‘Robust’ Increase in Tics During the Pandemic Explained?

Updated March 4, 2022 // Editor’s note: This story has been updated with additional comments from Davide Martino, MD, PhD, of the University of Calgary, Canada.

Early results from a new study show a significant correlation between tic initiation and social media use during the COVID pandemic in adolescents with a preexisting tic disorder.



Dr Jessica Frey

The findings should help answer questions surrounding a recent increase in tic disorders, lead author Jessica Frey, MD, a movement disorders fellow at the University of Florida, Gainesville, told Medscape Medical News.

“We’re trying to learn why there are new onset explosive tic disorders [or] functional tic disorders, and to find ways to educate patients, parents, and the general public about what Tourette Syndrome looks like — and how we can help patients have a better quality of life,” Frey said.

The findings will be presented at the American Academy of Neurology (AAN) 2022 Annual Meeting in April.

“Robust” Increase

A neurologic disorder that causes sudden repetitive involuntary muscle and sounds, Tourette Syndrome typically develops in childhood, increasess in adolescence, and improves or completely disappears in adulthood, Frey noted.

The condition is often negatively portrayed in films, showing people using obscene gestures or vulgar language, she said. Although social media can be an “empowering tool” for tic sufferers, it is unregulated and can be a vehicle for “false information,” she added.

Frey noted that during the pandemic, there has been a “robust” increase in use by teens of social media, particularly TikTok. At the same time, there have been reports of teen girls experiencing “explosive tic onset” that mimics videos from TikTok influencers.

The new analysis included 20 teens with a tic disorder, ranging in age from 11-21 years (average age, 16 years). About 45% of participants identified as male, 45% as female, and 10% as nonbinary.

The nature of the tic disorder varied widely among participants. Some had experienced tics for many years, while others only developed tics during the pandemic.

Participants completed a detailed survey, part of which inquired about where they received information about tics, such as from a doctor, media, parents, or teachers.

They were also asked to rank various social media platforms, including Tik Tok, Facebook, and YouTube on a five-point Likert scale as an information source about tics.

In addition, the survey inquired about tic severity and frequency, quality of life, and whether the pandemic or social media affected respondents’ tics.

Worsens Quality of Life

Results showed 65% of respondents used social media at least four to five times per day for an average of 5.6 hours per day. Approximately 90% reported increased use of social media during COVID.

Only 5% of participants reported using social media to provide information about tics.

About half of respondents indicated social media adversely affected their tics, and 85% said their tic frequency increased their frequency during COVID.

Frey noted that because teens had to attend school virtually, that may have led to increased hours spent online.

There was no significant correlation between social media use and self-reported frequency of tics since the onset of COVID (Pearson correlation coefficient [R] = -0.0055, P = .982).

However, there was a statistically significant correlation between social media use and tic severity (R = – 0.496, P = .026) and quality of life (R= -0.447, P = .048).

These results suggest teenagers did not develop more tics, but rather the tics they already had worsened and affected their quality of life, Frey noted. She added that teens sometimes injure themselves while experiencing tics.

The full study has now enrolled 50 participants, and investigators anticipate that number to go up to 80. “We’re hoping to see more patterns when we have a larger cohort of data available,” said Frey.

Asking parents to weigh in on the impact of social media on their child’s tic condition would be “a great idea for a follow-up study,” she added.

Symptoms Exacerbated

Commenting on the findings for Medscape Medical NewsTamara Pringsheim, MD, professor in the Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences at the University of Calgary, Canada, said she also has noticed the impact of increased social media use on young patients with tics during the pandemic .

“Many young people report that seeing other people with tics, or tic-like behaviors, can exacerbate their own symptoms,” said Pringsheim, who is the university’s Program Lead on Tourette and Pediatric Movement Disorders.

She noted a principle of the Comprehensive Behavioral Intervention for Tics, which is a nonpharmacologic technique demonstrated to reduce tic severity, is to identify anticedents or triggers for tics, and to learn to manage them. It might be a good idea to remind young patients of this principle, said Pringsheim, who was not associated with the current research.

“I suggest to young people who report specific social media content as a trigger for symptoms to recognize the effect of the exposure on their symptoms and make an informed choice about what they view and how much time they spend on social media,” she added.

Also commenting for Medscape Medical NewsDavide Martino, MD, PhD, associate professor of neurology and director of the Movement Disorders Program, University of Calgary, Alberta, Canada, said the survey is “very timely” as there has been very limited data on social media consumption in individuals with tics.

The nearly 6 hours per day that adolescents with tics reported using social media on average is “strikingly high,” Martino noted.

But perhaps the finding of a correlation between social media use and tic severity during the pandemic isn’t surprising, because “anxiety fuels tic incision,” he added.

He noted a 2019 study from before the pandemic that concluded adolescents spending more than 3 hours per day on social media may be at greater risk for mental health problems, particularly depression and anxiety.

“As we return to a lifestyle that is closer to pre-pandemic standards, this study prompts clinicians to follow more closely social media consumption in people with tics,” Martino said.

The study did not receive and outside funding support. Free has disclosed no relevant financial relationships.

American Academy of Neurology (AAN) 2022 Annual Meeting: Abstract 606. To be presented April 7, 2022.

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