This is a very uncommon form of tic disorder found in 1 in 10,000 children, especially males. The disorder usually begins in the school age period, and initially the child develops motor tics, affecting any muscle group in the body. Very often the tics then become more prominent, affecting multiple parts of the body, and then the child develops involuntary vocal tics. This may include grunts, barks and yelps, and then may progress to repeating the last words that he or a peer utters (echolalia). In about 40% of these children, the vocal tics may include rude or obscene phrases (coprolalia).
The cause of this condition is unknown, but it seems to have a genetic basis, often with a family history. Occasionally the condition appears to be precipitated by the administration of psychostimulant medication such as methylphenidate (Ritalin) or amphetamines which have been prescribed for ‘hyperactivity’ or attentional problems. The condition is associated with learning and behavioural problems, and sometimes language difficulties also occur.
This is a distressing and disabling condition which fortunately is very uncommon, and should not be confused with the common tics described above. Treatment consists of diagnosis and specific medications and ongoing management is best undertaken by a paediatrician or child neurologist. In many cases these children improve as they get older.
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