Case report: Advice for schools on managing functional tic-like behaviours

Abstract

There has been an increase in the occurrence of sudden onset functional tic-like behaviours in adolescents during the COVID-19 pandemic, which has had a significant impact on the affected individual’s ability to engage with education. The aim of this article is to generate discussion and inform practice within schools with regard to the management of functional tic-like behaviours. An advice sheet for schools has been produced based on clinical expertise and experience of consulting with schools around the management within education settings. Case examples are presented highlighting the importance and impact of these strategies. We also highlight the need for further evaluation of the effectiveness of the advice sheet in collaboration with schools and families.

Functional Tic-like Behaviors: From the COVID-19 Pandemic to the Post-Pandemic Era

“…The reports were published between 2021 and 2023. Three case series were from the United Kingdom [ 24 , 25 , 26 ], two from the United States [ 22 , 23 ], and one each from Denmark [ 29 ], Germany [ 27 ], and Hungary [ 28 ]; the largest series came from an international registry that collated data from ten specialist centers across North America, Australia, and Europe [ 30 ]. All the reported cases were seen at specialist clinics for patients with tic disorders, except for one small cluster of high school students experiencing functional tic-like behaviors [ 23 ].…”

“…The picture changed since the onset of the COVID-19 pandemic. Three early reports described five [ 28 ], six [ 22 ], and ten female patients [ 25 ] with acute-onset functional tic-like behaviors, respectively. Despite the low number of patients involved, these initial case series alerted the scientific community about a new clinical phenomenon detected in both North America and Europe, concomitant with the ongoing pandemic.…”

“…Despite the low number of patients involved, these initial case series alerted the scientific community about a new clinical phenomenon detected in both North America and Europe, concomitant with the ongoing pandemic. Of note, two of these small series (average age: 14 years) flagged a possible association with social media consumption [ 22 , 28 ], whereas the third one focused on younger patients (12 years old) and included practical advice for the management of functional tic-like behaviors in an educational setting [ 25 ]. Exposure to tic-like behavior on social media before symptom onset was reported by 27 out of 28 adolescents (all females but one) from a Danish specialist clinic [ 29 ].…”

“…Moreover, tic-related obsessive-compulsive symptoms of different degrees of severity can be reported by the majority of patients with neurodevelopmental tics but are rarely seen in association with functional tic-like behaviors [ 52 ]. Patients with Tourette syndrome are often diagnosed with co-morbid anxiety and affective disorders [ 53 , 54 ]; however, these symptoms seem to present with a higher prevalence in patients with functional tic-like behaviors [ 23 , 24 , 25 , 26 , 39 ].…”

“…These clinical features differ substantially from the phenomenology and patterns that are typical of neurodevelopmental tics [ 1 , 2 , 3 , 4 , 5 , 18 ]. The clinical phenotypes of patients with onset of functional tic-like behaviors during the pandemic have been documented in reports from the United States [ 22 , 23 ], the United Kingdom [ 24 , 25 , 26 ], and multiple European countries [ 27 , 28 , 29 ], as well as a multi-national registry collating data from ten specialist centers across North America, Australia, and Europe [ 30 ]. Moreover, phenotypical differences between patients with functional tic-like behaviors and patients with neurodevelopmental tics have been explored in multiple controlled studies from the same three continents [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ].…”