Tics for highly gifted students

On the one hand, tics can appear in highly gifted children and adults for the same reasons as in normal gifted children and adults. On the other hand, tics can develop due to the stronger perception of stimuli and sensitivity to stimuli of highly gifted children and adults. These can develop in the course of brain development.

Similar to normal gifted children, temporary tics may occur during the course of brain remodelling. As with the tics of normally gifted children, the behavior of the environment is often more stressful than the tic itself. A characteristic feature of highly gifted people is a so-called increased psychomotor sensitivity, which manifests itself in an urge to move, enthusiasm and an excess of energy.

Many highly gifted people of all ages can only learn contents by heart while moving. Thus, highly gifted people also show movements of their body, especially when they concentrate. In children, when they are learning, it can be, for example, a constant wiggling of the foot or the whole leg or tapping the table with a pen.

For example, some highly gifted adults can be observed to constantly move their mouth or hands while concentrating. These movements serve to relieve tension and are important for both highly gifted children and highly gifted adults. In order not to disturb other children at school, the gifted children can be offered a plasticine ball or a similar object.

Highly gifted adults can relieve their tensions by chewing gum or scribbling, knitting or even by a plasticine ball. If, in addition to the harmless tics or “quirks”, other and more persistent behaviors appear which, in their view, limit the everyday life of the person concerned, they should seek the advice of a competent person who is familiar with giftedness. In contrast to the tics described above, highly gifted children and adults report this type of tics, rarely a “premonition” in the form of sensations or similar.

However, as with other children and adults, the unconditional “acceptance” of the person is beneficial. The diagnosis is made by questioning (anamnesis) the patient and observing the symptoms over a longer period of time so that the severity of the disease can be determined. This is done by means of questionnaires and estimation scales.

It is also important to assess the patient’s own and his family’s medical history. However, there is no specific examination, neither laboratory nor imaging. However, a measurement of the brain waves (electroencephalogram, EEG) and a method for producing virtual sectional images (single-photon emission computed tomography, SPECT) of the brain can be used to distinguish tic syndrome from other diseases.

There is no standardized test for tics yet. Up to now, different tests are combined as needed to identify a tic or its cause and reveal possible pre-existing conditions. It is important to conduct a detailed interview with the person affected or the parents of the affected child.

In the “Diagnostic System for Mental Disorders according to ICD 10 and DSM IV for Children and Adolescents – II”, there is a diagnostic checklist, as well as third-party and self-assessment questionnaires that can be helpful in making a diagnosis. An indication of tics can be the previously experienced “prefeelings” in the form of sensations of discomfort or feelings of tension. In the EEG, a lack of readiness potential before simple tics may be missing, which is visible in the EEG during arbitrary movements.

In addition, special examinations can detect changes in the transport of dopamine, a messenger substance of the brain. If a tic disorder is suspected, liver, kidney and thyroid gland values are routinely checked. It is difficult to distinguish motor tics from obsessive-compulsive disorders.Obsessive-compulsive disorders are associated with obsessive fears, so that an anxious uneasiness arises when the action is suppressed.

As with tics, a certain number of repetitions of the action is necessary to avert the obsessive-compulsive apprehension. However, the fears are not understandable or even nonsensical to the patient, whereas patients with a tic disorder experience the previous sensation as tangible. The compulsive acts themselves are carried out deliberately, more purposefully and more slowly than the movements in motor tics.

In addition, tics are visible to others from the beginning, but compulsions can often be concealed for a long time. The prognosis of both diseases is also different: Compared to tics, a complete remission of the obsessive-compulsive disorder is rather rare. Motor tics must be distinguished from rapid involuntary muscle twitches (myoclonia) and movement disorders (dystonia).

Tics can be suppressed for a certain period of time, myoclonies not at all and dystonia only to a certain degree. In addition, tics are accompanied by a preceding paresthesia that triggers the actual movement. This sensory component is the essential difference to other movement disorders.

Many of the patients learn to handle their tics themselves over time and do not require psychotherapeutic or drug treatment. However, if therapy is needed, it can only be done symptomatically, i.e. the symptoms, i.e. the tics themselves, are treated, but the cause is usually unknown and cannot be treated.

Often a behavioral therapy is useful, in which one should learn how to master the tics in everyday life. Thus, the tics become weaker when concentrating on a thing or an action, but stronger when under stress. Drug therapy is usually only used for chronic tics that last longer than a year or that are so frightening to the environment that the patient becomes too restricted.

Drug therapy is also useful for aggressive tics that are directed against the patient himself or other people. The most effective tic-reducing drugs are neuroleptics such as haloperidol, pimozide and fluphenazine, whose effect is due to the influence of dopamine receptors. However, the benefits of the therapy must be weighed against the possible side effects of the drugs.

The use of neuroleptics leads to fatigue and reduced motivation, which is particularly problematic for school children. In addition, neuroleptics carry the risk of disturbing movement patterns (dyskinesia), which is why they should only be prescribed in severe cases. Clonidine, tiapride and sulpiride have fewer side effects, but are not as effective.

A temporary tic, is usually harmless at any age and often disappears spontaneously. Here no treatment is necessary. In some cases, homeopathic treatment for tics can also be helpful.

In this case, a detailed anamnesis and profound knowledge of the treating person is beneficial. Soothing effects have been observed with the following preparations: Agaricus muscarius, China officinalis, Cina/Artermisa cina, Cuprum metallicum, Hypscyamus niger, Ignatia amara, Lycopodium clavatum, Sepia officinalis, Zincum metallicum. The treatment must be individually tailored and depends on the type and extent of the tic, as well as on the psychological state of mind of the person affected and any accompanying symptoms.

For example, Zincum metallicum is used for children whose tic is expressed by involuntary movements of the eyes, mouth, hands and/or legs. In about 60% of patients, there is spontaneous complete remission or at least a significant improvement. If the disease occurred in childhood, the chances of improvement are even higher, with about two-thirds becoming tic-free towards the end of the first or beginning of the second decade of life.