Rapid onset of functional tic-like behaviours in young adults during the COVID-19 pandemic

Background and purpose Clinicians have reported an increase in functional tic-like behaviours in children and youth during the COVID-19 pandemic. We describe adults developing rapid onset of functional tic-like behaviours between May 2020 and June 2021. Methods Data were analysed from the Adult Tic Disorders Registry, a single-site,12-month prospective cohort study that began enrolment in January 2021. We compared clinical features of participants with Tourette syndrome or persistent motor/vocal tic disorder to participants with rapid onset tic-like behaviours. Results Thirty-three participants registered between January and June of 2021; nine had rapid onset tic-like behaviours, and 24 had Tourette syndrome or persistent motor tic disorder. Participants with rapid onset tic-like behaviours were younger (19.9 vs. 38.6 years, p = 0.003), had older age at onset (15.3 vs. 10.1, p = 0.0009), and were more likely female (p < 0.0001). They had higher motor and vocal tic severity and impairment scores (all p < 0.01) and were more likely to have complex arm/hand motor tics (p < 0.0001), complex vocal tics (p < 0.0001), and coprolalia (p = 0.004). They had significantly higher scores on all mental health symptom self-report measures (all p < 0.05) and were significantly more likely to be diagnosed with depression (p = 0.03). Conclusions The clinical features that help differentiate rapid onset tic-like behaviours from Tourette syndrome or persistent motor tic disorder include their phenomenology, onset age, and clinical course. Rapid onset tic-like behaviours are a distinct subtype of functional neurological disorder that has emerged during the COVID-19 pandemic in young people and appears to be strongly socially influenced.

Automated summary

Clinicians have observed an increase in functional tic-like behaviors during the COVID-19 pandemic in children and youth. This study describes the development of rapid-onset functional tic-like behaviors in adults between May 2020 and June 2021. These behaviors are characterized by a younger age of onset, higher severity and impairment scores, and a higher likelihood of complex motor and vocal tics, as well as coprolalia. Participants with rapid-onset tic-like behaviors also reported higher levels of mental health symptoms and were more likely to be diagnosed with depression. This subtype of functional neurological disorder appears to be strongly influenced by social factors related to the COVID-19 pandemic.