The Management of Functional Tic Like Behaviours: Psychoeducation Resources for Carers and Schools

Background: There has been an increase in the occurrence of sudden onset functional tic-like behaviours (FTLBs) in adolescents during the COVID-19 pandemic, which has had a significant impact on the affected individual's quality of life and access to education. Support for the management of FTLBs following diagnosis is limited and, when it is available, waiting lists to receive such support are long. Objective(s): Our aim was to devise and evaluate psychoeducation materials to guide carers and schools in how best to support young people with the day-to-day management of FTLBs. Method(s): A 3-h clinician-led webinar for carers and an advice sheet for schools were developed. The webinar was attended by 20 carers and the advice sheet was sent to a selection of schools of young people attending our service. Carers attending the webinar completed a pre-and post-evaluation measure and feedback was gained on the advice sheet via consultation with schools and young people. Result(s): Results from the completed evaluation measures indicated an improvement in carers' understanding of FTLBs and their management and increased confidence in supporting their child with the movements both at home and school. Initial consultation with schools and young people regarding the advice sheet for schools suggests the resource increased their understanding of FTLBS and gave useful management strategies. Conclusion(s): Psychoeducation resources can serve as an important component of a wider support package for young people with FTLBs. We highlight the need for further evaluation of the effectiveness of such resources, in particular, any direct impact on FTLBs.

Feasibility of a Novel Virtual Tic Tool Kit Therapy Group

Behavioural therapy is the main form of symptomology management for tics, such as Exposure Response Prevention (ERP) and Habit Reversal Therapy (HRT), and is typically administered in person. Due to challenges presented by COVID-19, this was no longer possible, raising questions surrounding the effectiveness of alternative delivery methods. The current study assesses the efficacy of virtually delivered tic therapy in a group setting. Delivered by the Tics and Neurodevelopmental Movements Service (TANDeM) at the Evelina London Children's Hospital, combined ERP and HRT delivered virtually with externalised attention strategies is a pioneering combination and has not yet been explored. Method(s): Sixteen TANDeM patients attended a six-session virtual tic therapy group, each lasting 1 h. The Yale Global Tic Severity Scale (YGTSS) was completed for all patients prior to and following the group, and qualitative feedback was also gathered post-hoc regarding satisfaction and acceptability of the management techniques. Results and Conclusion(s): Patients' post-group YGTSS scores showed a statistically significant improvement compared to pre group scores, and all patients reported better management of tics after having attended the virtual group. 91.6% of attendees returned positive feedback for the virtual aspect, such as it being 'more accessible', and availability of 1:1 practice with clinicians. Twelve of 16 attendees reported learning combined ERP and HRT to manage their tics was the main attraction of the group. The cost-effective virtual group produced a significant improvement in patient outcome, suggesting it is an effective way of delivering tic therapy. The significant difference between pre-and post-group YGTSS scores provides a preliminary basis for delivering combined ERP and HRT alongside externalised attention strategies.

Differentiating Functional Tic-Like Movements from Tourette-Related Tics

Functional tic-like movements or functional tic-like behaviours are functional symptoms that look like tics. There has been a sudden rise in these movements coinciding with the COVID-19 pandemic, prior to which functional tic-like movements were considered very uncommon. As a tertiary specialist Tourette clinic, we have seen our referrals multiply. The referring clinicians often diagnose these young people with Tourette syndrome. We want to describe the differentiating features between Tourette-related (typical) tics and functional tic-like movements based on our experience in London, with the help of data we have collected in a large number of adolescents and through the help of videos (both of typical tics and those of functional tic-like movements). We will also discuss some of the underlying factors that explain the rise of functional tic-like movements in young people. The main differentiating features of functional tics in our clinic (similar to other international specialist tic centres whom we collaborate with) are: (1) The comparatively late age of onset of functional movements (in adolescence) instead of (age 4-7 years) in Tourette-related/typical tics. (2) Change in prevalence by sex (F > M);majority cases are females in our clinic, in contrast the sex ratio in typical tics/Tourette is M > F (4:1). (3) A very abrupt onset over one to a few days in most cases. (4) Presence of complex motor and vocal behaviours, in fact complex tics being more common than typical tics (which is not the case in typical Tics). (5) Prominent involvement of the upper limbs (as opposed to movements starting in the eyes or face or minor sniffing or throat clearing). (6) A significant variability in movements and other symptoms depending upon the environment. We will discuss phenomenology of movements and why it may be better to describe these presentations as functional tic-like movements or behaviours rather than as functional-tics.