Tics are sudden, involuntary movements or sounds, for example shoulder shrugging or clearing the throat. Tics are typically symptoms of Tourette Syndrome and tic disorders which occur in around 1% of children and young people. Tics can be very upsetting and can impact quality of life.
During the coronavirus (COVID-19) pandemic, doctors noticed an increase in tics, particularly in teenage girls. This is unusual because tics in Tourette Syndrome and tic disorders usually begin in early childhood and are more common in boys.
The aim of this study is to show how many children and young people visited their doctors about tics before and during the pandemic. We will look at this overall and by age group (4 to 11 years and 12 to 18 years) and sex (males and females), to see if we can detect an increase in tics in teenage girls during the pandemic. We will look at the characteristics of children and young people who first visited their doctor about tics before the pandemic (in 2015 to 2019) and during the pandemic (2020 and 2021).
The results of this study could provide evidence to support the pattern that doctors reported – that there was a change in the numbers of people, especially teenage girls, who had tics during the pandemic compared to before the pandemic. This will help show the extent of the problem and who has been affected. This would help to identify where future support is needed and help healthcare professionals provide appropriate care.
The study aims to describe and compare the incidence of tics in children and young people in primary care before and during the coronavirus (COVID-19) pandemic. Monthly incidence rates of tics before (2015-2019) and during (2020, 2021) the pandemic will be calculated, stratified by age group (4-11 years, 12-18 years) and sex. The characteristics of children and young people with a first tic record in three time periods (2015-2019, 2020, and 2021) will be presented. Monthly incidence rates will be compared according to study period to assess whether the monthly rates were altered during the pandemic.
The study population will include people in CPRD Aurum aged 4-18 years in England with eligible follow-up and a first tic record during the period 01 January 2015 to 31 December 2021. To assess incidence, everyone in the study will need at least one year of practice registration before their first tic record.
The outcome is a first tic record during the study window. Monthly incidence rates will be calculated using the CPRD Aurum denominator data and presented according to age group and sex.
Demographic characteristics (age, sex, ethnicity, deprivation score, practice region) and comorbidities (autism spectrum disorders, attention deficit hyperactivity disorder, self-harm, eating disorders, obsessive compulsive disorder, anxiety, and depression) will be described according to study period of first tic record.
The monthly incidence rates of tics will be compared using Poisson or negative binomial regression, as appropriate. Interactions with study period, age group, and sex will be included in the models to test whether the monthly incidence rate for subgroups was altered during the pandemic years (2020, 2021) compared to pre-pandemic (2015-2019).
The study will help identify areas for future service development and will help healthcare professionals understand who may be most vulnerable to developing tics in response to significant environmental stressors.
Incidence of tics
Chris Hollis - Chief Investigator - University of Nottingham
Ruth Jack - Corresponding Applicant - University of Nottingham
Carol Coupland - Collaborator - University of Nottingham
Charlotte Hall - Collaborator - University of Nottingham
Ruth Jack - Collaborator - University of Nottingham
Yana Vinogradova - Collaborator - University of Nottingham
Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation