mert

Your Neurologist is right, and even with OCD/ADHD , 'Tourette' does not mean anything. Diagnostic criteria for 'labelling' Tourette is not logical , TIC's, as you experience have several parameters (frequency, type, intensity, when they happen etc..) and just because someone has couple of motor and vocal TIC's for a period of time does not make them go into a subgroup called 'Tourette' , it's way way more complex then this. Also if you are diagnosed with Tourette , this does not provide you with different treatment options. If you completely wipe the 'Tourette' diagnosis out of medical history, nothing will change. It's diagnosis made based on very narrow set of criteria, that was established when no one had any idea of tics were. Having observed my daughters tics, at least for my daughter I am 100% sure that some tics are triggered by external triggers. Mask triggered jaw triggers, swimming goggles triggered eye blinking, playing volleyball triggers some specific tics. My early approach was to cut the activity short to stop the tics. But then I've seen that if we continue for a few days/weeks she gets used to and tics with triggers also go away. So I am no longer cutting the activity off unless there is a specific reason like, she notices and becomes uncomfortable. Right now we are doing very well but we had a relative flare up 2 weeks ago. It wasn't very bad, but we had more tics and more frequent also, but now we are back to 'minimal' state. Tic's are here, but hard to notice unless you know what to look for. PS: There is also an interesting retrospective study that tries to understand why several tic studies are inconsistent.

Reading all the posts, I understand that most people are fearing the 'Tourette' diagnosis. 'Tourette' diagnosis is very outdated, defined at times where we had almost no understanding of the underlaying mechanisms of TIC's. (we still don't have much, but at least we know we don't have) Definition of what a vocal TIC is incorrect. TIC's are part of a urge control disorder. Like OCD and ADHD. If you are unable to control an urge to make some movements it's usually called motor TIC's. You can also unable to control urges for behavior or thoughts. (OCD/ADHD etc..) Coughing is usually not done for the sake of it's sound by the performer. Therefor it should not be categorized as a vocal tic, it's still a motor tic as coughing is still very physical. Repeating sentences or words (triggered or not triggered) is on different part of the spectrum, slightly closer to OCD dimension (perhaps) Also that 1 year 'mark' is imaginary. There never had been such a cut off. Recent studies has proven that once started these tics do stay for a longer time. Already pointed out bu several poster on the thread but 1. Read the latest research papers. You may need to google every word to understand these documents, but do it. Don't take the easiest path and try to learn from other peoples Facebook posts. 2. Seek help from professionals who have up to date information on the topic 3. CBIT has proven to be useful and can be delivered remotely. It's also proven that remote CEBIT is equally good. 4. There is no harm on going for a healthy diet or using approved supplements, but don't expect too much. best regards

Get any help you can. I understand you fully and we've been in the exact situation multiple times. I can not talk for your child but I know my daughter can catch me easily if I watch her tics and this makes her nervous and also negatively effects the tic frequency. I still get caught time to time, but I thought myself to make her comfortable during the peaks as it's the not the easiest but shortest way out for both of us. I think stress certainly has an effect. Under negative stress I see the tics rise quickly. I try to apply positive stress as much as possible, like a physical competition , memory games, any thing that would direct her concentration to somewhere else. Believe it or not, every 30 sec is not really a high frequency. I had so much worse on some tics. Just today, she started blinking both eyes same time (not like blinking but like closing and opening) , we had this tic couple of times before. Sometimes today it got really frequent. A few minutes after I told her, it might be better not to use iPad as her eyes look tired, she came and told me, I don't want to do it (close eyes) but I also want to ... trying to explain herself. I said, it's quite ok and to do whichever she feels better, closing or not closing and added it will go away in a few days maximum anyway (that's some good will) Back to my first sentence, get any help you can, if you are not well, you can not help.

Almost every child (with tics) I know of show same behavior when watching TV. We had the same, and we dropped the TV to 15 mins a day (most days never opened and only allowed content that would require some active listening/watching like documentaries, competition and she needed up being an F1 fan) and switched to board games, family games etc, for the first 1.5 year, then we slowly increased the amount of TV allowed, but because she had little TV around 5-6, she does not go for TV much to be honest even we would let her.

The old information regarding tics, that they will pass in a year or so and if not it's serious is 'old'. Most new studies, I think I linked some of them, show that tics do not pass in a year. The professor who was running a long term clinical trial was kind enough to answer my question and he said that on average he is seeing improvement year on year but he only seen few of the subjects free of tics at the 3rd year. (His research should be coming to 4th year) And he also agreed with me that Tourette naming is pretty old and meaningless. Tic's are the movements that are completed to satisfy an urge. An urge is a very complex thing in it self. An urge say something/make noise might be evaluated as vocal tic but coughing is certainly not a vocal tic. An urge can also be related to a thought (which leads to OCD or similar disorders) Throughout the years we had probably 100 different tics. Too many to write them. almost anything you can imagine, from jaw opening to eye movement to small jumps when walking to more regular stuff like head noding , tapping etc... Some are a bit more persistent but almost everyone of them replaced with something else during the course. The study I mentioned, which should be linked on one of my recent posts, is the only glass ball we have. At some moment I should search if the newer version of the study is released. If you can find the newer version before me please drop a link. I used to track frequency/intensity of each tic on an excel and that really helped me understand the frequency and peaks etc... As I said, I focused all my efforts on making here more confident with here self physically and mentally without pushing here, with right amount of challenging. What I see is she is quite happy to be in top physical shape and be competitive on every sports (as a side effect) and when she is involved in these activities she would never present tics.

It's quite normal that tics came back, probably they were never fully gone. And after a long recession when they come back, which also happened to us multiple times, it does exactly the same to me, that it does to you. No difference. I keep repeating myself 'ignoring' and making sure she/he does not feel 'odd' is the right approach and will shorten (not 100% sure but that's how I feel) the 'peak'. And I agree it's very difficult for parents, I am no different, it's very difficult for me too. Almost all older resources on tics have misleading information (including clinical trails) and also if you search there is a nice research on why these studies conflict. However there are quite nice newer publications/clinical studies on tics, I should have put some links on my previous posts. So make sure you have a functioning filter before you try to digest the information. There are proven therapies for tics. however it's recommended to have the therapies if tics are interfering with the life and decreasing the quality of life for the child, also it's usually recommended to have these therapies when child develops the 'I' function (around 9-10 ? ). These are the reason we have not utilized these therapies at the moment. One quick note, simple motor tics are usually benign, but if you also have OCD/ADHD or similar comorbid disorders, you should immediately seek help as early as you can.

Greeting from Dubai, I know how difficult it's, at least at the beginning. Tic disorders are a very wide spectrum and every child is wildly different though there are similar patterns shared among them. One thing that is very clear to me is, basic tic disorder is significantly common, I've seen it at several of my friends/relatives kids and if you think how uncommon it's among adults, you can understand that many of the kids will get to a point it's not easy to detect. There are several kinds of tics, but I think vocal/motor tics is a very bad way to categorize them, also meaningless. As many believe, I think Tourette Syndrome naming is not very meaningful. Coughing is an physical activity and unless your kids is doing it for the sound of it (very unlikely) it's more or less a motor tic. Our daughter also made some short noises like 'hih' when she had abdomen related tics. I did not consider them as vocal tics. As I pointed out in earlier posts I found that my kid had less tics when she felt more confident and I focused adding her skills that would make here feel confident of herself when under pressure. It's impossible to know exactly if that helped or not, but I don't think it caused any harm. Don't worry tics will wax and wane, peak points will start getting lower and lower after one year usually and every following year it seems to get better in our case. Do we have tics, yes, but to a point that I usually not notice them. But we still have some peak periods after four years and I repeat my self to hold on 1-2 weeks...

At the beginning most tics stayed around 4-8 weeks , usually each tic peaks within 1-10 days of surfacing but I’ve seen lot’s of exception, i’e. I’ve seen infrequent tics which stays thatway for weeks before gets frequent too. Also pattern have changed dramatically year after year. Right now it’s far different then it was the first year. First year (and probably the second one) we usually had 4-8 different tics at the same time, some being more dominant. Head turning was the first tic we had and it was by far the most frequent, disturbing and longest tic. It took months for it to go away. Went away several time but came back again , each time less frequent though. Can not remember how much it took but I am certain that it took more then 8 months and even when it was completely gone, it came back in different forms 2 year after. (Different head movement)

Hi, I am no doctor and make sure you that you verify everything you read/hear , including what’s written here. Recently there had been some new studies (EMTICS) and some others like https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316401/#!po=43.5780 My understanding is ‘transient tic disorder’ does not exist or very rare. That is also inline with all of the cases I’ve seen around us. (Tic’s are not rare) I had the chance to exchange some emails with the author of the paper on the link above, and he was kind of to respond to me. He told me that he did not see tics resolve (though severity/freq decrease year over year) in 2 year follow up , but had witnessed some of the children were free of tics at year 3. (These results were not published) My experience was smilar. We see the greatest decline after the end of 3rd year. Right now it’s pretty hard to detect any tics, but I won’t say we are tic free. I know I can not stop you worrying, been there, done that. But don’t worry excessively, you may (will) see some ups and downs , but it’s highly likely that tics will resolve in a few years. On the positive side, this issue allowed me to focus more on building her self esteem which now also helps here a lot even when there are no tics around. Keep reading scientific evidence and clinical trial results. We did kept a diary and an excell sheet to quantify the status and link events/circumstances etc that trigger or that help with tics. Best regards Mertol

We still have some tics here and there, but they are getting increasingly difficult to detect even by me. There still moments where tics do increase , but it's relatively a lot easier peak and relative to the first two years peaks duration is significantly shorter.

Hi, We are doing ok, we still have 3-4 tics with wax and wane. In the long run we think we are in a descending trend. Please do not consider me an authority. I am just an other worried parent. Unfortunately there are way too many unknowns about tic (and related) disorders. There are very few researches that focus on underlaying reason for tics and why some get better and others don't. Luckily there are now, some researches on the topic like EMTICS and some other I pointed out in other posts. I try to stick with evidence based treatment strategies but this does not mean that others methods can not work. Tics wax and wayne and expected trend from onset is downwards. This makes 'isolating' the effects of supplemental vitamins/diatery changes and other things very hard. We try to follow a healthy diet with no MC Donals or smilar stuff. We tried 'gluten free' diet for a while and also a 'milk' free one. It was quite hard for us. At the end we gave up but still limit 'milk' as our doctor told us that he does not think these have any relations with tics but reducing milk is considered healthy anyway and won't make harm. I am not knowledgable on mercury poisoning enough to comment on it. Mold is unhealthy and so there is no harm getting rid of it. I use dehumidifiers time to time to prevent mold as I am practically living on an island. For the naturopathic DR, I only believe in evidence based medicine/treatment , if the DR can point to some research results about why he is making the tests etc, I'd check , otherwise skip. But that's me. I know how 2 months feels like multiple years under stress, been there. I remember that I lost 20 lbs in the first 3 months very rapidly. However when it comes to tics, it's a very short period. Can some movements be other things then tics? Yes, they can be. Some hyperkinetic movements can easily be misdiagnosed as tics. (or there is a type of seizure which often looks like a tic.) Here is a paper on the topic you may find interesting. https://pubmed.ncbi.nlm.nih.gov/9613740/ Also compulsions, impulse behaviors etc can be misdiagnosed as tics too (does not like your case though) , you can read an old paper on the topic here, a google search may find newer ones. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656307/ I believe in the thesis that Tics, OCD, Hyperactivity etc.. are different manifestations of the same underlaying condition. I also read that tics being elastic is considered a good thing, on the other hand I think it's actually the norm. Tics keep changing, usually in 6-12 week periods. But some stick longer, some stick shorter some come and go changing a bit every time. While not useful much, I also observed that sensory physical stimulation does trigger tics. As an example, using googles at the pool, after some period of time would start triggering 'eye' related tics. Teeth development (new teeth coming etc..) can trigger tics around jaw. I believe relieving anxiety and supporting self esteem should be the focus. I support her to gain new skills as much as possible to up her self esteem. We had the same issue with gymnastics and continued online. Not 100% effective but 80% was ok. She got quite strong so she does not feel under stress when physically challenged. Btw you are as important as your kid and you also need to find ways to keep your anxiety levels low and manageable. It will build up and it can result in behavior that will result in increased anxiety in the child. (been there , done that) Keep on updating us PS: Intensity of the movement (speed, extension, strength behind) etc is also a good measure like frequency and can give you insight on the trend. I think we've seen noticeable decline after 4-5 months or a bit more. best regards Mertol

I personally think that hyper activity is an other form of a ‘tic’ , an urge to do something, so might be considered part of the spectrum. That’s my personal opinion yet prof I chatted on the topic agreed the view. We had the same issue of tics before sleeping for a long while, almost a year. Make sure you got all the help you can to cope with the situation. i am positive that you will be in a lot better situation in short time.

It’s quite common that tics will rise when she is tired. It used to be 10x common for my daughter at the beginning.Also we realized that she would have a lot less tics if she slept more the usual. That’s what we did, 1) Limited the TV and ipad time to almost 0... Basically we played games instead. Bonus is she now prefers playing with vs any screen time. (We are not that strict on screen time as we did those days) 2) We did not push her out of the bed for school, asked school to tolerate this which they did (but it was fs1/2 anyway) I personally do not think anythink we did changed the course of tics much in the long run. But removing anxiety, spending more family time helped with ironing out the peaks. Statistically it’s very likely that she will get better. However recent studies show that it’s likely to be with you for a few more years.

If she is aware of the tics, relieve the stress by explaining this is ok and sometimes normal and it’s likely to go away. Don’t try to make her stop, this creates anxiety and makes things 3x worse. First month was by far the worst one. PS : it’s important to asses if there are comorbid behavioral disorders like adhd , ocd etc. as they should be treated. If they are not present I would not worry much.

Allergy tests came back negative and I could not corralate tics flare ups with allergy in the long run, although I am still having an eye on it. since your doughter is older and if she is aware if the tics, unless tics decrease (which is likely to happen) quickly you can start BCIT (or bict , cant remember ) For positive stress , I try to create competitive games and spare time for them. For example we play hours of woleyball with a balloon where a coach devides the fileds or play miniature football competitively. It’s basically involving just a bit if competitiveness (making sure she has more then a fair chance of winning) to some tasks (not everything) i.e. When making dresses to her ponies , I challange as can we make the best ever dress etc... best regards mertol

Hi, I feel you. First of all every one has a different progress. It’s more probable that situation will improve in 12 months and will continue to improve. There is too much emphasis on ‘vocal’ tics. My view is some vocal tics are not actually vocal tics (any tic that involves muscles to make noises are not ) and Even if your kid has ‘real’ (whatever that means) vocal tics , this should not create extra worry at the moment. The diagnostics criteria for TS is quite out dates and pretty much meaningless and most doctors agreed I concentrate in a few things 1) Remove negative anxiety from her (positive stress is good , should he regulated though) as much as possible. 2) Improve self esteem , make sure she gains skills / strengths that makes her comfortable These seem to help a lot. And with time our situation improved, although it’s not fully linear. We had several periods where it went tue other way, for a few weeks/months. I keep an excel sheet to quantify the status and trends. It also relaxes me. let me know how it goes for you PS: There are a few quite interesting studies going on about the subject. best regards

Here comes an other update. I started following tics on an excellent sheet that helps me figure out progress of tics and when they emerge and when they get out of the picture. At the very first 2 months after 'new' noticeable tics kicked in we had some ups and downs however they never got very bad or to a point that would effect her social life. At the 8th week a steady decline started and leg/arm jerking slowly decreased in intensity and frequency and now gone. However during the course a few more tics came and go. We had some head nodding that was very infrequent for 5 weeks , we had a jaw opening tics that was also very infrequent for 8 weeks , a hip related tic that was frequent when walking but went away in a few weeks. Interestingly some long standing tics are gone now too , like broadening nostrils and nose twitching (not sure this was tics or related to allergic rhinitis) are either gone or very very infrequent that I do not notice. On the other hand an abdomen tic (that is pretty easy to mistaken for a breathing tic ) is back. It's not frequent and very hard to recognize externally so that does not worry me as much. EMTICS have published several papers , so if you've not read them those can be good resources. We are not using any supplements other then the very usual stuff. We are still focused on 'positive stress' , less TV/Phone'Tablet time , more physical activity. I think that being confident really helps her a lot and at her age part of the confidence comes from her physical capabilities, so I feel like gymnastics really help her a lot.

Please note some of the EMTICS based research WP's are released with a lot of new information on tics. This page gives an excellent summary of all EMTICS based WP's at the moment. (more to be released everyday , probably slowed down by the Covid situation in Europe) https://cordis.europa.eu/project/id/278367/reporting?rcn=59137

That, I think was a theory and as of today , to my knowledge, root cause still is not identified. I am very glad that your son has recovered. it'd help us a lot if you can share more information about when tics started and how severe where they (according to YGSSt score) and at what speed tics went down to a manageable level.

Maybe I should clarify , I did not say that food/allergy/environmental factors etc are not related to tics. As a side note, on a few scientific researches allergy frequency seems to be higher among children with tics vs general population. However there seems to be no scientific, properly managed research on effect of diet on tic severity. that does NOT mean that diet has not effect on tics. It's not easy to plan a research that will correlate diet vs tic severity due to several factors. Individual experiences should not be presented as 'cases' , one of the reasons is, as stated on the research I linked on my first post, tic severity has tendency to decrease upon onset date within 12 months, significantly already. So it would be very difficult to asses the effects of diet change ( or complementary vitamins etc... ) alone unless you have significant amount of people monitored a long with a control group. That still does not say say diet has no effect, it only says there is no scientific research backing up this claim. There are lot's of unknowns about this spectrum, however it looks like at last it's now been recognized that while not fatal , it's effects on quality of life of the individuals and family can be severe. So we will be seeing lots of new research on the topic in this year.

Tics wax and wane , I am recording an excel sheet that saves all sub-parameters of YGTSS (which I find pretty coarse) for each and every day for my DD. Unfortunately I am unable to correlate tics to food/allergy/complements at the moment (also there is no scientific evidence on this too) but still watching closely. At most of the tic disorder cases , tics elevate in frequency and intensity during TV/ipad/phone watching (there are 1-2 theories on this) and I've read on several episodes that eating also has a similar effect. Both of those hold true also for my daughter. First of all I think that TS should be removed as diagnosis completely. Tics are likely a spectrum, and here is a nice study supporting this : https://www.ncbi.nlm.nih.gov/pubmed/30661132 I also disagree that every tic resulting a 'sound' is actually a vocal tic. Abdominal tics can result in sound outputs involuntarily. (which we also had) Unfortunately it looks like either there is no such thing as transient tic disorders or it's rare. Here is a nice study that shows that tics were detectable after 12 months in 100% of the cases, however severity decreases significantly. https://www.ncbi.nlm.nih.gov/pubmed/30850688/ In your case absence of anxiety disorder clearly gives an advantage for marked improvement in 12 months. Our case looks very familiar to your case. I have thread where I regularly update our status. In summary we started with very severe tics on large muscle groups and now in 18 months (with a lot of waxing and waning) tics are still with us, however significantly milder and the difference between our best/worst periods are decreasing. In our case I found the following mostly helpful : 1) Keep her occupied. We sometimes watch TV, but I try to make it as interactive as possible and don't leave her a lone with TV. Still her tics elevate during TV sessions usually. Ipad is only used for accessing information. 2) Even without visible anxiety disorder, we do our best to either remove unnecessary anxiety from the environment or give her necessary skills to manage difficult situations without being anxious. I am almost sure that you will be better and better with time.

Hi Mlee, Excellent question. Earlier studies about this topic had strong discrepancy between each other. (there is also an other study about what could be the reason about this discrepancy) Good news is there are a few newer studies about exactly this topic , that were managed a bit more carefully to achieve more consistent results. One of the largest studies is called EMTICS , unfortunately despite all my efforts I am unable to reach the results. However this one is very very good : https://www.ncbi.nlm.nih.gov/pubmed/30850688/ You'd better read it yourself , but a brief summary is : Tics improve as a group in 12 months. Absence of anxiety disorder looks like one of the biggest factors. I'd also recommend this study : https://www.ncbi.nlm.nih.gov/pubmed/31241402/ This study correlates improvement with the ability to suppress tics. I am expecting to see a few more related studies being released in this year that would help parent/doctors plan treatment based on outlook rather then wait and see approach. As a side note, I've never believed in transient tic disorder and TS diagnoses. What we are experiencing is more like a Spectrum Disorder and here is a nice study supporting this approach, https://www.ncbi.nlm.nih.gov/pubmed/30661132 I also believe current assessment methods are very coarse (YGTSS) and preventing from correlating symptoms/improvements etc with other factors. We will get significantly better information once researchers move away from YGTSS and smiler coarse classifications. Back to your question EMTICS should at the end of the day provide a better answer to your question in the long run. Best regards Mertol

It's been a while. But just in case there might be someone interested in the progress, here is an update after more then a year. Number of active tics, frequency, intensity everything followed a down trend until previous week to a point where tics were not easy to notice externally. Only visible one was nose twitching (or what ever it's called) , and I've seen exact same mimic on some other kids and it might have been more related to her allergic rhinitis rather then tics. However a month ago I started to sense a bit shaking on her arms , tiny, hard to sense unless you are holding her hand. Their frequency and intensity kept rising , interestingly nose twitching also lost it's frequency and intensity in parallel (but her allergy got under control too ) . 2-3 days ago shaking on arms and legs became externally visible to trained eye. Quite naturally this started worrying me and wife. We are taking our usual precautions that seems to usually work (or maybe just coincidence) 1- Decrease negative stress to a minimum. We are already quite careful but not focus a bit more and micromanage... She does not have any anxiety disorder. 2- Increase positive stress, like competitions , family puzzle solving sessions etc... 3- Increase family and friend time , increase play time (shift balance from other places like homework unfortunately ... ) 4- Less TV , less diphone (we are already in great shape so not much of a problem) Maybe we restart magnesium tablets , hard to know if they work or not... And finally a research paper answered some of my questions. If you've not seen it , please read. https://www.nature.com/articles/s41598-019-40133-4/email/correspondent/c1 Don't feel unlucky that tics did not getaway. Looks like they don't getaway very quickly, it always takes sometime.

Hi, Sorry for long answer My advice is first sticking with science, which unfortunetly does leave a lot to be answered on this topic at the moment. I fully understand and have seen the same exact behavior of accusing vaccines/antibiotics or other stuff. That is very unlikely to take you anywhere. There is no proof that links vaccines and antibiotics to TS/TICS. TS/Tics are quite different then most other illnesses and assessing them are quite difficult, which leads most scientific papers having contradicting and confusing information. Here is a very brief and quick summary of what I learnt so far after reading more then 1000 pages , closely following all research and observing all the cases nearby. (I will include a link to a very recent research that will also shed some light) 1. TS is not much different then having only motor tics (I am not the only one thinking this way) . Some tics that are categorized as vocal tics are not true vocal tics. 2. Tics are very common, some go unnoticed and some reduce to unrecognizable level quickly and got forgotten 3. It's very likely that there is no such thing as transient tics. Almost all tics stay for longer then a year. This one year mark put on the diagnosis criteria is arbitrary and is based on scientific evidence. (see the paper below) 4. On significant amount of the cases , tics will get a lot better in 12 months of onset. However presence of anxiety disorder correlates with worse outcome on tics severity decreasing. 5. Tics usually don't come alone and come with OCD/ADHD/Anxiety disorder. After reading several research reports, I think not having a comorbid issue is suggests the best outcome. Having Anxiety Disorder has the most negative impact on tic severity. So if your child also exhibits these comorbid issue , you need to focus on them too. 6. Multiple tics are very very common, it's quite normal that number of tics to increase and some of the tics be replaced with others. To sum up, this is most probably going to be a journey. Your first focus should be reducing anxiety over the child as much as possible and watching for symptoms of stress. Keep a diary. It's very probable that tic severity will be down very significantly in 12 months. We had the exact same issues (I think I've seen and still seeing , almost every tic in the book and had sometimes 5-6 different tics at the same period) and after 18 months, severity is very significantly lower (still waxing and waning) and I hope it will keep on getting better (though some people comment puberty can make things bit worse for a few years..) Some people are able to determine links between tic severity and some external factors like allergy or certain types of food intolerance, environmental factors etc... I did my best and I could not be able to positively relate the severity of tics to anything other then anxiety and sleep. So I am focused on better sleep and keeping anxiety and stress to bare minimum. My child has allergic rhinitis (confirmed by a specialist) but I could not able to link tic severity to allergy severity positively, but I took all the precautions to decrease allergens around (remove carpets, hepa filters every where , anti-allergic stuff etc..) Please read the latest research on the topic , do not bothered much with words like TS. Unfortunately, despite the high frequency of tics in population this is still uncharted territory. https://www.nature.com/articles/s41598-019-40133-4/email/correspondent/c1 BTW : I am trying to reach out to EMTICS research reports with no success at the moment. If anyone knows a link I'd appreciate. That is the only large enough study that can shed light to some of the outstanding questions. (though I got some doubts) best regards Mertol

Back with more update. Even on a declining thread, my ds tics kept on morphing , however they got increasingly harder to notice. I think that I still see some tics on her face, I am no longer certain. If I were not well informed on the topic, I'd not notice anything. However I got a feeling that school may increase her stress little bit and may trigger old tics. Not sure though. This is how it's going on at the moment.