A person can develop tics as an adult, but the causes and the context surrounding this onset are typically distinct from the primary tic disorders that begin in childhood. While the vast majority of chronic tic disorders, such as Tourette Syndrome, first appear before the age of 18, a new onset of involuntary movements or sounds in adulthood requires thorough medical investigation. These adult-onset tics are often symptomatic of another underlying issue rather than a late manifestation of a primary, idiopathic tic disorder. When a new tic develops later in life, medical professionals focus on identifying a secondary cause, which may include neurological, pharmacological, or functional factors. Seeking an evaluation from a movement disorder specialist or a neurologist is the appropriate first step to determine the specific cause and guide effective management.
Distinguishing Adult-Onset Tics from Childhood Tics
Tics are sudden, brief, repetitive, and non-rhythmic movements (motor tics) or vocalizations (vocal tics). They are typically preceded by a premonitory urge, which is an uncomfortable sensation relieved by the tic itself. Primary tic disorders, which include Tourette Syndrome (TS), are neurodevelopmental conditions that must have an onset before the age of 18.
The course of childhood-onset tics often involves a peak in severity during early adolescence, followed by significant improvement by early adulthood in many cases. Adult-onset tics, particularly those beginning after age 21, are much less common.
When tics are truly new in adulthood, they are classified as “secondary” or “symptomatic” tics, meaning they have an identifiable external or medical trigger. Secondary tics are not considered part of the established spectrum of idiopathic (unknown cause) persistent tic disorders. This distinction means that a new tic in an adult necessitates a search for a specific underlying condition that is causing the movement disorder.
Underlying Causes of New Tics in Adults
The causes of new-onset tics in adults are grouped into secondary, medication-induced, and functional categories, all of which require a different treatment approach than primary tic disorders.
Secondary Tics
Secondary tics arise from acquired neurological conditions that affect the basal ganglia, the brain structures involved in movement control. Examples of these acquired causes include focal brain injury, such as from a stroke or head trauma, or infections like encephalitis. Certain neurodegenerative disorders, such as Huntington’s disease or Parkinson’s disease, can also manifest with tic-like movements. In some cases, patients developed tics following an identifiable event, such as a severe infection or cocaine use. These specific triggers suggest a disruption of the brain’s movement pathways, which are regulated by neurotransmitters like dopamine.
Medication-Induced Tics
This category usually involves drugs that alter dopamine signaling in the brain. Antipsychotic medications, which are designed to block dopamine receptors, are known to sometimes cause involuntary movements, including tics or a related condition called tardive dyskinesia. Stimulant medications used for Attention-Deficit/Hyperactivity Disorder (ADHD) can also trigger or exacerbate tics due to their effect on dopamine pathways. For medication-induced tics, stopping the offending drug may or may not lead to the complete resolution of the movement.
Functional Tic Disorder (FTD)
Functional tics, sometimes called psychogenic tics, are related to underlying psychological stress, anxiety, or conversion disorders. Functional tics often present as more complex, elaborate, and variable movements than typical organic tics, and they may not be preceded by the classic premonitory urge. There has been a documented increase in the rapid onset of these functional, tic-like behaviors, particularly among young adults, often associated with significant psychological distress.
Medical Evaluation and Diagnosis
The initial step for any adult who develops a new tic is a comprehensive medical evaluation, ideally by a neurologist specializing in movement disorders. The diagnostic process focuses heavily on a differential diagnosis, which is the systematic process of ruling out serious secondary causes before assigning a primary or functional diagnosis. A detailed review of the patient’s medical history is paramount, including all medications, recent infections, and any history of head injuries or substance use. The physical and neurological examination involves observing the tic characteristics, such as their complexity, rhythm, and suppressibility, to help differentiate organic tics from functional ones.
To exclude secondary causes, the following diagnostic tools are often used:
- Brain imaging, typically a Magnetic Resonance Imaging (MRI) scan, to rule out structural brain lesions or neurodegenerative conditions.
- Laboratory blood tests are also conducted to rule out infection, autoimmune disorders, or metabolic imbalances that can mimic or cause tics.
The goal of this thorough investigation is to ensure the tic is not a symptom of a condition requiring urgent or specific medical intervention.
Management and Treatment Options
Once a diagnosis is established, treatment for adult-onset tics is highly individualized and depends directly on the identified cause. If a tic is determined to be secondary to another medical condition, managing that underlying condition becomes the primary focus. For medication-induced tics, treatment involves adjusting or discontinuing the causative drug.
Behavioral therapy is considered a first-line treatment for managing tic symptoms in adults. Comprehensive Behavioral Intervention for Tics (CBIT) is the most evidence-based approach and involves two main components. The therapy teaches patients to become more aware of the premonitory urge and the tic itself. It then trains them to perform a competing response, which is a voluntary movement that is physically incompatible with the tic.
Pharmacological intervention is reserved for cases where tics cause significant impairment and behavioral therapy alone is insufficient. The medications used primarily target the dopamine system in the brain. Alpha-2 adrenergic agonists like clonidine are often used as a first-line option. Anti-dopaminergic medications, such as certain antipsychotics, are highly effective but carry a higher risk of side effects like tardive dyskinesia and metabolic issues.