Generalized tics in children prognosis. Nervous tics in children. How to deal with them? Non-drug treatments

Hello, dear readers. In this article, we will talk about what constitutes a nervous tic in a child. You will find out what are the manifestations of this condition. Find out what can influence the occurrence of tics. Let's talk about methods for diagnosing and treating ticks. You will be aware of preventive measures.

Definition and classification

Nervous tics are called muscle contractions of a pathological nature, which appear episodically or regularly. In babies, as a rule, it has a paroxysmal type. An aggravation of the condition is most often observed in the presence of an unpleasant or dangerous situation.

Distinguish between local and generalized nervous tics. The former are contractions of single muscle groups, the latter are several.

Distinguish:

• vocal;
• mimic tics;
• motor.

According to the duration, they are distinguished:

• transistor - last less than a year, are able to disappear on their own, and then reappear;
• chronic - characterized by long-term presence, more than a year.

Nature of occurrence

Severe fear can lead to a nervous tic in a child

The reasons why a nervous tic can develop are most often the following:

• hereditary predisposition;
• lack of attention of parents or their overprotection;
• early transferred infectious disease, especially influenza, intoxication of the body;
• dysmetabolic or organic lesions in the brain, excess dopamine production;
• restless environment - situations when the baby cannot feel protected in a team or in a family, experiences excessive nervousness, which subsequently results in the occurrence of tics;
• excessive mental stress, excessive demands placed on the child regarding studies or sports achievements;
• improper diet - a situation where there is a lack of vitamins and trace elements in the baby's body, in particular magnesium or calcium;
• Excessive consumption of drinks that have a disturbing effect on nervous system(coffee, strong black tea);
• severe stress - it can be constant domestic scandals, and divorce of parents, the presence of an alcoholic in the family, the death of a relative or friend, sexual or physical abuse.

Characteristic manifestations

Mimic tick

There are certain symptoms that may indicate the presence of a tic. Home distinctive feature is the absence of manifestations at night.

Signs of facial tics include:

• change in the lumen of the nostrils;
• wrinkling of the nose, which is unnatural;
• tension of nasal wings;
• closing and opening of the mouth;
• twitching of lips, cheeks;
• "twitching eye", constant, squinting;
• trembling of the chin;
• eyebrow movement;
• circular eye movements.

Vocals include:

• frequent smacking, sniffing, mumbling;
• pronunciation of certain sounds;
• uncontrollable need for obscene, cynical swearing, pronunciation of curses;
• constant repetition of words previously heard from other people;
• the child's need to repeat phrases or individual words over and over again, while there is an increase in the speed of pronunciation, a change in the intonation of the voice;
• illegibility may be observed.

The presence of motor tics is indicated by the following signs:

• obscene gestures;
• sudden start;
• recalculation of certain objects;
• indecent actions;
• constant touching of certain parts of the body;
• inattention;
• fussiness;
• excessive impatience;
• special attention to personal hygiene;
• arranging objects in a certain sequence;
• inability to bring what has been started to the end;
• lack of perseverance;
• excessive noise.

Diagnostics

In certain cases, providing good nutrition can get rid of nervous tics.

Let's figure out what to do if you suspect that your child has a nervous tic.

First of all, you need to take care of identifying the factors that influenced the development of this condition. If the tick is not aggravated by any complications, then the essence of the treatment, depending on the causes, is as follows:

• psychological support of the child's close environment, establishing contact with the baby, building trust, providing increased attention if there was a lack of it before;
• procedures to calm the nervous system: relaxing baths with the addition of essential oils, massage;
• soothing decoctions can be used, for example, with valerian root or mint;
• it is important to provide the child good nutrition enriched with everything necessary for a growing organism;
• strengthening children's immunity;
• normalization of intellectual loads;
• relaxation of the daily regimen, the correct calculation of time for rest and vigorous activity;
• if the situation around the child provokes the occurrence of tics, it needs to be changed;
• provide the baby tactile contact, kiss, hug him;
• If you cannot cope with the problem on your own, seek the help of a psychologist. The specialist will help determine the causes that influenced the occurrence of tics and their treatment.

The doctor may also prescribe medication. It may include:

• the use of sedatives to improve sleep, reduce anxiety, normalize the functioning of the nervous system (Novopassit, Valerian extract);
• nootropics - improve cerebral circulation, strengthen the nervous system, increase stress resistance (Phenibut);
• antipsychotics - reduce the manifestation of phobias, relieve tension (Sonapax);
• tranquilizers - prescribed in especially severe cases to reduce anxiety, get rid of the manifestations of phobias, to have a beneficial effect on sleep, relieve muscle tension (Relanium, Diazepam);
• with a lack of Magnesium or Calcium in the body, it is necessary to replenish these elements either with the help of a specialized diet, or by taking medications, in particular, Magnesium B6, calcium gluconate.

Precautionary measures

To reduce the risk of tics in your baby, you need to apply the following actions.

1. Timely notice that the child is worried about something, discuss his problems with him.
2. If there is a change in the usual environment, be especially attentive to your child, monitor his behavior, support him.
3. If any repetitive movements, twitches occur, it is not necessary to concentrate the child's attention on this.
4. Give your child the right daily routine. Make sure your daily routine includes different kinds activities: intellectual, physical, as well as recreation.
5. Limit sitting at the computer and TV.
6. Provide your child with a balanced diet.
7. Minimize the impact of stressful situations, do not swear in the presence of the baby.
8. Ensure healthy sleep.
9. Spend enough time on fresh air.
10. Strengthen your child's immunity. Remember the option with .

Now you know that blinking your eyes can indicate the presence of a nervous tic. If you notice a similar manifestation in your baby, it is better to consult a doctor, you may need his help. Do not close your eyes to what is happening, hope that everything will pass by itself. It is very important to notice the problem in time, identify the cause of its occurrence and begin the necessary treatment.

Tic spasm in children is a neurological disorder that is a type of hyperkinesis (uncontrolled body movements). Today, almost every fifth baby suffers from this pathology.

The disease occupies one of the leading places among neurological disorders. Increasingly, it affects newborns, although most cases occur in children older than two years. How to recognize and treat this disease? How serious is he? What are the main reasons for its sudden appearance?

What is a nervous tic and how does it manifest itself in children?

Spasmodic movements of the same type that occur spontaneously and cannot be controlled are called a nervous tic. Similar reflex muscle contractions appear mainly in stressful situations. Most often, a tick is observed on the neck and face in the form of twitching of the lips or eyelids, blinking, sniffing, shuddering of the shoulders and head. Less commonly, tics affect the arms and legs. In some cases, spasm may first manifest as a twitch of the eyelid, and then move to the lips.

Tic movements affect about 25% of young children. Most often, tic symptoms appear in the period from 6 to 7 years, when the kids become first graders, and they have to adapt to a new team.

In children, this disorder can manifest as grinding of teeth, pulling out hair on the head, swaying of the legs and arms, noisy breathing, sneezing, grunting, etc. This disease is more common in boys.

Tick ​​classification

The main types of nervous tics in children:

• motor;
• vocal;
• generalized;
• ritual.

According to the etiology, nervous tics are:

By the nature of the flow:

• transient;
• chronic (remitting, stationary, progredient);
• Tourette syndrome.

According to symptoms:

• local;
• common;
• vocal;
• generalized.

Depending on the severity of the pathology:

• single;
• serial;
• tic.

Main types

Vocal

Vocal tics (or sound) in children are expressed in the form of coughing, sniffing, shouting obscene words, repeated pronunciation of the same words and expressions. This type muscle spasms is divided into simple and complex tics. The first variety is represented mainly by low sounds: noisy breathing, coughing, grunting, “clearing the throat”. Sometimes there are also high-pitched sounds such as whistling, screeching, “uf”, “ay”, “i”, “af”.

The second type of vocal tics occurs in 6% of children with Tourette's syndrome. Patients repeat curses, shout out the same words, say something quickly and unintelligibly.

Motor

Motor tics include muscle spasms of the upper and lower extremities: stomping and shuffling feet, high jumps, clapping, rocking, tapping, various movements of the head and shoulders.

If the child turns his head to the side or throws it back, blinks rapidly, grimaces, sniffs, taps his fingers on the table, opens his mouth wide, or makes other body movements that are beyond his control, then this means that the child has a motor muscular tic.

This type of tic pathology is divided into:

• simple (uncontrolled head movements, abdominal muscle tension and retraction, eye squinting, etc.);
• complex (vulgar gestures, bouncing in one place, hitting one's own body, repeating the same gestures).

Generalized

If nervous tics involve several muscle groups in one child at the same time, for example, the child tightens his lips, twitches his shoulders, blinks frequently and at the same time makes repeated sounds, then we are talking about a generalized form of tics. The main reasons for the simultaneous contraction of all muscles in a child are:

Ritual

The group of ritual nervous tics includes muscle spasms associated with any action. For example, involuntary monotonous walking from one side to another or in a circle, winding hair around a finger, straightening it, biting nails, twitching the earlobe, etc. Some children begin to complex due to the fact that they do not notice such behavior in themselves.

Classification by the nature of the flow

Transient tics

Most often occur on the neck, arms, torso, in the eye area. They do not last long and are not dangerous for the health of the child. They appear as:

• frequent licking of the lips;
• blinking, twitching and blinking of the eyes;
• tongue protrusion;
• frequent grimacing.

Transient tics are characterized by:

• high frequency of manifestation;
• lack of rhythm
• short duration;
• spontaneity of manifestation.

Chronic tics

Chronic tics are those that do not go away for more than one year. This pathology is quite rare. Sometimes it is called a mild form of Tourette's syndrome, but still distinguished as a separate group.

This type of tic disorder is characterized by mimic (nervous tic of the eye) and motor disorders. Diseases are characterized by periods of exacerbation and remission of different duration.

Tourette syndrome

This pathology is characterized by a combination of vocal and motor tics. Tourette's syndrome affects babies as young as 5 years old and can last until the age of 15, after which the symptoms subside.

Pathology first affects the face, then the muscles of the arms, legs, neck, torso are involved. In some patients, muscle spasms disappear without a trace, in others they remain for life.

A child with Tourette's syndrome is distracted, restless, too vulnerable. Half of adolescents suffering from Tourette's pathology develop obsessiveness syndrome. It is manifested by groundless fears, thoughts and actions. These phenomena are beyond the control of the patient, so he cannot suppress them.

Causes

The main causes of tic movements in children:

Also, tic movements can occur due to:

• taking certain medications;
• skull trauma;
• intoxication;
• infectious lesions of the brain;
• neoplasms (malignant or benign) in the brain;
• genetic pathologies.

Features of the course of tics in children

Tick ​​disease in children proceeds in different ways. A problem may appear in a child's life suddenly. It can just as suddenly disappear without requiring treatment. However, there are cases when the disease drags on for several years and is accompanied by pronounced symptoms and changes in the behavior of the child.

Toddlers with tics are very irritable, constantly in a state of anxiety, it is difficult for them to concentrate on anything, they have impaired coordination of movements and sleep. Such children do not like to ride in public transport, they cannot stand stuffiness, it is difficult to fall asleep and sleep restlessly.

The disease makes itself felt when the child begins to worry about something. As soon as the baby's attention shifts and he concentrates on something else (for example, a game), the tics go away on their own. The severity of the pathology depends on the mood of the child and his psycho-emotional state, as well as on the time of year and time of day.

Diagnostics

In order to diagnose a child with a nervous tic, he must be examined by a neurologist, psychologist and psychiatrist. A comprehensive survey includes the following activities:

In about 15 cases out of 100, the primary signs of the disease go away on their own, without requiring therapy. The remaining cases require immediate treatment that can prevent unwanted consequences.

Treatment of tics

First of all, after diagnosing a nervous tic in a child, it is necessary to exclude the factors that provoke it. You can get rid of the problem by:

• creating a favorable psychological environment in the family;
• exclusion of excessive physical and psychological stress;
• rational nutrition;
• limiting stay at the computer, listening to loud music, reading books in a supine position;
• good sound sleep.

If the pathology is severe, the child is prescribed medication. However, in some cases, a nervous tic can be cured using traditional medicine methods.

Medical

The basis of drug treatment is the use of sedatives and sedatives. The type of drugs prescribed by the doctor depends on the duration of the disease and its symptoms. It can be both weak (motherwort, valerian), and very strong (up to psychotropic) drugs. Groups of drugs prescribed against ticks:

Folk remedies

If the disease is mild, then a positive effect can be achieved using traditional medicine methods. Such therapy, as a rule, is aimed at reducing nervous tension. Before treating a child with home remedies, a pediatrician should be consulted to prevent complications. Folk recipes to help overcome a nervous tic in a child:

1. Hawthorn decoction - 2 tbsp. fruit pour 1/2 tbsp. hot water and let it brew for 15 minutes. It is necessary to drink the resulting tincture 15-20 minutes before a meal.
2. Chamomile tincture - Pour a handful of plant petals with a glass of hot boiled water and let it brew for about 15 minutes. Ready broth must be drunk every 4 hours for half a glass at a time.
3. Valerian root decoction - 1 tsp crushed root should be boiled for 15 minutes in 1 tbsp. water. The resulting medicine should be given to the baby at bedtime or 30 minutes after eating, 1 tsp.
4. Bath with pine needles and sea salt has a relaxing effect.

Famous pediatrician Komarovsky E.O. believes that nervous spasms in children are psychogenic in nature. For this reason, it is not recommended to treat them with drugs. Evgeny Olegovich emphasizes that in most cases this pathology disappears without outside help. All responsibility for the rapid improvement of the condition of the baby rests with the parents.

What should moms and dads do if a child is diagnosed with a nervous tic? The main task is to eliminate the disease by conducting confidential conversations with the child. The sooner you can find the cause of the appearance of muscle spasms, the sooner the child will get rid of the habit of transforming the pathology into a nervous tic.

For citation: Fesenko Yu.A., Lokhov M.I., Rubina L.P. Modern approach to the diagnosis and treatment of tic disorders in children // RMJ. 2005. No. 15. S. 973

Introduction The word “tic” refers to fast, involuntary, stereotypically repetitive movements of certain muscle groups or, in other words, various automated habitual elementary movements. More often this applies to the muscles of the face: blinking, blinking, wrinkling, frowning, sniffing, puffing the wings of the nose, licking the lips, stretching the mouth, smacking, "grimaces". More complex movements are often noted - twitching the head, twitching the neck, moving the shoulders, limbs, parts of the body, as well as squatting, dancing, retracting the abdomen, coughing, heavy sighs, "grunting", intermittent, stutter-like speech, "grunting" sounds, squeaking (the so-called respiratory tics, otherwise - focal tic movements), which arise as a result of the fixation of some protective action, which at first had an expedient protective character (“blinking a mote”, coughing with a cold, etc.). In other words, the development of tics can be represented as follows: at first they arise for a specific reason, for example, twitches of the neck appear, as if releasing from a tight collar, tie, or movement of the body in connection with the tightening elastic band of the underpants. Children may lick their lips when they are dry, or frown when their hair is long and covers their eyes. In children, such actions are very quickly fixed according to the type of pathological conditional connection and are subsequently repeated without an external stimulus. Sometimes tics are a consequence of certain diseases. For example, blinking occurs as a result of transferred conjunctivitis. Later, these movements are fixed and remain for a long time after the inflammatory process in the eye area subsides.

Introduction
The word "tic" refers to fast, involuntary, stereotypically repetitive movements of certain muscle groups or, in other words, a variety of automated familiar elementary movements. More often this applies to the muscles of the face: blinking, blinking, wrinkling, frowning, sniffing, puffing the wings of the nose, licking the lips, stretching the mouth, smacking, "grimaces". More complex movements are often noted - twitching the head, twitching the neck, moving the shoulders, limbs, parts of the body, as well as squatting, dancing, retracting the abdomen, coughing, heavy sighs, "grunting", intermittent, stutter-like speech, "grunting" sounds, squeaking (the so-called respiratory tics, otherwise - focal tic movements), which arise as a result of the fixation of some protective action, which at first had an expedient protective character (“blinking a mote”, coughing with a cold, etc.). In other words, the development of tics can be represented as follows: at first they arise for a specific reason, for example, twitches of the neck appear, as if releasing from a tight collar, tie, or movement of the body in connection with the tightening elastic band of the underpants. Children may lick their lips when they are dry, or frown when their hair is long and covers their eyes. In children, such actions are very quickly fixed according to the type of pathological conditional connection and are subsequently repeated without an external stimulus. Sometimes tics are a consequence of certain diseases. For example, blinking occurs as a result of transferred conjunctivitis. Later, these movements are fixed and remain for a long time after the inflammatory process in the eye area subsides.
World practice and our own experience (more than 1,000 children with tics aged 3 to 15 years have been examined) allows us to attribute this disease to the category of serious brain disorders, perhaps no less serious than epilepsy. According to the international classification of diseases, tic disorders are included in the section of mental illness and are associated with metabolic disorders in the block of regulation and control of voluntary actions.
The trigger mechanism in the occurrence of tics can be acute or chronic mental trauma, improper upbringing of the child. It is possible that tics can develop in children through imitation mechanisms: for example, a child repeats some familiar actions of adults or movements of animals, which gradually becomes fixed.
It is believed that tics are more common between the ages of 7 and 12 years and are a very common childhood pathology (according to some authors - in 4.5 - 23% of children aged 2 to 13 years). They are 2-4 times more common in boys than in girls. Although tics can occur in adults, in most cases they appear in children. Often, tics get worse as puberty approaches and gradually decrease with age.
The first mentions in the literature date back to the middle of the 7th century, when "tics" were called "the habit of muscles to contract." In the next century, the terms "tic hyperkinesis" and "pain tics" appeared, and Babinskiy (1906) and Janet (1912) at the beginning of the 20th century called tic movements "a caricature of obsessive movements" (cited in ). In short, tics were seen as a functional disorder. And only in the 50s of the twentieth century began to study the organic nature of tics. In the 70s, the priority scientific hypothesis was considered to be the presence of a systemic weakness of the striopallidar functional mechanisms, which can be both acquired in connection with the residual effects of an early organic lesion, and congenital, including familial hereditary. Currently, it is believed that tics occur when the nuclei of the extrapyramidal system are damaged in the prenatal period or during the neonatal period.
Tick ​​classification
Over the past 300 years of active interest in the problem of tics, many typologies have been put forward, in which their authors set the task of streamlining the existing knowledge about this complex pathology.
Late XIX century:
habitual tic (usual but unmotivated movements);
- convulsive tic (rapid, sudden movements);
- tonic tic (prolonged muscle contraction).
Late 1960s:
1) localized;
2) widespread;
3) functional;
4) expressed with an alleged organic basis;
5) having a clear organic basis;
6) forms associated with peripheral lesions of the nervous system.
Or: - neurotic
- encephalitic (flaccid encephalitis)
- residual hyperkinetic syndromes.
The classification of prof. Pushkov (Research Institute named after Bekhterev):
1. Gilles de la Tourette's syndrome (named after the French scientist, who first described these phenomena 150 years ago. French doctors believed that this disease always leads to profound mental retardation. Later it turned out that this was not so: the intellectual capabilities of patients are more some do not suffer. productive activity due to pronounced tics: it is difficult to write, hold a book, play musical instruments).
2. Generalized tick.
3. Common tick.
4. Residual organic tics.
5. Obsessive (neurotic) tic.
In modern ICD-10, tics are identified as a separate diagnostic group - F 95 Tics, divided into diagnostic categories: F 95.0 Transient tics; F 95.1 Chronic motor tics or vocalizations; F 95.2 Gilles de la Tourette's syndrome; F 95.8 Other tics; F 95.9 Tics, unspecified.
Over a 15-year period of observation and therapy of children with tics in the City Department of Neurosis in Children and Adolescents of the Association "Children's Psychiatry" and at the Research Institute of Experimental Medicine of the Russian Academy of Medical Sciences, the authors concluded that three main forms of tics predominate:
- neurosis-like tics of residual organic origin (by analogy with the previously described neurosis-like stuttering and enuresis), the main diagnostic criterion for which is the detection on electroencephalograms of patients of gross changes in the bioelectrical activity of the brain: irritative, focal, paroxysmal, epileptiform;
- neurotic tics (as one of the symptoms of neurosis);
- neuropathic tics that appear against the background of neuropathy, the so-called "congenital childhood nervousness", against the background of non-rough residual-organic changes in the central and peripheral nervous system.
Various organic violent hyperkinesis (the so-called tic-epilepsy, choreic and athetoid hyperkinesis) should not, in our opinion, be considered as a special form of tics.
Undoubtedly, here the main efforts should be directed to the fight against the underlying disease. In addition, tics should not be identified with hyperkinesis at all, which is often found in the literature. In contrast to the opinion of many leading experts in the field of neurosology, etc., the authors do not recognize the priority of the neurotic form of tics. Moreover, neurosis-like tics in modern conditions are at least 4 times more common than neurotic ones.
Both common (generalized) tics and Gilles de la Tourette's syndrome (although this syndrome requires mandatory isolation!) Should be attributed to neurosis-like tics, since they are based on signs of residual-organic damage to the central nervous system, which makes it possible to attribute neurosis-like tics to residual -organic neuropsychiatric disorders.
Etiology and pathogenesis of tics
The cause of residual-organic neuropsychiatric disorders are hazards that damage the child's brain in the prenatal, perinatal and early (up to 2 years) postnatal periods of development. S.S. Mnukhin attributed to them early organic lesions that occurred before the complete formation of the brain systems, i.e. up to 3 years of a child's life. V.V. Kovalev, on the contrary, believed that there were no age limits for the occurrence of residual-organic mental disorders, and all organic lesions in children pass into the residual (residual) stage.
The prevalence of these disorders, according to different authors, reaches 17-25% of children in the population. It should not be forgotten that residual-organic lesions of the brain are one of the most important factors in the development of neuroses, psychopathy, in the occurrence of epilepsy. They often change the classic course of schizophrenia.
All of the above once again confirms that tics, being predominantly neurosis-like, require special attention to themselves both in terms of diagnosis, therapy, and in relation to the prognosis for the future. It is no coincidence that the authors during the electroencephalographic examination of children with tics revealed the following: paroxysmal activity in the background records is observed in 70% of cases, and irritation in the parietal-occipital cortex - in 36%. Convulsive readiness for a test with hyperventilation was noted in 60%, and in the aftereffect of 1.5-2 minutes - in 22% of children.
Tics are the final link in a complex disease process. An important role in it belongs to the hereditary transmission of increased neuromuscular excitability and excessive sharpness of movements (impulsivity) on the part of the father, who, as a rule, also had tics in childhood. It can even be said that tics in their transmission are a purely “male” type of pathology, although they can also appear in girls, especially those who resemble fathers. Often, moreover, these girls are much larger and taller than their peers; they have physical development that is ahead of age, while at the same time there is insufficient coordination of movement, general awkwardness and stiffness. These girls can have both phlegmatic and choleric temperamental traits. In the latter case, they do not differ in weight and height from their peers.
More often than in girls, tics are observed in boys, primarily with choleric temperamental traits, as well as in those who lag behind their peers in growth and physical development. Despite the mobility, these boys also show insufficient coordination of movements.
Another factor directly contributing to the occurrence of tics is internal stress or excitability, which accumulate gradually, from within and, for various reasons, cannot be expressed externally, i.e. responded. The sources of internal, painfully sharpened tension are varied and relate to organically damaging factors of the brain (asphyxia during childbirth, inflammation, bruising or concussion of the brain), neuropathy and neuroses. Often these sources are combined with each other, and the allocation of the leading role of one of them is made on the basis of a number of restrictive features.
Tics arising on the basis of residual cerebral organic insufficiency are characterized by a persistent course, little dependent on the actions of external, situational or psychological factors. Most noticeable is the connection between ticks and organically produced, i.e. unreasonable, agitation, especially in hyperactive, mentally and motor-excited and often disinhibited children (with attention deficit hyperactivity disorder - ADHD or minimal brain dysfunction - MDM). These tics are characterized by significant irradiation, a tendency to generalization. There is always a so-called "tic accent", a "hearth", which is a "favorite place" (for example, blinking or "coughing"). They are extremely stable, do not disappear (unlike neurotic ones) in summer time, during the holidays, and often provoked by the sun and heat. For neurosis-like tics, it is even characteristic that they first appear against the background of the child's rest. It is typical that these tics do not arise from psychogenic causes, but on the contrary, as if in spite of the situation.
In the overwhelming majority of cases, neurosis-like tics begin with "blinking" movements, and their dynamics depend on the behavior of the parents. If they choose the path of persistent and long-term treatment by an ophthalmologist, then the movements are transformed: “blinks” are joined by nose twitches, “grimaces”, a transition occurs to the shoulder girdle (they move their shoulders, straighten the straps, etc.). There may be further spread - there are respiratory tics, diaphragmatic ("clapping the stomach"), dancing. Respiratory tics are usually characteristic of children with ADHD whose parents (or their relatives!) had signs of hyperactive behavior in childhood, and a history of tics, stuttering, enuresis.
It should be noted that the group of children with a neurosis-like form of tics is characterized by the presence of fears that exist in the form of a kind of emotional tic. It is because of the fears that these tics are often mistaken for neurotic ones. V.V. Kovalev believes that with all the complexity of distinguishing between neurotic and neurosis-like tics, one should remember about stereotypy, monotony, characteristic only for the latter, as well as manifestations of a psychoorganic syndrome and focal neurological symptoms.
The first tic attack, as a rule, is relieved by something (usually by herbal medicine), but after a short period of time the tics reappear, and the parents note the “transfusion” of tics (“stopped coughing, but began to shrug their shoulders”), which is explained by the fact that usually one tries to treat the outward manifestation (sedatives) without affecting the organic basis of the suffering.
Separately, it is necessary to say about the most complex forms of neurosis-like tics: generalized tics and, as the most severe, Gilles de la Tourette's syndrome.
Generalized tics are a common disorder. It is found on all continents and in all ethno-cultural formations. Researchers are concerned about the unfavorable prognosis and insufficient effectiveness of all therapeutic methods and agents used today. This is confirmed by the formation of associations and scientific societies for the study of this disease in England and in many states of the USA.
The cause of the disease is genetically determined. The severity of the disorders is explained by the different manifestations of the gene. In families of patients with Tourette's syndrome, signs of this disease, from tics to serious mental disorders, occur both in a straight line and along the lateral lines. In these families, stuttering, epilepsy, and schizophrenia are more common. Boys get sick 4-5 times more often than girls.
Tourette's syndrome is preceded by long-lasting tics, which eventually begin to manifest themselves with complex movements: jerky movements of the hands or constant touching of something. In addition, tics of the vocal cords are observed. They are manifested by involuntary barking, whistling, repetition of phrases and incomprehensible speech. There are so-called. focal tics - squeaks, diaphragmatic tics and bouncing. A generalized tic in Tourette's syndrome has an extremely pronounced character, reaching an extreme degree in the form of shouting and violent coprolalia (shouting out swear words, obscenities). Speech stereotypes appear several years after the onset of the disease. Most often these are single words, sometimes short phrases. For example, a boy turns to his mother: "Say no." There is a combination of stereotyped actions with speech stereotypes: the boy says “No, no, no!” and stereotypically slams his hand on the door frame. Sometimes he shouts to his mother: “Stop me, I can’t do it myself!”. Coprolalia in the structure of generalized tics occurs only in the later stages of development, more often in adolescence.
This syndrome is the most severe and is known for its infamous convulsive movements that occur before the age of 21. Individuals with Tourette's syndrome may also experience hyperactivity. According to scientific research, Tourette syndrome occurs in only 2 out of 10,000 people.
Tics due to neuropathy are less stable, depend on the action of climatic, weather factors, including stuffiness, heat, changes in barometric pressure; amplified in a situation of increased sound background, bright light, flickering before the eyes (especially when watching TV). The increase in tics during fatigue is also characteristic, which indicates intolerance, weakening of the body. This usually occurs after long-term or frequent somatic and infectious diseases, indicating insufficiently reliable body defenses.
The syndrome of neuropathy, or "congenital childhood nervousness", "constitutional nervousness" should be recognized as the most common syndrome of mental illness in early childhood. childhood(up to 3 years). The main symptoms of this syndrome are increased excitability, pronounced instability of autonomic functions, which are combined with increased affective and psychomotor excitability, rapid exhaustion and behavioral inhibition in the form of fears of everything new, unusual, or, conversely, everyday sounds, water, excessive fearfulness. Prominent experts who studied neuropathy pointed out that its manifestations are typical in the first 2 years of life, and the leveling of symptoms occurs by 4-5 years. However, they believed that neuropathy can manifest itself to varying degrees in preschool and early school age, and in some children until the pubertal period. It is noted that at an older age, the intensity of somatovegetative disorders weakens, dyspeptic disorders persist, and mental disorders come to the fore: increased affective excitability, greater impressionability, exhaustion, timidity. G.E. Sukhareva singled out 2 clinical variants of neuropathy: with one (asthenic) children are timid, shy, inhibited, highly impressionable, easily exhausted; in the second (excitable) - affectively excitable, irritable, motor disinhibited.
The authors, agreeing with such a distinction between two forms of neuropathy, believe that in children of preschool and early school age, the excitable variant according to G.E. Sukhareva should no longer be considered as neuropathy itself, but as the above-mentioned attention deficit hyperactivity disorder or MDM syndrome (in addition to the symptoms noted by Sukhareva, these children also have all the symptoms that are characteristic of ADHD - attention deficit hyperactivity disorder), and asthenic variant - as a manifestation of neurosis, usually neurasthenia, and with the addition of obsessive tics - obsessive-compulsive neurosis (obsessional neurosis).
In general, it should be noted that neuropathy syndrome is quite often included in the structure of residual organic neuropsychiatric disorders that occur, as mentioned earlier, as a result of intrauterine and perinatal organic brain lesions, which allowed one of the founders of Russian child psychiatry S.S. Mnuhin to call this syndrome "organic" or "residual" neuropathy.
The tics that occur with neuroses are largely due to the action of psychological factors, and primarily anxiety. They occur throughout childhood (more often from 3 months of life and older: from the moment when the child develops a differentiated perception and emotion of fear, especially up to one year, and is explained by a neurotic reaction to an experienced emotional shock), i.e. always associated with psychotrauma. Contribute to ticks all sorts of unrest associated with an unusual situation of communication, expectation of something, fear or internal contradictions and conflict. But this does not mean that tics in neurosis are exclusively functional in nature, since the psychogenic factor can also lead to an increase in the underlying tics of cerebral-organic, or constitutional-neuropathic, insufficiency. IN AND. Garbuzov notes that neurotic tics within the framework of obsessive-compulsive disorder “while maintaining certain features, have an undoubted and pronounced proximity to obsessive states, being in some cases a stage in the development of obsessive movements and actions, in others - supplementing them. Neurotic tics preceded obsessive movements and actions or were noted simultaneously with them in 73.3% and occurred in the clinical picture in 44% of all patients suffering from obsessive-compulsive disorder.
Neurotic tics (unlike neurosis-like and neuropathic ones) are recognized by the child. He reports that "they want to do." Children anticipate unnecessary movements, they can regulate them (for example, delay, suppress "willpower" in certain situations). If tics linger for a long period of time, then the child develops a feeling of discomfort (“I want to do something”), and after a long absence of ticoid movements, they are rapidly replenished. If the child is busy with something interesting, then these tics are absent. They become more frequent with excitement, as well as with overwork and during a period of passive attention (watching TV shows, etc.). Neurotic tics are not stable, very often one movement is replaced by another, there is no “accent” described above. Subjectively, children evaluate them as a kind of “habit”, often consider it painful (they are critical), but unlike patients with obsessive movements, they usually do not actively try to overcome this “habit”. With tics of an obsessive nature, the child is aware of their strangeness, he struggles with them (“tired, tired of them”). These tics are often ritualistic and more complex than usual ones (in the form of a coordinated motor act), it is almost always possible to reveal their "psychoprotective meaning". When they are delayed, massive fears appear, anxiety increases and emotional stress increases. Often, tics are regarded by adults as grimaces, deliberate antics and self-indulgence. Therefore, they try to eliminate them by continuous reprimands, prohibitions or punishments. But if the child can delay the tics for a while, then they resume with greater force. Moreover, the conscious delay of ticks is far from indifferent and turns into a sharp increase in internal tension, manifested by headaches, irritability and aggressiveness.
If tics in organic disorders, as already noted, are due to overexcitation, in neuropathy - overwork, then tics in neurosis are associated primarily with anxiety, anxiety and fear, and then with overwork and excitement.
Basic approaches to the treatment of tics
Treating tics is a long and continuous process. Ready schemes No. Our experience has shown that the selection of drugs should be made in strict accordance not only with the leading direction of the disease, but also with the obligatory consideration of all pathogenetic mechanisms of the main and additional symptoms. In addition, it is necessary to anticipate the activation of past pathological systems. Particular care and caution is needed in the treatment of patients with increased convulsive readiness. The appointment of the so-called restorative treatment using electrotherapy or the appointment of piracetam increase the manifestations of tics and can cause an epileptic seizure.
The intermittent course of tics and their spontaneous disappearance during the first year of the disease does not mean recovery. In most patients, summer disappearance or weakening of tics is noted. However, tics may recur after several years with the same or more severe symptoms. In other words, the treatment of tics, as well as other neurosis-like syndromes, should continue until the normalization of EEG parameters, which the authors drew the attention of readers to in their previous works.
All cases of tics require a thorough examination of the patient and the immediate appointment of treatment. We repeat that tics are a very difficult phenomenon and it is almost impossible to deal with them directly (using symptomatic therapy). First you need to determine the clinical form of tics. If we are dealing with tics on the basis of organic disorders or neuropathy, then a large role here should be given to medical and restorative treatment. If we are talking about tics in neurosis, it is necessary to treat neurosis and use for this mainly medical-pedagogical and psychotherapeutic influence. It is necessary to carry out appropriate explanatory work with parents in order to change their misperception of tics as licentiousness, pampering or stubbornness, and, if possible, correct their excessively tense, and often conflicting relationships with children.
We propose to be guided by the first and immutable rule for any form of suffering: tics should be invisible to parents. They are not, even if they are. You can talk about them only in the doctor's office, which can use the mention of tics for therapeutic purposes (in the form of direct or indirect suggestion). Fixation of ticks is the most dangerous thing that the parents of a sick child “sin” with.
No less important than the first second rule: you should “revive” the child, breathe into him a stream of cheerfulness and optimism. Go with him once again to the puppet theater, play joint outdoor games, such as tags, battles, give him plenty to ride a bike, sled, drive the ball. Let him get excited, play pranks, shout, be direct, uninhibited, cheerful, like all boys. That's what games and games are for. This is necessary as an outlet in a monotonous, monotonous life, where everything is laid out on the shelves, provided for, calculated.
The principle of treatment of the neuropathic form of tics is similar to that of the neurosis-like form, but with one amendment - general strengthening methods of therapy are widely used. In addition, sedatives are used during the daytime ("Reasonable balance of restorative and sedatives"). Particular attention is paid here to the prevention of colds.
In the treatment of neurotic tics, psychotherapeutic methods come to the fore, given the fact that this form of tics is only a symptom in the overall picture of a neurotic disorder. Nevertheless, considering neurosis as a psychogenic disease of the developing personality of the child, the authors suggest using the complex application of psychological and biological methods in treatment. The leading of them is psychopharmacotherapy. The value of medications is to provide the necessary biological (psychosomatic) background for psychotherapy. Moreover, as noted in our earlier works, the fact is confirmed that during a neurotic conflict, disturbances of the bioelectrical activity of the brain with varying degrees of severity are often found in the electroencephalograms of patients (especially in obsessive-compulsive disorder neurosis). In this case, the value of psychopharmacotherapy can hardly be overestimated.
At the stage of the neurotic reaction (when the tics have just appeared for the first time), the psychotherapeutic effect is most effective. Quite often, tics disappear when the child is removed from the psycho-traumatic environment, or when the family situation is normalized with the help of a psychotherapist, by eliminating or smoothing out the psycho-traumatic factors. It is often important to create emotionally significant interests and hobbies in a child, where sports are especially effective.
At the stage of a developed neurotic state, individual psychotherapy acquires particular importance, during which various types of suggestion (direct, indirect) are actively used, carried out against the background of family psychotherapy (it is important that all people significant to the child participate in psychotherapeutic sessions). Family psychotherapy is seen as a way to restore the functional unity of the family through the normalization of relations and mental health of its members. This process consists of several stages: 1) examination of the family; 2) family discussion; 3) joint psychotherapy of the patient and his parents. The goal of family therapy is to ensure that parents can learn to treat their children more attentively and adequately. Successful family therapy allows both parents and children to better imagine themselves in the place of another, understand and change their attitude towards other family members.
Of great importance for the formation of the personality of such a child is education by the type of emotional rejection. E.G. Eidemiller believes that the basis of such rejection is the conscious or, more often, unconscious identification of the child's parents with any negative moments in their own lives. Children in this situation may feel like a hindrance in the lives of their parents, who unwittingly establish a great distance in relation to them.
From the foregoing, it becomes clear that in addition to the method of psychopharmacocorrection, family systemic psychotherapy is extremely relevant, which implies a complex of psychotherapeutic methods and techniques aimed at treating the patient in the family and with the help of the family. The purpose of this type of psychotherapy is to optimize family relationships, the role of which in the fight against borderline mental disorders is beyond doubt.
Play is one of the most basic needs of a child. In the dictionary of S.I. Ozhegov defines the word "game": "The one who loves to play, frolic, naughty." Children are the most active, active, mobile. And if we are talking about hyperactive ones, which are mostly children with tics, then it becomes clear how such children are close to the game and everything connected with it. Psychiatrists are aware of the alertness that arises in them if the child does not play or plays “strangely” (shifts, for example, caps from a fountain pen from place to place, shakes a box with small objects inside it, doing all this monotonously, “robot-like” in for several hours). Any pediatrician knows that the refusal of a sick child to play habitually is a prognostically unfavorable sign for any disease.
The choice of gaming techniques in psychotherapy is a priority method in rehabilitation work with children suffering from tics of various forms, as well as tics combined with attention deficit disorder with hyperactivity (hyperkinetic behavior disorder). In our previous works we touched upon the topic of psychotherapy of borderline mental disorders, mentioning also about game psychotherapy. "Difficult" children, among which experts no doubt include children suffering from ADHD, are very dependent on their own emotions and do not know how to correctly show or restrain them. They often do not realize what they are doing, because they cannot foresee a difficult life situation, detect a mistake that has already been made, defuse internal negative tension in a socially acceptable way, and choose a role adequate to a particular situation. And no matter how paradoxical it sounds, such children play very little! There are many reasons explaining this paradox, but the main ones should be singled out: their games (as a rule, noisy and damaging everything around) “everyone is already tired of the hell out” - the child is simply already afraid to play! Because of the fear of "harm", they learn to play very quickly.
The hero of the famous movie said the catchphrase that has become: “Happiness is when you are understood!”. With a high degree of probability, we can call a hyperactive child unhappy, since neither peers nor adults understand him, and this frightening misunderstanding forms a rigid capsule around the hyperactive child, inside which hyperpassions rage (usually negatively colored and aggressively directed), passions that, being realized positively, they intensify the already pronounced ticoid manifestations (often becoming the subject of ridicule of other children - another way to fix tics!).
The tasks of group play psychotherapy, therefore, follow from that tangled tangle of problems that literally envelop a sick child. All work in the group aims to influence the main components of personality relationships: cognitive, emotional and behavioral. Psychotherapy in children and adolescence(as no other!) always, in any form - this is family psychotherapy. Therefore, parents of patients take part in our classes (sessions, sessions). Various forms of this participation are used - from passive observation to playing a role in trainings.
The following can be considered as the main mechanisms of the therapeutic effect of group psychotherapy: corrective emotional experience, confrontation and learning.
The advantage of pathogenetic psychotherapy, which includes group play psychotherapy, is its openness to integration with other psychotherapeutic approaches, which reflects current trend in the development of psychotherapy. This is especially true for the methods of cognitive-behavioral, phenomenological, altruistic approaches (cognitive psychotherapy A. Beck, positive psychotherapy H. Pezeshkian, rational - emotive psychotherapy A. Ellis, gestalt therapy F. Perls, altruistic psychotherapy V. Garbuzov).
Hypnosuggestive psychotherapy and autogenic training have also been successfully used by us in the treatment of children with tics (usually school-age children), with preference given to group sessions. A relative contraindication for these methods of therapy may be the presence of severe convulsive readiness and epileptiform activity in the background record, identified during the electroencephalographic examination of the patient. In preschool children, the method of maternal suggestion, used by the mother of the child when he falls asleep in the evening, has proven itself well.
Recognizing all the psychotherapeutic methods described above as fully acceptable for the treatment of neurosis-like tics, it should be noted that in this case, biological methods of therapy are still the priority, against which psychotherapy gives significantly better results of treatment. More details on the methods of treating tics and ADHD can be found in the authors' monograph "Bad good child".

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Childhood neurosis frightens and puzzles parents, especially if such mental states are associated with the manifestation of tics. In search of reasons and answers to their questions, adults bypass dozens of doctors, but often it is not possible to clarify the situation. The only thing that parents get is a prescription for a psychotropic drug, which adequate parents absolutely do not want to feed their child. In this article, we will help you understand what neurotic tics are associated with, what are the causes of neuroses and how to help a child without heavy medications.

What it is?

The concept of "neurosis" hides a whole group of psychogenic disorders. The bad news for moms and dads is that all neurosis is prone to a very protracted, chronic course. And the good news is that neuroses are reversible, and in most cases the child is completely able to get rid of such conditions.

Due to the fact that children cannot always tell in words what worries or worries them, constant nervous tension transforms into a neurotic state in which disturbances are observed both at the mental and physical levels. The behavior of the child changes, mental development may slow down, a tendency to hysteria appears, mental activity suffers. Sometimes internal tension finds a kind of release on the physical level - this is how nervous tics occur. They are not independent disorders and always appear against the background of a neurosis or a neurosis-like state. However, the neurosis itself may well proceed without tics. Here much depends on the personality of the child, his character, temperament, upbringing, the state of the nervous system and other factors.

Neurosis practically does not occur in infants, but then the frequency of such disorders in children begins to grow rapidly, and at kindergarten age, approximately 30% of children have neuroses to one degree or another, and by the middle school age the number of neurotics grows to 55%. Almost 70% of adolescents have neuroses.

Nervous tics are for the most part a problem exclusively for children. There are few adults in the world who suddenly, under the influence of stress, began to suffer from a tic. But there are adults who endured neurotic tics from their childhood, since most often the violation is laid down precisely in childhood.

Tics of various types are most common in children between the ages of 5 and 12. Approximately a quarter of all neurotic children suffer from some kind of tic. In girls, physical manifestations of nervous conditions are 2 times less common than in boys of the same age. Experts explain this fact by the fact that the psyche of girls is more labile, it undergoes age-related changes faster and goes through a period of formation.

Neurosis and tics are disorders of higher nervous activity. Modern medicine believes that these conditions contribute to the emergence of a wide variety of diseases and pathologies. There was even a whole direction - psychosomatics, which studies the possible connections of psychological and mental states with the development of certain diseases.

So, it is believed that hearing problems most often occur in children whose parents were too authoritarian and suppressed the child, and kidney disease is characteristic of children whose mothers and fathers often conflict with each other and often verbally and physically abuse their child. Since neuroses are reversible conditions, the task of parents is to start the process of reverse development as soon as possible, and for this it is necessary to find the cause of the child's condition and put all their efforts into eliminating it.

Causes

The search for the causes of neurosis in a child is always very difficult task. But if you look at the problem from a medical point of view, the search area narrows significantly. Neurosis, and consequently, neurotic tics, is always associated with the development of conflict - internal and external. The fragile children's psyche with great difficulty can withstand many circumstances that do not seem out of the ordinary for adults. But for children, such circumstances are very difficult, causing psychological trauma, stress, overstrain of the intellectual, mental and emotional spheres.

Scientists and doctors are still arguing how exactly the mechanism for the development of a violation of nervous activity is realized. The difficulty of studying this issue is primarily due to the fact that the mechanisms are quite individual, unique for each baby, because a child is a separate person with his own fears, attachments and the ability to resist stress.

The most common causes of neurosis and neurosis-like conditions are:

• unfavorable situation in the family (scandals, quarrels, divorce of parents);
• total mistakes in raising a child (hyper-care, lack of attention, permissiveness or excessive severity and exactingness of parents in relation to the baby);
• features of the child's temperament (cholerics and melancholics are more prone to the development of neuroses than sanguine and phlegmatic people);
• fears, phobias of the baby, with which he is not able to cope due to age;
• overwork and overstrain (if the baby does not get enough sleep, attends several sections and two schools at the same time, then his psyche works “for wear and tear”);

• psychological trauma, stress (we are talking about specific traumatic situations - death loved one, forced separation from one of the parents or both, physical or moral violence, conflict, severe fear);
• doubts and fears for safety in the future (after moving to a new place of residence, after transferring the child to a new kindergarten or a new school);
• age-related "crises" (during periods of active reconfiguration of the nervous system and psyche - at 1 year old, at 3-4 years old, at 6-7 years old, during puberty - the risks of developing neuroses increase tenfold).

Nervous tics develop in about 60% of neurotics of preschool age and in 30% of schoolchildren. In adolescents, tics on the background of neurosis appear only in 10% of cases.

The reasons for the development of involuntary muscle contractions on an erroneous command of the brain can also be different:

• past disease(after severe bronchitis, reflex coughing may develop into a tic, and after conjunctivitis, the habit of blinking frequently and fractionally may remain as a tic);
• mental shock, severe fear, a situation that caused enormous psychological trauma (this is not about prolonged exposure to stress factors, but about a specific one-time situation in which the nervous system and psyche of the child did not have time to “compensate” for the damage, since the impact of stress turned out to be many times stronger);
• desire to imitate(if a child observes tics in one of the relatives or other children in the kindergarten or school team, he can simply start copying them and gradually these movements will become reflex movements);
• aggravation of manifestations of neurosis(if the negative factor that caused the neurosis not only does not disappear, but also increases its impact).

The true causes may remain unknown, since the field of the human psyche has not yet been sufficiently studied, and not all violations in the child's behavior can be explained by doctors from the point of view of science.

Classification

All childhood neuroses, despite the lack of scientific data on the causes and mechanisms of development, have a strict classification, designated in the international classification of diseases (ICD-10):

• obsessional or obsessive-compulsive disorder(characterized by increased anxiety, anxiety, conflict of needs and norms of behavior);
• anxiety neuroses or phobic neuroses(associated with intense and uncontrollable fear of something, such as fear of spiders or the dark);
• hysterical neuroses(destabilization of the emotional sphere of the child, in which there are behavioral disorders, hysterical attacks, motor and sensory disorders that occur in the child in response to situations that the child considers hopeless);
• neurasthenia(the most common type of illness in childhood, in which the child experiences an acute conflict between the requirements for himself and the actual inability to meet these requirements);
• compulsive movement neurosis(a condition in which the child uncontrollably performs certain cyclic movements with annoying methodicalness);
• food neurosis(bulimia nervosa or anorexia - overeating, constant feeling of hunger or refusal of food against the background of nervous rejection);
• panic attacks(violations characterized by bouts of intense fear that the child cannot control and explain);
• somatoform neuroses(conditions in which the activity of internal organs and systems is disrupted - neurosis of the heart, neurosis of the stomach, etc.);
• guilt neurosis(disturbances in the activity of the psyche and nervous system, which developed against the background of a painful and in most cases unjustified feeling of guilt).

Nervous transient tics that can develop against the background of any type of neurosis also have their own classification.

They are:

• Mimic- with involuntary repetitive contraction of the muscles of the face. These include facial tics, eye tics, tics of the lips and wings of the nose.
• Vocal- with spontaneous nervous contraction of the vocal muscles. An audio tic can be manifested as a stutter or an obsessive repetition of a certain sound, a cough. Voice tics are very common among children, especially preschoolers.
• Motor- with contraction of the muscles of the limbs. These are twitching of arms and legs, waving and splashing of arms, which are repeated often and have no logical explanation.

All tics are divided into local (when one muscle is involved) and generalized (when a whole group of muscles or several groups work at once during the movement). Also, tics are simple (with elementary movement) and complex (with more complex movements). Usually, children develop primary tics as a result of severe stress or other psychogenic causes. Doctors talk about secondary only if tics accompany brain pathologies (encephalitis, trauma).

Quite rarely, but still there are hereditary tics, they are called Tourette's syndrome.

What kind of tics a child has is not difficult to establish, it is much more difficult to find the true cause, including the connection with neurosis. And without this, a full-fledged treatment is not possible.

History of study

For the first time, neurosis was described in the 18th century by the Scottish doctor Cullen. Until the 19th century, people with neurotic and neurosis-like tics were thought to be possessed. Famous people stood up to fight obscurantism at different times. Sigmund Freud explained neurosis as a conflict between the true needs of the body and personality and social and moral norms that are invested in a child from childhood. He devoted a whole scientific work to this theory.

Academician Pavlov, not without the help of his famous dogs, concluded that neurosis is a violation of higher nervous activity, which is associated with violations of nerve impulses in the cerebral cortex. Society ambiguously perceived the information that neurosis is characteristic not only of people, but also of animals. American psychologist Karen Horney in the 20th century concluded that childhood neurosis is nothing more than a defensive reaction from the negative impact of this world. She also proposed to divide all neurotics into three groups - those who strive for people, pathologically need love, communication, participation, those who try to move away from society and those who act contrary to this society, whose behavior and actions have the goal of proving to everyone that they can do a lot and are more successful than everyone else.

Neurologists and psychiatrists of our time hold different points of view. But they are in solidarity on one thing - neurosis is not a disease, rather, it is a special condition, and therefore its correction is both desirable and possible in all cases.

Symptoms and signs

Neurosis in children and the possible accompanying tics have different symptoms, which depend on the type and type of disorder. However, all neurotic states are characterized by a group of signs that can be traced in all neurotic children.

Mental manifestations

Neurosis can by no means be considered a mental disorder, since disturbances arise under the influence of external circumstances, while most truly mental illnesses are associated with internal factors. Most mental illnesses do not have a sign of reversibility and are chronic, and neurosis can be overcome and forgotten about.

With real mental illnesses, the child has growing signs of dementia, destructive personality changes, and backwardness. With neurosis, there are no such signs. Mental illness does not cause rejection in a person, the patient regards it as part of himself and is not capable of self-criticism. With neurosis, the child understands that he is doing something wrong, not right, and this does not give him rest. Neurosis causes inconvenience not only to his parents, but also to himself, with the exception of certain types of tics, which the baby simply does not control, and therefore does not consider significant.

You can suspect a neurosis in a child by the following changes:

• Child's mood changes frequently, unexpectedly and without objective reasons. Tears can turn into laughter in minutes, and good mood in seconds to change to depressive, aggressive or otherwise.
• Almost all types of neurosis in children are characterized by pronounced indecision. It is very difficult for a child to make even a simple decision on his own - which T-shirt to wear or which breakfast to choose.
• All children with neurotic changes experience certain communication difficulties. It is difficult for some to establish contacts, others experience a pathological attachment to the people they communicate with, others cannot maintain communication for a long time, they are afraid to say or do something wrong.
• Self-esteem of children with neurosis is not adequate. It is either overestimated and this cannot go unnoticed, or underestimated and the child sincerely does not consider himself capable, talented, successful.
• Without exception, all children with neurosis experience from time to time bouts of fear and anxiety. Moreover, there are no objective reasons for alarm. This symptom can be mildly expressed - only occasionally the child expresses fears or behaves wary. It also happens that the attacks are pronounced, up to panic attacks.
• A child with neurosis can't decide on a value system the concepts of “good and bad” are somewhat blurred for him. His desires and preferences often contradict each other. Often a child even at preschool age shows signs of cynicism.

• Children with certain types of neurosis are often irritable. This is especially true for neurasthenics. Irritability and even anger can manifest itself in the simplest life situations - it didn’t work the first time to draw something, the laces on the shoes were untied, the toy broke.
• In neurotic children, almost no stress tolerance. Any little stress causes them attacks of deep despair or pronounced unmotivated aggression.
• Can talk about neurosis excessive tearfulness, increased resentment and vulnerability. Such behavior should not be attributed to the character of the child; normally, these qualities are balanced and not striking. With neurosis, they hypertrophy.
• Often a child dwells on the situation that traumatized him. If the neurosis and tics were caused by the attack of a neighbor's dog, the baby often experiences this situation again and again, the fear grows and turns into a fear of all dogs in general.
• The performance of a child with neurosis is reduced. He quickly gets tired, cannot concentrate his memory for a long time, quickly forgets previously learned material.
• neurotic children hard to handle loud noises sudden noises, bright lights and temperature changes.
• In neuroses of all types, there are sleep problems- it can be very difficult for a child to fall asleep, even if he is tired, sleep is often restless, superficial, the baby often wakes up, does not get enough sleep.

physical manifestations

Since there is a connection between neurosis and the work of internal organs and systems, a violation cannot but be accompanied by signs of a physical property.

They can be very different, but most often neurologists and child psychiatrists note the following symptoms:

• The child often complains of headaches, tingling in the heart, palpitations, shortness of breath and pain of unknown origin in the abdomen. At the same time, medical examinations for the search for diseases of these organs and areas do not reveal any pathologies, the child's tests are also within the normal range.
• Children with neuroses are often lethargic, sleepy, they don't have the power to do anything.
• Children with neuroses have unstable blood pressure. It then rises, then decreases, while there are bouts of dizziness, nausea. Often doctors diagnose - vegetative-vascular dystonia.
• In some forms of neurosis in children, vestibular disorders are observed. associated with difficulties when necessary to keep balance.

• Problems with appetite characteristic of the vast majority of neurotics. Children can be undernourished, overeat, feel almost constantly hungry, or, conversely, almost never feel very hungry.
• Children with neurotic disorders unstable chair- constipation is replaced by diarrhea, vomiting often occurs for no particular reason, indigestion occurs quite often.
• neurotics are very sweating and more often than other children run to the toilet for a small need.
• Neuroses are often accompanied idiopathic cough without a justified reason, in the absence of any pathologies from the respiratory system.
• With neurosis, there may be enuresis.

In addition, children with neurosis are more susceptible to acute viral infections, colds, they have weaker immunity. In order to conclude whether a child has a neurosis or prerequisites for its development, one should evaluate not one or two individual symptoms, but a large list of signs of both physical and psychological properties together.

If more than 60% of the above symptoms match, you should definitely make an appointment with a doctor.

Manifestations of tics

Nervous tics are visible to the naked eye. With primary tics, all involuntary movements are local in nature. They rarely spread to large muscle groups. Most often, they involve the face and shoulders of the child (blinking, twitching the lips, blowing the wings of the nose, shrugging).

Tics are not noticeable at rest and only get worse when the child is in a stressful situation.

The most common primary violations are manifested as:

• blinking;
• walking in a vicious circle or in a straight line back and forth;
• teeth grinding;
• splashes of hands or strange movements with the hands;
• winding strands of hair around your finger or pulling hair out;
• strange noises.

Hereditary and secondary tics usually appear in a child closer to 5-6 years. They are almost always generalized (involving muscle groups). They are manifested by blinking and grimaces, uncontrolled shouting of curses and obscene expressions, as well as the constant repetition of the same word, including that heard from the interlocutor.

Diagnostics

There is a big problem in diagnosing neuroses - overdiagnosis. It is sometimes easier for a neurologist to make such a diagnosis for a child than to search for the true cause of disorders. That is why statistics show a rapid increase in the number of neurotic children over the past few decades.

Not always a child with poor appetite, sleep disturbances or mood swings is a neurotic. But parents demand help from a specialist, and the doctor has no choice but to make a diagnosis and prescribe treatment. After all, it is incredibly difficult to refute the diagnosis of "neurosis", and therefore no one can accuse the doctor of incompetence.

If there are suspicions of a neurosis in a child, it is not enough for parents to visit a district neurologist alone. It will be necessary to show the child to two more specialists - a child psychiatrist and a psychotherapist. The psychotherapist will try to understand as much as possible in what psychological environment the child lives in; for children of middle and senior school age, the method of hypnotic sleep can be used. This specialist pays special attention to the relationship between parents, between parents and the child, between the child and his peers. If necessary, a series of tests for behavioral reactions will be carried out, an analysis of the baby's drawings, a study of his reactions during the game process.

The psychiatrist examines the child for a connection between neurosis and impaired brain function, for this specific tests will be used, an MRI of the brain may be prescribed. A neurologist is a specialist with whom the examination should begin and with which it is then completed.

He summarizes the data received from the psychiatrist and psychotherapist, analyzes their conclusions and recommendations, prescribes:

• general and biochemical analysis blood;
• radiography and computed tomography of the brain;
• electroencephalography.

The presence of neurosis as such can be judged in cases where:

• the child did not have pathologies of the brain and conduction of impulses;
• the child has no mental illness;
• the child does not have and did not have craniocerebral trauma in the recent past;
• the baby is somatically healthy;
• neurotic manifestations are repeated for six months or more.

Treatment

The treatment of neurosis always begins not with taking pills, but with the correction of relationships in the family where the baby lives and is brought up. Psychologists and psychotherapists help with this. Parents should change their attitude towards the child, eliminate or correct their pedagogical mistakes, try to protect the child from severe stress, frightening and traumatic situations. Joint activities are very useful - reading, creativity, walking, playing sports, as well as the subsequent detailed discussion of everything that has been done, seen or read together.

If a child learns to formulate his feelings and emotions in a particular situation, it will be easier for him to get rid of traumatic memories.

A marriage that is bursting at the seams is not necessarily saved for the sake of a child who has developed a neurosis on this occasion. Parents should weigh well how it will be better - without one of the parents who fights, drinks, uses violence or with him.

However, it should be remembered that one parent who is calm, self-confident, who loves and appreciates the baby is better for the child than two tormented and suffering parents.

Very much in the treatment of neurosis falls on the shoulders of the family. Without her participation, the doctor will not be able to do anything, and pills and injections will not bring any result. Therefore, drug treatment is not considered the main type of therapy for neuroses. A neurologist, a psychologist, and a psychotherapist, who have interesting methods of helping neurotic children, are ready to help parents in their difficult task.

Types of therapy

In the arsenal of a psychotherapist and a child psychologist there are such methods of correcting the condition of the baby, such as:

• creative treatment(the specialist sculpts, draws and cuts together with the baby, while talking with him and helping to sort out a complex internal conflict);
• pet therapy(treatment through communication and interaction with pets);
• play psychotherapy(classes on special techniques during which the specialist will carefully observe and evaluate the child's behavioral and psychological reactions to stress, failure, excitement, etc.);
• fairy tale therapy(understandable for children's understanding and an entertaining way of psycho-correction, allowing the child to accept models of correct behavior, set priorities, determine personal values);
• autotraining(a method of relaxation on the physical and mental levels, great for teenagers and children of high school age);
• hypnotherapy(a method of correcting the psyche and behavior by creating new settings during immersion in a trance. Suitable only for older children and adolescents);
• group sessions with a psychotherapist(allow to correct the neuroses associated with difficulties in communication, in adapting to new conditions).

A good result is brought by classes in which children are present with their parents. After all, the main type of therapy for neurosis, which has no equal in terms of effectiveness, is love, trust, mutual understanding between the child and his family members.

Medicines

Medicines for the treatment of simple and uncomplicated types of neurosis are usually not required. The doctor may recommend herbal preparations that have a calming effect: "Persen", a pharmacy collection of motherwort. The child can be given as an aid tea with lemon balm, mint, motherwort, do baths with decoctions of these herbs.

In some cases, the doctor prescribes nootropic drugs Pantogam, Glycine. They require systematic and long-term use, because they have a cumulative property of action. To improve cerebral circulation prescribed "Cinnarizine" in age dosage. If laboratory tests show a lack of calcium or magnesium in the child's body, which also contributes to neurological disorders, the doctor prescribes accordingly "Calcium gluconate " or its analogues, and "Magnesium B6" or other magnesium preparations.

The list of drugs that can be prescribed for nervous tics is much longer. It may include antipsychotics and psychotropic drugs. A prerequisite for the appointment of such powerful and serious drugs - tics must be secondary, that is, associated with disorders of the brain and central nervous system.

Depending on the nature of tics and other behavioral characteristics (aggressiveness, hysteria or apathy), Haloperidol, Levomepromazine, Phenibut, Tazepam, Sonapax. For severe convulsive tics, the doctor may advise Botox and botulinum toxin preparations. They allow you to "turn off" a specific muscle from the pathological chain of nerve impulses for a time during which this connection can cease to be a reflex. Any medicine for serious neurotic disorders must be prescribed and approved by a doctor, self-medication is inappropriate.

Most neurotic children are helped by drugs that promote normal sound sleep. After a few weeks, the child becomes more calm, adequate, friendly. Doctors do not advise the use of strong sleeping pills for childhood neurosis. It will be enough to light drugs or homeopathic remedies like drops "Bayu-Bai", "Dormikind", "Hare".

Physiotherapy and massage

Massage is useful for all children with neuroses. It is not necessary to turn to the expensive services of specialists, because therapeutic massage is not indicated for such disorders. A relaxing massage will be enough, which any mother can do on her own at home. The main condition is not to do tonic techniques that have the opposite effect - exciting and invigorating. Massage should be just relaxing. When carrying out such an impact, pressure, tingling, deep kneading should be avoided.

A relaxing effect can be achieved with gentle strokes, circular movements with hands without effort, light rubbing of the skin.

In the presence of nervous tics of a primary nature, additional massage techniques can be added to the place affected by involuntary muscle contraction. Massage of the face, hands, shoulder girdle should also be relaxing, non-aggressive, measured. It is enough to massage once a day, in the evening, before bathing. It is important for kids that massage gives them pleasure, so it is advisable to carry it out in game form.

With secondary tics, professional therapeutic massage is required. It is better to turn to a good specialist who, in a few sessions, will teach mom or dad all the necessary techniques, so that they can then carry out course treatment of the child on their own. Among physiotherapeutic methods, acupuncture is quite often and quite successfully practiced. The method has no age restrictions, however, provided that the child is somatically healthy.

Do not underestimate the effect of physical therapy. Children at 2-3 years old can already attend such classes with their parents. When drawing up a lesson plan for a particular baby, a specialist will take into account all the motor manifestations of neurosis, teach special exercises, which will allow you to relax and strain the necessary muscle groups in order to save the child from the manifestation of tics.

A child with neurosis and tics will benefit from swimming. In the water, the child relaxes all muscle groups, and the physical load on them during movement is uniform. It is not necessary to enroll the child in the professional sports section, it is enough to visit the pool once a week, and for the kids to arrange swims in a large home bath.

See the following video for what treatment Dr. Komarovsky recommends for this type of disorder.

Prevention

Avoiding the development of neurosis in a child will help measures that maximize prepare the child's psyche for possible stressful situations:

• Adequate upbringing. A child should not grow up in greenhouse conditions, so as not to grow up as a weak-willed and insecure neurasthenic. However, excessive severity and even parental cruelty can also disfigure the baby's personality beyond recognition. Do not resort to blackmail, manipulation, physical punishment. The best tactic is cooperation and constant dialogue with the child from an early age.
• Family well-being. It is not so important whether a baby grows up in a complete or incomplete family. Of greater importance is the microclimate that reigns at home. Scandals, drunkenness, tyranny and despotism, physical and moral violence, swearing, shouting - all this provides fertile ground for the development of not only neuroses, but also more complex mental problems.

• Daily routine and nutrition. Free-romantics are more likely to experience neurotic disorders in their children than parents who have taught the child from birth to follow a certain daily routine. The regimen is especially important for children of primary school age, who are already in a state of severe stress - the beginning of schooling requires endurance and patience from them. Children's nutrition should be balanced, rich in vitamins and all the necessary trace elements. Fast food should be mercilessly limited.

• Timely psychological help. It will not be possible to completely protect the child from stress and negative effects on the psyche, no matter how hard the parents try. However, they must be sensitive enough to notice the slightest change in the behavior and mood of your child, in order to respond in a timely manner and help the baby understand what happened. If your own strength and knowledge is not enough for this, you should contact a psychologist. Today there are such specialists in every kindergarten, in every school, and their task is to help a child, regardless of his age, overcome difficult situation, find correct solution to make an informed and informed choice.
• harmonious development. A child must develop in several directions in order to become a whole person. Children whose parents require only sports records or excellent school performance are more likely to become neurotic. It is good if the child combines sports with reading books, with music lessons. At the same time, parents should not overestimate their requirements and torment their child with their high expectations. Then failures will be perceived as a temporary test, and the child's feelings about this will not overpower the compensatory abilities of his psyche.

A nervous tic is an involuntary (compulsive) contraction of one or more muscles. Tics in children in their manifestations are very diverse. They are similar to natural movements, but the difference is involuntary and stereotyped. The disease develops at absolutely any age, but a nervous tic in children still happens almost 10 times more often than in adults, more often in boys than in girls. So, according to one study, out of 52 children with tic disorder, there were only 7 girls, and 44 boys (ratio 1:6).

Tic disorders are already observed in every 5th child. They firmly took almost the first place among children's neurological disorders. And the number of children suffering from this disease is increasing, and the disease itself tends to “become younger”. It is increasingly affecting infants.

More often, people from 2 to 17 years old experience tics, if we talk about the average age, 6-7 years. The disease occurs in 6-10% of the child population. In 96%, hyperkinesis occurs before 11 years of age. Its most common manifestation is blinking of the eyes. 7-10 years is the age when vocal tics may appear.

The disease is characterized by an increasing course, the peak occurs at 10-12 years, then the symptoms gradually decrease. In 50% of patients by the age of 18 years there is a complete recovery.

Simple and complex…

Tics in children come in various forms and types; at the first stage of the disease, not only parents, but also the doctor will not always suspect something alarming in the behavior of the child.

Depending on the nature of the occurrence of tics, they are divided into:

• primary;
• secondary (occur after illness or injury)

Based on the symptoms that appear, they distinguish:

• Motor - facial or limb tics (eyelid or eyebrow twitching, blinking, grimacing, teeth grinding, shuddering, leg swinging, etc.
• Vocal, vocal muscles work - (hunting, coughing, smacking, pronunciation of certain words, phrases, etc.)

According to another feature - prevalence, local and generalized(Tourette syndrome) tic. In the first case, one muscle group involuntarily contracts, in the other, several (a combination of vocal and motor). The video talks in detail about generalized hyperkinesis.

The tic condition is divided into simple and complex. Simple tics in children are involuntary, for example, he purses his lips or twitches his head, and with complex ones he jumps and crouches, bends over and actively gesticulates.

There is a division of hyperkinesis into transient and chronic. Transient (transient) - when the symptoms of the disease disappear within about 1 year. Chronic tic disorders are usually characterized by motor hyperkinesis (without vocal) lasting more than a year. And separately vocal in a chronic form are extremely rare. The chronic course of the disease is characterized by periods of exacerbation and remission. Exacerbation lasts from 1-2 weeks to 3 months, and the period of remission - from 2-6 months to 1 year or more long time- up to 5-6 years.

Causes

In young children, a complex process of formation of groupings of nerve cells and their connections takes place in the brain. If the bonds are formed insufficiently strong, then they are destroyed, and the formation of the entire nervous system is accordingly disrupted. The imbalance manifests itself in the hyperactivity of the child, in nervous tics. The so-called crisis periods are distinguished: 3.5-7 years and 12-15 years, when “leaps” occur in the development of the cerebral cortex.

The causes of the appearance of tics may also be hidden in the diseases of the central nervous system already present in the child. Neurosis-like tics can be a consequence of birth trauma, inflammation of the brain (encephalitis). Their appearance is preceded by some external unfavorable factor: fear, psychological overload, and many others. An example could be: the first visit to a kindergarten or school, divorce or conflicts between parents, uncontrolled use of TV and a computer. Simple motor tics are often noted after a traumatic brain injury suffered by a child. And voice provoke frequent respiratory infections.

The causes of tics in children may also lie in hereditary predisposition. Recent medical research is looking at immune and infectious mechanisms. For example, mothers suffering from an autoimmune disease are more likely to give birth to children with hyperkinesis.

The first, as a rule, there are local facial tics, for example, eye or blinking and twitching of the shoulders. The limbs suffer next, turns, throwing and shuddering of the head, contraction of the abdominal muscles, squats, bouncing appear. There is a change from one tick to another. Vocal sounds can gradually be added to motor ones and intensify when the stage of exacerbation occurs. And, conversely, in some patients, vocal are the first signals of Tourette's syndrome, motor hyperkinesis is added to them.

Sometimes attention is enough

Very often, children suffering from tic disease do not need special treatment at all. Involuntary movement of the eyebrows, mouth, shoulders, blinking syndrome are very common manifestations of a neurotic nature, they often affect children under 7 years of age. Tics in a child caused by emotional, psychological factors go away by themselves when the factors that caused them disappear. Children should feel the attention, affection and participation of loved ones. Endless remarks, shouting can only aggravate the situation.

But even if the situation is more complicated, it is permissible to count on the help of psychotherapy. In a playful way, the therapist teaches the child to cope with stress on their own. He treats using various psychotherapeutic techniques: gestalt therapy, kinesiology, hypnotherapy, body-oriented therapy. Therapeutic effect have outdoor activities, a properly organized daily routine.

They get rid of hyperkinesis if you create a stronger counter irritation, try to make the child's attention concentrate on something else. various outdoor games, swimming, dancing are suitable here.

Dance to your health!

In the alternative treatment of hyperkinesias, the dance of the tectonics is of interest. It was invented at the beginning of the century by young people in Paris. They were going to the Paris metro and did not want to be like others. Tectonic combines several different dance styles. All of them are characterized by "ticonic" movements. Tectonic in the style of Milky Way - a dance with continuously moving arms, a swaying body.

Most importantly, he demonstrates a good mood, a playful demeanor. The French Tek style tectonist uses mostly only legs, which are thrown back and forth by the dancer in various combinations. The effect of "running man" is created. But the Hardstyle Tectonic uses very sweeping, wide arm movements combined with jumps. In another style, Vertigo, tectonics are danced using the same wide hand and body movements.

Children enjoy learning the amazing tectonics dance. The video shows that even kids can do tectonics.

The tectonist is not able to cure the disease, but the hobby will definitely contribute to recovery.

But for neurosis-like tics, psychotherapeutic methods, except autogenic training, are ineffective. If psychotherapeutic treatment does not work for a long time, then you should turn to medications.

Medical treatment of nervous tics

In the treatment of the disease, sedatives (sedatives) are used, both medicinal and herbal. But even the tincture of valerian, motherwort is not recommended for a long time. Homeopathy offers a range effective drugs, there are good reviews: valerian-hel, spascuprel, galium-hel, hepel, which have a sedative, antispasmodic effect. Of course, for each diagnosis, the homeopathic doctor selects the appropriate remedy. For example, homeopathy suggests Argentum Nitricum 6 to help cure nictitating, vocal hyperkinesia in a child.

Generalized hyperkinesis has to be overcome with medicines. Drug treatment of tic hyperkinesis, the development of its methodology is an urgent problem of modern pediatric neurology. Among the drugs prescribed for children, benzodiazepine tranquilizers are more often used: mezapam, clonazepam; neuroleptics: Melleril. But reviews of their use speak of undesirable side effects.

Atarax will help to heal

The non-benzodiazepine tranquilizer atarax is increasingly being used. It relieves emotional stress, anxiety, fears. Atarax is a derivative of the anthelmintic drug perazin, which paralyzes the muscles of helminths. Atarax gives a relaxing effect on the muscles of the child. The results of recent scientific and clinical studies prove and confirm the effectiveness of the use of the drug "Atarax" in the treatment of tic hyperkinesis, especially transient. In addition, there is an improvement in more complex forms of the disease. A very important circumstance is that atarax, when influencing the reduction of impulsivity and hyperactivity, does not affect attention.

Atarax is applied to patients of any age, except for infants. Before using all medicines, you must read the instructions, and you need to remember children's body able to react to the drug in an unusual way. It is better to take the drug as prescribed by the doctor, because in case of adverse reactions, the doctor can always adjust the treatment. The doctor also develops the regimen for taking the drug, it will depend not only on the severity of the disease, but also on the age of the child (from a year to 6, and after 6 years).

According to many parents, atarax in the treatment of nervous disorders in children always gives a positive effect.

Other Treatments for Hyperkinesis

Treatment of tic hyperkinesis involves the use of various methods of reflexology: (moxotherapy, electropuncture, acupuncture, acupressure), herbal medicine, physiotherapy. When exposed to bioactive points, not only the symptoms are eliminated, but the cause of the disease disappears.

Phytotherapy treatment, in addition to increasing the effectiveness of all medical procedures, has its own therapeutic value: it stabilizes the psycho-emotional state, reduces the increased excitability of the nervous system, and increases stress resistance.

In the treatment of hyperkinesis, general massage, massage of the neck-collar zone, and underwater shower-massage are widely used. Massage of the collar zone will significantly improve the blood supply to the brain and has a beneficial effect on the entire nervous system of the child. And underwater massage eliminates muscle tension.

From physiotherapy methods best reviews about coniferous, carbonic and sulfide baths (especially effective for 4-7-year-old children), as well as about ozocerite applications on the cervical-collar zone.

A lot of information regarding the disease of your child is drawn from various forums. For example, on the forum "Doctor Komarovsky" parents of 6-7 year old kids communicate a lot. It is on the forums that there are reviews of both the Atarax preparation and the effectiveness of homeopathic remedies. Here you can find out what kind of massage is better to do, what psychotherapeutic methods are most effective.

Many procedures for babies can be done at home: baths, massage, gymnastics. Parents just need to master massage, at least its simple forms.