Objectives
Clinicians and researchers have noted significant increases in tics and tic-like behaviors in adolescents and young adults over the course of the COVID-19 pandemic, often in the context of active social media use, notably TikTok. These presentations differ from typical presentations of Tourette’s disorder (TD). Experts in functional neurological disorder (FND) and TD will discuss this phenomenon followed by a panel discussion with active audience engagement.
Methods
Jeff Waugh, MD, PhD, will provide an overview of FND, review the relevant literature on FND in youth, and discuss common FND features and demographics. Christos Ganos, MD, will compare and contrast primary tic disorders/TD with tic-like behaviors seen in FND. Tamara Pringsheim, MD, will focus on characteristics of patients who present with functional tic-like behaviors and discuss this in the context of the pandemic, social media usage (eg, TikTok), and the concept of social contagion. Joseph McGuire, PhD, will review evidence-based therapy for tics and use a case-based approach to discuss adapting and augmenting this therapy for youth with functional tic-like symptoms in order to enhance treatment response. Video vignettes will be shown. Dorothy Grice, MD, and Cathy Budman, MD, will lead a panel discussion and support audience participation.
Results
FND is common in youth. Presentations of functional tic-like behaviors have increased during the pandemic, spurred by social media posts. Recognition of FND and how FND symptoms do, and do not, overlap with TD is important to establish an accurate diagnostic formulation and effective treatment. These patients often have an older age of onset, a skewed sex ratio toward females, abrupt symptom onset, prominent complex movements, and higher rates of self-injurious behaviors and other challenging symptoms. Recognizing the presence of life stressors and anxiety or mood symptoms is an integral part of care.
Conclusions
The symptom course and symptom constellation of tic-like behaviors of FND differ from primary tic disorders. Evidence-based treatments for tics may be effective in decreasing symptom acuity; however, augmentation with additional therapeutic approaches is indicated, as is awareness of the overall psychosocial health of each patient. An understanding of FND and knowledge of tic disorders will help clinicians to provide optimal care for youth who present with these symptoms.
TICD, ADOL, MED