As a result of the pandemic, there was a significant increase in the number of teens experiencing functional tic-like behavior, which can be similar to Tourette syndrome but has a different origin. A study conducted at Boston Children’s Hospital found that about 80% of these teens’ symptoms improved after pandemic restrictions were lifted, even if they were treated, but a minority continued to experience extensive mental health problems, indicating deeper psychosocial effects.
The Journal of Brain and Behavior published the study.
The emergence of functional tic-like behavior was particularly puzzling, as it almost always arises suddenly in people with no known history of tics, and many of those cases were directly related to social media use – mostly in the case of TikTok, as teens shared their thoughts on videos posted by online influences in some cases – and some teens join in on videos mimicking these symptoms – raising concerns over the impact of tics on vulnerable youth through digital means.
TikTok tics are often classified as a social disease, as they are believed to involve social or environmental exposure rather than biological factors, and this may have made teens playing on TikTok during the pandemic more susceptible to having symptoms. Many of these influencers created online communities to share their experiences and provide validation and support, such as online support groups for people isolated by pandemic restrictions, which often became their lifelines.
Despite this, constant exposure to tic-like behaviors through videos may have inadvertently primed their brains to repeat these behaviors. On the other hand, TikTok tics are not such a thing and, unlike traditional tics, occur in rapid, repetitive increments.
TikTok’s popularity was associated with other pandemic-related stressors, such as school closures, social isolation, and increased rates of anxiety and depression in teens. Many researchers believed that the combination of psychological vulnerability, pandemic-related stress, and social media exposure created a perfect storm for the development of functional tic-like behaviors. This theory agreed with earlier theories of mass psychological illness, where symptoms spread to those close to oneself or in close proximity, such as at school or the workplace. However, this theory was more sensitive and in some circles.
The study, conducted by researchers at Boston Children’s Hospital, investigated three key questions that aimed to address the causes of functional tic-like behavior, changes that occurred after pandemic restrictions were lifted, and the effectiveness of treatment strategies.
To investigate these findings, the researchers conducted a retrospective study, analyzing medical records of adolescents who displayed symptoms suggestive of functional tic-like behavior. The study included 56 patients aged 10 to 18 years who developed the behavior between March 2020 and the end of the pandemic. They used standardized clinical scales to assess symptom improvement and overall functioning.
The assessment of outcomes involved two primary tools: the Clinical Global Impression Improvement Scale (CGI-I) and the Clinical Global Impression Severity Scale (CGI-S). The CGI-I measured the development of tic-like behaviors, while the CGI-S provided a more comprehensive view of patients’ mental health and functional abilities.
Patients who scored 1-2 on the CGI-I test were found to have significant improvement, while patients who scored 3 or more showed no improvement. Similarly, a CGI-S score of 1-3 indicated that patients had no functional impairment, while patients with a score of 4 or more indicated moderate to severe impairment. Follow-up assessments were conducted from August 2022 to January 2023, with a median follow-up period of 518 days.
The results showed cognitive behavioral intervention (CBIT), general mental health therapy, and medication – 79% of patients showed improvement in tic-like behaviors as measured by the CGI-I.
Investigations indicated that tic-like movements do not always impair overall recovery. While 71% of patients evaluated had no functional impairment at follow-up, the remaining 29% experienced moderate to severe difficulties with mental health and psychosocial functioning.
Additionally, the study population was overwhelmingly Thanksgiving Day obese. Psychogenic non-epileptic seizures, dissociative episodes, or functional gait impairment were among other functional neurological symptoms.
It is curious to find that treatment style has no significant impact on the chances of improvement. 86% of patients opted for psychotherapy, including CBIT, and 91% received SSRIs, but neither method was more successful.