Vocal Tics

Vocal tics are sudden verbal sounds or words not in a person's control. These tics range from subtle sounds to shouting or yelling repeated words or phrases. Vocal tics are not harmful but can be embarrassing for some people. Symptoms can occur without a known cause, as part of an underlying health condition, or as a side effect of medication.

This article discusses symptoms of vocal tics, potential causes, and treatments.

Symptoms of Vocal Tics

Tics commonly show up during childhood. Vocal tics range from subtle to more severe, and symptoms can include:

• Barking (or other animal noises)
• Clearing the throat
  
• Coughing
  
• Grunting
• Hissing
• Humming
  
• Repeating phrases or words
  
• Sniffing
• Use of profanity
• Yelling or calling out

Symptoms often get worse with:

• Caffeine
• Excitement
• Heat
• Lack of sleep
• Stress

Causes of Vocal Tics

The cause of vocal tics isn't always known. Vocal tics can be part of an underlying health condition or a side effect of certain medications.

Tic Disorders

Tic disorders are conditions with specific criteria for diagnosis, found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). For all types of tic disorders, symptoms begin before age 18.

These include:

• Persistent (chronic) motor or vocal tic disorder: A person with this condition has vocal or motor tics, but not both. Symptoms are present for at least one year.
• Provisional tic disorder: People with this disorder have both motor and vocal tics, and symptoms have been present for less than one year.
• Tourette's syndrome: Criteria for diagnosing this condition include two or more motor tics and one or more vocal tics. Symptoms are present for at least one year.

Other Health Conditions

Vocal tics can occur with other health conditions, such as:

• Attention deficit hyperactivity disorder (ADHD)
  
• Autism
• Obsessive-compulsive disorder (OCD)
  
• Schizophrenia
• Traumatic brain injury

What Medications Can Cause Vocal Tics?

Tics can be a side effect of certain medications. These tics typically cause jerky movements of the body or face rather than vocalizations. This condition—called tardive dyskinesia—often occurs with antipsychotic medications.

Tics can also develop from the use of medications such as:

• Anticholinergics (chronic obstructive pulmonary disease, bladder control)
• Anticonvulsants (seizures)
• Antidepressants (depression)
• Antiemetics (nausea, acid reflux)
  
• Antihistamines (allergies)
  
• Antimalarials (malaria)
• Anxiolytics (anxiety)
• Antiparkinsonian agents (Parkinson's disease)
  
• Decongestants (cold and flu)
• Mood stabilizers
• Stimulants such as caffeine, amphetamines, nicotine
  

How to Treat Vocal Tics

Vocal tics that are mild or infrequent may not require treatment. Tics that develop in childhood can resolve without treatment as a person becomes an adult. If medication is causing tics, switching to another drug can help.

Tics can negatively impact a person's social life. Medications and therapy can help decrease the frequency and intensity of tics.

Medications

Medications can be used to help treat tics. These include:

• Abilify (aripiprazole)
• Haldol (haloperidol)
• Orap (pimozide)

Some providers may prescribe "off-label" medications, meaning they are approved to treat something other than tics but appear to help with tics. For example, Tenex (guanfacine) and Catapres-TTS-2 (clonidine) are drugs to treat blood pressure issues and are also used to treat tics.

Comprehensive Behavioral Intervention for Tics (CBIT)

Comprehensive behavioral intervention for tics (CBIT) is a therapy used to support people with tics. The goals of this treatment are:

• Education in stress management and coping strategies
• Increased awareness of tics and urges to tic
• Recognition of triggers for tics and ways to change them
• Substitution of a new behavior to replace tics

Are There Tests to Diagnose the Cause of Vocal Tics?

A healthcare provider or mental health professional can diagnose a tic disorder with a medical history and physical examination. They will apply the criteria from the DSM-5 to categorize the underlying disorder.

When to See a Healthcare Provider

Vocal tics are not harmful but can significantly impact your social life. Talk to a healthcare provider about treatment options if your tics negatively affect your life. Consider talking to a therapist to learn coping strategies and tools to reduce the tics.

Summary

Vocal tics are involuntary sounds or words. They can occur without a known cause, be part of an underlying health condition, or be a side effect of certain medications. Treatment for tics is not always necessary, but the symptoms can be embarrassing and prompt treatment. Medications and CBIT therapy can help reduce the frequency and intensity of tics.