During the COVID-19 pandemic, healthcare providers observed a sharp increase in adolescents experiencing functional tic-like behaviors—involuntary movements and sounds resembling Tourette Syndrome but arising from distinct causes. A study from Boston Children’s Hospital revealed that nearly 80% of these adolescents showed improvement in their symptoms after pandemic restrictions were lifted, regardless of the treatments they received. However, a subset continued to struggle with broader mental health issues, suggesting deeper psychosocial factors at play.
The research has been published in the journal Brain and Behavior.
The surge in functional tic-like behaviors was particularly puzzling because it often appeared suddenly in individuals with no prior history of tics. Unlike typical tic disorders, many of these cases were linked to social media use, especially TikTok. Adolescents frequently reported engaging with videos featuring influencers who displayed tic-like behaviors, and some began mimicking these symptoms. Dubbed “TikTok tics,” this phenomenon raised concerns about the role of digital environments in influencing vulnerable youth and spreading functional neurological symptoms.
TikTok tics are thought to be a form of sociogenic illness, a condition where symptoms spread through social or environmental exposure rather than biological causes. Adolescents who spent increased time on TikTok during the pandemic may have been particularly susceptible. Many of these influencers shared their experiences with tics or neurological conditions, creating online communities that provided validation and support. For adolescents isolated by pandemic restrictions, these communities often became lifelines for social connection.
However, the constant exposure to tic-like behaviors through videos may have inadvertently triggered their brains to mimic these actions. Unlike traditional tics, which are often preceded by a sensory urge, TikTok tics typically lack this feature and appear in rapid, repetitive sequences.
The rise of TikTok tics coincided with several other stressors related to the pandemic, including school closures, social isolation, and increased rates of anxiety and depression among adolescents. Researchers began to suspect that the unique combination of psychological vulnerability, pandemic-related stress, and social media exposure created a “perfect storm” for the development of functional tic-like behaviors. This theory aligned with earlier examples of mass psychogenic illness, where functional symptoms spread within tight-knit communities, such as schools or workplaces. In this case, the online environment provided the medium for widespread exposure.
In their new study, researchers at Boston Children’s Hospital aimed to address three key questions: what factors contributed to the onset of functional tic-like behaviors, how these behaviors evolved after pandemic restrictions were lifted, and which treatment approaches were most effective.
To investigate this, the researchers conducted a retrospective study examining the medical records of adolescents who presented with these symptoms. The study focused on 56 patients aged 10 to 18 who developed functional tic-like behaviors between March 2020 and the lifting of pandemic restrictions. Researchers collected data on the patients’ demographic characteristics, comorbid mental health diagnoses, and treatment approaches, using standardized clinical scales to measure symptom improvement and overall functioning.
Two key tools were employed to assess outcomes: the Clinical Global Impression Improvement Scale (CGI-I) and the Clinical Global Impression Severity Scale (CGI-S). The CGI-I evaluated the progression of tic-like behaviors, while the CGI-S provided a broader view of patients’ overall mental health and functional abilities.
Patients with CGI-I scores of 1–2 were considered to have significantly improved, while those with scores of 3 or higher were categorized as not improved. Similarly, CGI-S scores of 1–3 indicated mild or no functional impairments, whereas scores of 4 or higher suggested moderate to severe impairments. Follow-up assessments occurred between August 2022 and January 2023, with an average follow-up duration of 518 days.
The study found that 79% of patients showed improvement in their tic-like behaviors, as measured by the CGI-I. This improvement was consistent regardless of the specific treatments patients received, such as cognitive behavioral intervention for tics (CBIT), general mental health therapy, or medication.
However, the findings indicated that improvement in tic-like behaviors did not always correlate with overall recovery. On the CGI-S scale, 71% of patients were rated as having mild or no functional impairments at follow-up, but the remaining 29% continued to experience moderate to severe difficulties, highlighting ongoing struggles with mental health and psychosocial functioning.
Comorbid mental health conditions were prevalent among the study population, with over 90% of patients diagnosed with anxiety disorders and 71% with depressive disorders. Many patients also reported other functional neurological symptoms, such as psychogenic non-epileptic seizures, dissociative episodes, or functional gait impairments. These findings suggest that functional tic-like behaviors are part of a broader pattern of psychological and neurological vulnerabilities rather than isolated phenomena.
Interestingly, treatment type did not appear to significantly impact the likelihood of improvement. While 86% of patients engaged in some form of psychotherapy, including CBIT, and 91% received medications such as selective serotonin reuptake inhibitors (SSRIs), neither approach proved more effective than the other.
Patients who received therapy without medication showed similar improvement rates (78%) to those treated with SSRIs (76%). This broad trend of recovery, independent of treatment modality, led researchers to speculate that the resolution of pandemic-related stressors, such as isolation and restricted social interaction, played a significant role in symptom improvement.
However, the study also identified a subset of patients who experienced persistent challenges. Adolescents who identified as gender-diverse were particularly vulnerable, showing similar rates of improvement in tic-like behaviors but significantly lower improvement in overall functioning compared to their cisgender peers. Additionally, some patients whose tic-like behaviors improved went on to develop other functional symptoms, such as eating disorders or self-harm, underscoring the complex and evolving nature of these conditions.
Looking ahead, the study highlights several directions for future research. One pressing area is the development of modified therapeutic approaches that address the unique characteristics of functional tic-like behaviors, such as their rapid onset and sociogenic components. For example, adaptations of CBIT that incorporate sensory grounding techniques and emotional acceptance may prove more effective. Another key area is the exploration of social media’s influence on adolescent mental health, particularly in the context of identity formation and validation.
The study, “Time is ticking for TikTok tics: A retrospective follow-up study in the post-COVID-19 isolation era,” was authored by Kinga K. Tomczak, Jennifer Worhach, Michael Rich, Olivia Swearingen Ludolph, Susan Eppling, Georgios Sideridis, and Tamar C. Katz.
