What is it about?
This study showed that being in the room with a clinician reduced tics much more than asking people not to tic did. Top-drawer methods for counting tics from video recordings were used prospectively to document tic frequency and the number of body parts with a tic in 39 people enrolled in a treatment study. Tics were quantified in 4 settings before treatment and in 3 settings after treatment: = alone in a room, free to tic = alone in a room, asked not to tic = sitting with a clinician who is rating tics over the past week on the YGTSS. In this condition one talks about tics in the past week and the clinician observes you for tics now. = sitting with a clinician who is asking about all kinds of psychiatric symptoms (the MINI semi-standardized diagnostic interview). In this condition one is still talking with the clinician, but not about tics. This is the condition that only occurred at the pre-treatment visit. Please note that during the YGTSS rating or the MINI, some children would have long moments during which the clinician was talking with the parent rather than directly interfacing with the child.
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Why is it important?
Previous reports had suggested that tics usually were less frequent when around other people and more frequent when "home alone." This study gathered much more data, in more conditions, with better video scoring methods. The results clearly show an enormous reduction in tics during the two conditions in which the patient is in the room with a clinician. In fact, those conditions reduced tics more than asking the person not to tic!
Perspectives
Dr. Wellen and colleagues from the Conelea lab are to be commended for a very carefully done study that teaches us something important about tic disorders. A year or two ago I was talking about our "New Tics" study results. I mentioned that at our return visits, a good fraction of children had zero tics during a 30-45 minute interview with me and then had tics as soon as we closed the door to watch them seated alone via closed-circuit camera! My suspicion was that this reflected (not necessarily intentional) tic suppression while being observed by someone else (me)--or, to coin a phrase, "social automatic tic suppression." I lamented not having recorded some segment of those face-to-face sessions to document the phenomenon better. Dr. Conelea said she had the perfect setup to study this phenomenon, and Dr. Wellen and others in the lab took it from there. To my mind, the most _important_ implication of this work is that not seeing tics in the doctor's office doesn't mean tics are gone, even if patients are unaware of any tics. That observation has implications for clinical care, but more for epidemiology and genetics research on tic disorders. The most _interesting_ observation is that tics decrease more just from being in the room with someone than they do when you are trying not to tic. The most _financially interesting_ result is that tics measured either by the YGTSS total tic score or by tic counts when the person sat alone improved substantially with treatment, but the two kinds of improvement did not correlate with each other! If I were a pharmaceutical company trying to study a new treatment for tics, I'd want to include both in the study so as to have a better chance of demonstrating success with my product.
Dr Kevin J. Black
Washington University in St. Louis
Read the Original
This page is a summary of: Social context is a cue for tic reduction in clinical settings, European Child & Adolescent Psychiatry, August 2025, Springer Science + Business Media,
DOI: 10.1007/s00787-025-02818-2.
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