The spectrum of functional tic-like behaviours: data from an international registry
Abstract
BACKGROUND AND PURPOSE: Between 2019 and 2022, there was a marked rise in adolescents/young adults seeking urgent help for functional tic-like behaviours (FTLBs). Given the global scale of this phenomenon, we aimed to pool cases from different institutions in an international registry to better characterize this spectrum and facilitate future longitudinal observation. METHODS: An international collaborative group from 10 tertiary referral centres for tic disorders collected retrospective data on FTLB patients who sought specialists' attention between the last quarter of 2019 and June 2022. An audit procedure was used for collection of data, which comprised demographics, course of presentation and duration, precipitating and predisposing factors, phenomenology, comorbidities, and pharmacological treatment outcome. RESULTS: During the study period, we collected data on 294 patients with FTLBs, 97% of whom were adolescents and young adults and 87% of whom were female. FTLBs were found to have a peak of severity within 1 month in 70% of patients, with spontaneous remissions in 20%, and a very high frequency of complex movements (85%) and vocalizations (81%). Less than one-fifth of patients had pre-existing primary tic disorder, 66% had comorbid anxiety disorders, 28% comorbid depressive disorders, 24% autism spectrum disorder and 23% attention deficit/hyperactivity disorder. Almost 60% explicitly reported exposure to tic-related social media content. The vast majority of pharmacologically treated patients did not report benefit with tic-suppressing medications. CONCLUSIONS: Our data from the largest multicentre registry of FTLBs to date confirm substantial clinical differences from primary tic disorders. Social modelling was the most relevant contributing factor during the pandemic. Future longitudinal analyses from this database may help understand treatment approaches and responsiveness.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The case series sample is reflective of the sex composition of patients who presented to the clinical practices for treatment and is largely consistent with FTLB presentations in the population, with an estimated female:male ratio of 9:1.
“While this case series sample is reflective of the sex composition of the patients who presented to our clinical practices for treatment and is largely consistent with the FTLB presentations in the population, with an estimated female:male ratio of 9:1 (20, 29, 30)”
From Integrated cognitive behavioral intervention for functional tics (I-CBiT): case reports and treatment formulation (2023) · cites this paper as [29]
Cites
The yale global tic severity scale: initial testing of a clinician-rated scale of tic severity
LECKMAN, J. F., RIDDLE, M. A., HARDIN, M. T., ORT, S. I., SWARTZ, K. L., STEVENSON, J., & COHEN, D. J. (1989) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-198907000-00015 · Cited by 2,146 · see citing works
Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders
Espay, A. J., Aybek, S., Carson, A., Edwards, M. J., Goldstein, L. H., Hallett, M., LaFaver, K., LaFrance, W. C., Lang, A. E., Nicholson, T., et al. (2018) · JAMA Neurology · doi:10.1001/jamaneurol.2018.1264 · Cited by 786 · see citing works
Does time spent using social media impact mental health?: An eight year longitudinal study
Coyne, S. M., Rogers, A. A., Zurcher, J. D., Stockdale, L., & Booth, M. (2020) · Computers in Human Behavior · doi:10.1016/j.chb.2019.106160 · Cited by 701 · see citing works
Course of Tic Severity in Tourette Syndrome: The First Two Decades
Leckman, J. F., Zhang, H., Vitale, A., Lahnin, F., Lynch, K., Bondi, C., Kim, Y.-S., & Peterson, B. S. (1998) · Pediatrics · doi:10.1542/peds.102.1.14 · Cited by 685 · see citing works
Help-Seeking Behaviour and Adolescent Self-Harm: A Systematic Review
Rowe, S. L., French, R. S., Henderson, C., Ougrin, D., Slade, M., & Moran, P. (2014) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867414555718 · Cited by 299 · see citing works
Fréeman, R. D., Fast, D. K., Burd, L., et al. (2000) · Developmental Medicine & Child Neurology · doi:10.1111/j.1469-8749.2000.tb00346.x · Cited by 216 · see citing works
<scp>TikTok</scp> Tics: A Pandemic Within a Pandemic
Olvera, C., Stebbins, G. T., Goetz, C. G., & Kompoliti, K. (2021) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.13316 · Cited by 158 · see citing works
Lidstone, S. C., Costa-Parke, M., Robinson, E. J., Ercoli, T., & Stone, J. (2022) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2021-328462 · Cited by 139 · see citing works
Rapid Onset Functional Tic‐Like Behaviors in Young Females During the <scp>COVID</scp>‐19 Pandemic
Pringsheim, T., Ganos, C., McGuire, J. F., Hedderly, T., Woods, D., Gilbert, D. L., Piacentini, J., Dale, R. C., & Martino, D. (2021) · Movement Disorders · doi:10.1002/mds.28778 · Cited by 133 · see citing works
Self-citationTourette Syndrome and Chronic Tic Disorders: The Clinical Spectrum Beyond Tics
Martino, D., Ganos, C., & Pringsheim, T. M. (2017) · International review of neurobiology · doi:10.1016/bs.irn.2017.05.006 · Cited by 129 · see citing works
Self-citationRepetitive Behaviours in Patients with Gilles de la Tourette Syndrome: Tics, Compulsions, or Both?
Worbe, Y., Mallet, L., Golmard, J., Béhar, C., Durif, F., Jalenques, I., Damier, P., Derkinderen, P., Pollak, P., Anheim, M., et al. (2010) · PLoS ONE · doi:10.1371/journal.pone.0012959 · Cited by 127 · see citing works
Self-citationThe clinical features of psychogenic movement disorders resembling tics
Baizabal-Carvallo, J. F., & Jankovic, J. (2014) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp-2013-305594 · Cited by 125 · see citing works
Tics and functional tic-like movements: Can we tell them apart?
Ganos, C., Martino, D., Espay, A. J., Lang, A. E., Bhatia, K. P., & Edwards, M. J. (2019) · Neurology · doi:10.1212/wnl.0000000000008372 · Cited by 124 · see citing works
Self-citationSinger, H. S. (2019) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/con.0000000000000752 · Cited by 122 · see citing works
COVID-19 related increase in childhood tics and tic-like attacks
Heyman, I., Liang, H., & Hedderly, T. J. (2021) · Archives of Disease in Childhood · doi:10.1136/archdischild-2021-321748 · Cited by 120 · see citing works
Self-citationStop that! It’s not Tourette’s but a new type of mass sociogenic illness.
Müller-Vahl, K. R., Pisarenko, A., Jakubovski, E., & Fremer, C. (2022) · Brain · doi:10.1093/brain/awab316 · Cited by 114 · see citing works
Self-citationTics and <scp>TikTok</scp> : Functional Tics Spread Through Social Media
Hull, M., & Parnes, M. (2021) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.13267 · Cited by 108 · see citing works
A positive diagnosis of functional (psychogenic) tics
Demartini, B., Ricciardi, L., Pareés, I., Ganos, C., Bhatia, K. P., & Edwards, M. J. (2014) · European Journal of Neurology · doi:10.1111/ene.12609 · Cited by 93 · see citing works
Pandemic Tic‐like Behaviors Following Social Media Consumption
Paulus, T., Bäumer, T., Verrel, J., Weißbach, A., Roessner, V., Beste, C., & Münchau, A. M. (2021) · Movement Disorders · doi:10.1002/mds.28800 · Cited by 73 · see citing works
Rapid onset of functional tic‐like behaviours in young adults during the COVID‐19 pandemic
Pringsheim, T. M., & Martino, D. (2021) · European Journal of Neurology · doi:10.1111/ene.15034 · Cited by 71 · see citing works
Self-citationThe Phenomenology of Tics and Tic-Like Behavior in TikTok
Vera, A. G. Z., Bruce, A. B., Garris, J. F., Tochen, L. S., Bhatia, P., Lehman, R., Lopez, W. L., Wu, S. W., & Gilbert, D. L. (2022) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2022.02.003 · Cited by 68 · see citing works
Self-citationPaediatric tic-like presentations during the COVID-19 pandemic
Buts, S., Duncan, M., Owen, T., Martino, D., Pringsheim, T., Byrne, S., McWilliams, A., Murphy, T., Malik, O., Liang, H., et al. (2022) · Archives of Disease in Childhood · doi:10.1136/archdischild-2021-323002 · Cited by 60 · see citing works
Self-citationHan, V. X., Kozlowska, K., Kothur, K., Lorentzos, M., Wong, W. K., Mohammad, S. S., Savage, B., Chudleigh, C., & Dale, R. C. (2022) · Journal of Paediatrics and Child Health · doi:10.1111/jpc.15932 · Cited by 60 · see citing works
Self-citationMartindale, J. M., & Mink, J. W. (2022) · Frontiers in Pediatrics · doi:10.3389/fped.2022.863919 · Cited by 34 · see citing works
Course of Tic Severity in Tourette Syndrome: The First Two Decades
Leckman, J. F., Zhang, H., Vitale, A., et al. (1999) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199904000-00029 · Cited by 33 · see citing works
Prognosis of rapid onset functional tic‐like behaviors: Prospective follow‐up over 6 months
Howlett, M., Martino, D., Nilles, C., & Pringsheim, T. M. (2022) · Brain and Behavior · doi:10.1002/brb3.2606 · Cited by 33 · see citing works
Self-citationThe recent surge of functional movement disorders: social distress or greater awareness?
Nilles, C., Pringsheim, T. M., & Martino, D. (2022) · Current Opinion in Neurology · doi:10.1097/wco.0000000000001074 · Cited by 28 · see citing works
Self-citationWong, B. H.-C., Vaezinejad, M., Plener, P. L., Mehdi, T., Romaniuk, L., Barrett, E., Hussain, H., Lloyd, A., Tolmac, J., Rao, M., et al. (2022) · BJPsych Open · doi:10.1192/bjo.2022.41 · Cited by 24 · see citing works
Self-citationCreating a Patient-Based Diagnostic Checklist for Functional Tics During the COVID-19 Pandemic
Trau, S. P., Quehl, L., Tsujimoto, T. H. M., Lin, F., & Singer, H. S. (2022) · Neurology Clinical Practice · doi:10.1212/cpj.0000000000200067 · Cited by 20 · see citing works
Nagy, P., Cserháti, H., Rosdy, B., Bodó, T., Hegyi, M., Szamosújvári, J., Fogarasi, D. J., & Fogarasi, A. (2022) · Ideggyógyászati szemle · doi:10.18071/isz.75.0211 · Cited by 16 · see citing works
Self-citationComparison of Impairment in Functional Tic Disorders Versus Tourette Syndrome
Larsh, T. R., Wu, S. W., & Gilbert, D. L. (2022) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2022.06.013 · Cited by 12 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Pringsheim, T., Ganos, C., Nilles, C., Cavanna, A. E., Gilbert, D. L., Greenberg, E., Hartmann, A., Hedderly, T., Heyman, I., Liang, H., et al. (2023) · European Journal of Neurology · doi:10.1111/ene.15672 · Cited by 72 · see citing works
Self-citationCavanna, A. E., Purpura, G., Riva, A., Nacinovich, R., & Seri, S. (2023) · European Journal of Neurology · doi:10.1111/ene.15867 · Cited by 23 · see citing works
Maxwell, A., Zouki, J.-J., & Eapen, V. (2023) · Frontiers in Pediatrics · doi:10.3389/fped.2023.1265123 · Cited by 18 · see citing works
Kozlowska, K., Schollar-Root, O., Savage, B., Hawkes, C., Chudleigh, C., Raghunandan, J., Scher, S., & Helgeland, H. (2023) · Children · doi:10.3390/children10111724 · Cited by 14 · see citing works
Self-citation
- Authors
- Martino, D., Hedderly, T., Murphy, T., Müller‐Vahl, K. R., Dale, R. C., Gilbert, D. L., Rizzo, R., Hartmann, A., Nagy, P., Anheim, M., Owen, T., Malik, O., Duncan, M., Heyman, I., Liang, H., McWilliams, A., O'Dwyer, S., Fremer, C., Szejko, N., Han, V. X., Kozlowska, K., & Pringsheim, T. M.
- Affiliations
- University of Calgary (CA)
- St Thomas' Hospital (GB)
- Great Ormond Street Hospital (GB)
- Medizinische Hochschule Hannover (DE)
- The University of Sydney (AU)
- Cincinnati Children's Hospital Medical Center (US)
- University of Catania (IT)
- Sorbonne Université (FR)
- Division of Neurodevelopmental Disorders Bethesda Children's Hospital Budapest Hungary
- Centre National de la Recherche Scientifique (FR)
- University College London (GB)
- King's College London (GB)
- Medical University of Warsaw (PL)
- Corresponding author
- Martino, Davide
- ORCID
- Martino, Davide
- Hedderly, Tammy
- Murphy, Tara
- Müller‐Vahl, Kirsten R.
- Dale, Russell C.
- Gilbert, Donald L.
- Rizzo, Renata
- Hartmann, Andreas
- Anheim, Mathieu
- Owen, Tamsin
- Malik, Osman
- Duncan, Morvwen
- Heyman, Isobel
- Liang, Holan
- McWilliams, Andrew
- Fremer, Carolin
- Szejko, Natalia
- Han, Velda X.
- Kozlowska, Kasia
- Pringsheim, Tamara M.
- Venue
- European Journal of Neurology
- Publisher
- Wiley
- Published
- 2022-11-06
- Volume
- 30
- Issue
- 2
- Pages
- 334-343
- ISSN
- 1351-5101 (ISSN-L)
- 1468-1331
- OpenAlex
- W4307210273
- Cited by
- 58
- References
- 31
- Citations by year
- 2026: 17 · 2025: 5 · 2024: 18 · 2023: 17 · 2022: 1
- FWCI
- 9.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Neurology (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Neurological and metabolic disorders
- Keywords
- adolescents and young adults, social media exposure, pandemic, anxiety comorbidity, comorbid depression, autism spectrum disorder, attention deficit hyperactivity disorder, complex movements, vocalizations, spontaneous regression, social modeling
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Attention Deficit Disorder with Hyperactivity, Female, Tourette Syndrome, Humans, Male, Retrospective Studies, Tic Disorders, Comorbidity, Tics, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
