FND Education Project

REFERENCE · RECOVERY

Functional Tics and Tic-Like Symptoms

Refers to:

For a fuller description of this symptom and the diagnostic techniques used to assess it, see Understanding & Diagnosis.

Assessed functional motor movements and vocal/phonic tic-like symptoms: sounds, throat clearing, words, phrases or combinations of movement and sound. Readers may call these functional tics, tic-like behaviours (FTLBs) or verbal tics. The research word “behaviours” does not mean intentional action. Scope boundary: Tics are not another name for functional jerks, speech or voice impairment, or cough. Tourette syndrome and other primary tic disorders need their own assessment and may coexist with functional tic-like symptoms. A new sound or word does not by itself establish which diagnosis applies.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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For the Person With FND

When tics interrupt a conversation, leave you sore or draw unwanted attention, “just ignore it” may not feel like much help. A useful plan makes room for both treatment and the life you are trying to live. You deserve help with distress, injury and communication even when symptoms are slow to change.

There is no single approach that fits everyone. The options below bring together clinical guidance, a small treatment case series and practical care planning. They are eight overview entries, not eight independently proven treatments. [1][4]

The eight detailed pages explain each entry below.

Recovery and treatment components

  1. Positive explanation and a shared plan. Ask the clinician to explain what supports the diagnosis, what remains uncertain and what help is available. Agree on one or two goals that matter to you, such as finishing a conversation or getting through a meal more comfortably. [Clinical consensus]

  1. Brief pattern and context mapping. If useful, note a few examples of what happened before, during and after symptoms, including discomfort, urges, surroundings and other people’s responses. Stop if tracking makes life revolve around symptoms; no warning or trigger has to be found. [Assessment and treatment-planning component; clinical consensus]

  1. Individually formulated behavioral or psychological treatment. A clinician familiar with both tics and FND can discuss an approach suited to your symptoms and priorities. I-CBiT combines several methods and has early case-series evidence. Its exercises, including exposure and response prevention, need individual assessment and consent; this page is not a home suppression programme. [Emerging evidence; uncontrolled series of eight young people]

  1. Supported return to routines and valued activity. Choose a manageable way to stay involved in something important, with breaks, help or adaptations as needed. Review effort, pain and recovery cost. Participation does not have to wait until symptoms disappear. [Clinical consensus; individualized rehabilitation principle]

  1. Coexisting-condition and medication review. Review a possible primary tic disorder, ADHD, OCD, anxiety, depression, pain, sleep difficulty or other FND when relevant. Medication may treat a coexisting condition; it is not automatically a treatment for the functional symptom mechanism. Change medicines only with the prescriber. [Coordinated care; clinical consensus]

Supporting care, safety and access

  1. Motor and vocal safety and communication planning. Plan safer handling of hot or sharp objects, seating and other tasks affected by movements. For vocal interruptions, agree how to finish a message: time, a pause, typing or writing may help. Accommodations protect access even when symptoms continue. [Safety and access planning; not a separately proven treatment]

  1. Family, school and workplace response planning. Agree who should know, what help you want and how others should respond. Options include a private break space, alternative presentations and a simple explanation of involuntary words. Avoid punishment, shame or demands to suppress symptoms to earn access. [Support and accommodation planning]

  1. Tic-attack, cluster and flare planning. For familiar intense bouts, agree how to reduce immediate hazards, offer calm support, allow recovery and recognize a change needing assessment. A prolonged bout is not automatically a functional seizure. A plan should work even when there is no warning. [Safety and relapse planning; clinical consensus]

The first five entries concern explanation, formulation, treatment and coordinated rehabilitation. The final three are supporting care. These categories help keep page counts separate from treatment evidence. The first-version list is recorded in the history audit.

What to expect from treatment evidence

The 2022 expert review reported no controlled treatment studies specific to functional tic-like symptoms. The 2023 I-CBiT report described improvement in eight young people, but had no control group. That cannot tell us how much improvement was caused by treatment, which component helped, or whether the results apply to older adults or other presentations. This page does not treat evidence for CBIT in primary tic disorders as direct evidence for functional tics. [1][4]

Later observational follow-up describes varied outcomes and associations with care for coexisting conditions. Those findings do not establish which treatment caused improvement. Persistent symptoms remain a reason for continued support. [6][7]

A plan can be revised if it is exhausting, painful or unhelpful. A useful question is: “Is this helping me do something I care about, at a cost I can manage?” Fewer tics can matter, but so can less injury, easier communication and being included. Continuing symptoms do not mean you have failed.

When a familiar bout happens

Use the plan you agreed with your care team. Where possible, put down dangerous objects and move to a safer position without restraint. A supporter can offer space, time and the agreed communication option. Afterwards, check for injury and allow recovery before deciding what to resume.

Seek appropriate medical assessment for a new or substantially different pattern. Serious injury, breathing or swallowing danger, marked confusion, acute neurological change or a possible serious medication reaction need urgent help. Do not automatically treat these as a familiar flare.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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For Family, Friends, and Other Supporters

Ask privately what would help. A person may want you to carry on with the conversation, offer a break or explain the symptoms to someone else—but they should have a say. Involuntary words are not a reliable expression of intent. Do not punish, mock or require an apology for them.

A calm response still includes care. It does not mean ignoring pain, injury or a request for help. If a clinician discusses how interactions affect symptoms, the aim should be to find helpful patterns together, without blaming the person or family. [1]

For school or work, write down a few agreed choices: who can be contacted, where a break is available, how the person can communicate or complete a presentation, and what counts as a medical change. Do not require suppression as a condition of participation.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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For Clinicians and the Care Team

Confirm the diagnostic formulation and record coexisting primary tics before selecting treatment. Develop goals with the person. Mapping should be brief and purposeful, avoiding excessive monitoring. Consider consent-based behavioral or psychological work, rehabilitation and treatment of coexisting conditions according to the individual formulation. Do not assume anxiety or trauma explains every presentation. [1]

Describe I-CBiT as an uncontrolled, multicomponent case series in eight young people. Do not present it as established comparative efficacy, copy its dose into universal instructions, or infer that urge acceptance, grounding or exposure is independently effective. Standard CBIT evidence from primary tic disorders is adjacent evidence, not a substitute for functional-tic trials. [4]

Review medication indications and adverse effects with the prescriber. Avoid assuming anti-tic medication treats the functional mechanism; a coexisting primary tic disorder or another condition may still justify it. Coordinate neurology/tic expertise, FND care, psychology, occupational therapy and speech-language support as needed. Assess both motor and vocal symptoms, injury, distress, access and participation over time. [1][5]

Community experience and review

No new patient quotations have been verified for this page. Motor and vocal experiences, helpful and harmful care, adult perspectives and supporter accounts remain explicit gaps in the source notebook. A quote about jerks or facial spasms will not be silently reassigned as a functional-tic diagnosis.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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Research and Sources

Entries 1, 2, 4 and 5 reflect individualized clinical guidance rather than independently tested treatments. Entry 3 includes preliminary I-CBiT evidence. Entries 6–8 are care-planning recommendations. The diagnostic consensus and critique explain why assessment and follow-up remain essential.

Citation Full citation and evidence limit
[1] Malaty IA, Anderson S, Bennett SM, et al. Diagnosis and management of functional tic-like phenomena. Journal of Clinical Medicine. 2022;11(21):6470. FND-CIT-0110. Source. Expert review; diagnostic formulation and individualized management. The review reported no controlled treatment studies specific to functional tic-like symptoms.
[2] Pringsheim T, Ganos C, McGuire JF, et al. European Society for the Study of Tourette Syndrome 2022 criteria for clinical diagnosis of functional tic-like behaviours: international consensus from experts in tic disorders. European Journal of Neurology. 2023;30(4):902–910. FND-CIT-0111. Source. Expert Delphi consensus. The publication explicitly states that prospective sensitivity and specificity testing was lacking; not a validated self-diagnostic checklist.
[3] Andersen K, Cavanna AE, Szejko N, et al. A critical examination of the clinical diagnosis of functional tic-like behaviors. Movement Disorders Clinical Practice. 2024;11(9):1065–1071. FND-CIT-0112. Source. Critical review of diagnostic reasoning, clinical benchmarks and coexistence. Supports transparent uncertainty, not dismissal of symptoms.
[4] Maxwell A, Zouki JJ, Eapen V. Integrated cognitive behavioral intervention for functional tics (I-CBiT): case reports and treatment formulation. Frontiers in Pediatrics. 2023;11:1265123. FND-CIT-0113. Source. Uncontrolled case series of eight young people. Reported improvement cannot establish causal efficacy, comparative benefit or generalizability to other populations.
[5] Szejko N, Robinson S, Hartmann A, et al. European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part I: assessment. European Child & Adolescent Psychiatry. 2022;31:383–402. FND-CIT-0114. Source. Primary tic-disorder assessment guideline; adjacent evidence for terminology and differential diagnosis, not functional-tic treatment evidence.
[6] Nilles C, Szejko N, Martino D, Pringsheim T. Prospective follow-up study of youth and adults with onset of functional tic-like behaviours during the COVID-19 pandemic. European Journal of Neurology. 2024;31(1):e16051. Source. Prospective observational cohort; treatment associations are not causal treatment comparisons. FND-CIT-0218.
[7] Ducroizet A, Eccles C, Lancaster R, et al. Outcomes of functional tics in adolescents: a single-centre tertiary study. Archives of Disease in Childhood. 2025;110(7):528–532. Source. Parent/carer interviews concerning 43 adolescents; selected service population and reported outcomes limit generalization. FND-CIT-0219.

Evidence check: September 24, 2026 · Human, clinical, lived-experience and accessibility review pending.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —