Tics typically wax and wane, as you describe your daughter’s doing, and they tend to get worse when a child is stressed or fatigued. Usually they are markedly reduced when the child is sleeping. While some forms of tics are thought to be related to strep infections, in most cases, we don’t know what causes these tics. We usually treat them only if they become impairing, interfering in her life or limiting her activities.

This article was last reviewed or updated on January 28, 2023.