Tic Severity in Teens Rises With Social Media Use During Pandemic

Increased social media use during the COVID-19 pandemic was linked with tic severity and reduced quality of life, a preliminary study of young people showed.

Of 20 adolescents and young adults with tics, 85% had tic frequencies that worsened during the pandemic and 50% said social media negatively affected their tics, reported Jessica Frey, MD, of the University of Florida in Gainesville, in an abstract released in advance of the American Academy of Neurology annual meeting.

“Given the known increases in social media use during the pandemic, as well as the parallel increase in tic disorders that we have seen in our clinic, we investigated whether there was any correlation between social media use and tic symptoms,” Frey said in a statement.

The study involved patients with tics, ages 11 to 21, who completed a survey assessing their time spent on social media, how often they experienced tics, the severity of tics, and their overall quality of life.

Most participants (65%) reported using social media four to five times a day (mean 5.6 hours/day). Nearly all (90%) said they used social media more during the pandemic than previously. Only 5% of participants reported using social media for information about tics.

Researchers found no significant correlation between social media use and self-reported frequency of tics at the time of the survey (R -0.249, P=0.289) or since the onset of the pandemic (R -0.0055, P=0.982). However, there was a statistically significant correlation between tic severity, quality of life, and social media use during the pandemic (R -0.496, -0.447, P=0.026, 0.048, respectively).

“Our results have begun to shed light on the impact that the COVID-19 pandemic and increased social media use may be having on teens and young adults with tic disorders,” Frey said. “More research is needed to better identify the exact stressors that are leading to more severe tics so we can work to reduce stressors for those who are experiencing them.”

The findings add to other research linking tics and tic-like behaviors in young people with possible pandemic stress. Throughout COVID-19, at least eight different Tourette syndrome clinics have reported an increase in patients, ages 12 to 25 years, with sudden motor and vocal tic-like behavior, almost exclusively girls and young women.

“Since the onset of the COVID-19 pandemic, clinicians have witnessed an increase in young people presenting with the rapid onset of functional tic-like behaviors, which has persisted over the past 2 years,” Tamara Pringsheim, MD, of the University of Calgary in Canada, told MedPage Today.

“This disorder is phenomenologically distinct from Tourette syndrome, with many affected young people developing the sudden onset of large amplitude repetitive arm movements, and complex vocalizations consisting of the repetition of words, phrases, and offensive statements,” she noted. “These tic-like behaviors appear strongly socially influenced, with many young people displaying phenomenologically similar behaviors to popular social media influencers.”

But social media exposure alone is insufficient to trigger these tic-like behaviors, Pringsheim observed.

“The majority of individuals with rapid onset functional tic-like behaviors have significant co-occurring distress, anxiety, or depressive symptoms,” she said. “We have found a positive response to treatment of underlying distress, anxiety, and depression, with reduction or remission of functional tic-like behaviors over a period of weeks to months.”

Physicians need to be aware that stress and anxiety can be expressed as physical symptoms including abnormal vocalizations and motor behaviors that mimic tics, noted Mohammed Aldosari, MD, of the Cleveland Clinic Children’s Hospital.

“The rapid onset of motor and vocal tics or tic-like behaviors in teenage girls should raise concerns of possible stress or anxiety as potential causative factors, rather than being expression of new-onset Tourette syndrome,” Aldosari told MedPage Today.

“Early identification and proper referral to therapy or psychology can lead to avoiding unneeded medical testing and early intervention which can improve prognosis,” he pointed out. “Physicians should remember that these vocalizations and movements aren’t fake or attention-seeking.”

Frey and colleagues plan to enroll an additional 60 participants to further explore the effect of social media behavior in adolescents with tics. Limitations of their study included self-reported symptoms; in addition, changes in the character and complexity of tics were not assessed.