The Phenomenology of Tics and Tic-Like Behavior in TikTok

Background: Pediatricians and pediatric subspecialists worldwide have reported a marked increase in functional (conversion) disorders with tic-like behaviors during the COVID-19 pandemic. These patients often report frequent viewing of Tourette syndrome (TS) TikTok videos, suggesting disease modeling. We aimed to evaluate tic phenomenology in videos posted on TikTok.Methods: The 100 most-viewed videos under #tourettes in TikTok were randomly assigned to two of three primary reviewers (<2 years independent practice), all pediatric neurologists specializing in movement disorders, for extraction and classification of tic phenomenology. Initial disagreements were solved by consensus. If not resolved, one of five senior reviewers (>2 years independent pediatric movement disorder practice) served as a tiebreaker. In addition, two primary and one senior reviewer rated each video on a Likert scale from 1 = All the tics are typical of TS to 5 = None of the tics are typical of TS. Median scores and Spearman correlation between primary and senior reviewers were calculated.Results: Six videos without tic-like behaviors were excluded. Most videos depicted coprophenomena (coprolalia: 53.2%; copropraxia: 20.2%), often with unusual characteristics. Frequently, videos demon-strated atypical phenomenology such as very strong influence by the environment (motor: 54.3%; phonic: 54.3%), aggression (19.1%), throwing objects (22.3%), self-injurious behaviors (27.7%), and long phrases (>3 words; 45.7%). Most videos portrayed atypical, nontic behaviors (median [IQR] Likert ratings: 5 [4-5]). Primary vs. senior rater scores demonstrated moderate agreement (r 1/4 0.46; P < 0.001).Conclusions: TS symptom portrayals on highly viewed TikTok videos are predominantly not represen-tative or typical of TS.(c) 2022 Elsevier Inc. All rights reserved.

Automated summary

Pediatricians and pediatric subspecialists have observed an increase in functional disorders with tic-like behaviors during the COVID-19 pandemic. Most TikTok videos under #tourettes depict atypical tic phenomenology that does not represent typical Tourette syndrome symptoms, suggesting a potential influence of social media on disease modeling.