Rapid onset of functional tic-like behaviors among adolescent girls-Minnesota, September-November 2021

Melanie J Firestone; Stacy Holzbauer; Christine Conelea; Richard Danila; Kirk Smith; Rebecca H Bitsko; Susan M Klammer; Stefan Gingerich; Ruth Lynfield

doi:10.3389/fneur.2022.1063261

Rapid onset of functional tic-like behaviors among adolescent girls-Minnesota, September-November 2021

Front Neurol. 2023 Jan 19:13:1063261. doi: 10.3389/fneur.2022.1063261. eCollection 2022.

Authors

Affiliations

¹ Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States.
² Minnesota Department of Health, St. Paul, MN, United States.
³ Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States.
⁴ Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States.
⁵ Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States.

Abstract

Background: On October 15, 2021, the Minnesota Department of Health began investigating a school cluster of students experiencing tic-like behaviors thought to be related to recent COVID-19. The objective of this report is to describe the investigation, key findings, and public health recommendations.

Methods: Affected students and proxies were interviewed with a standardized questionnaire including validated depression and anxiety screens.

Results: Eight students had tic-like behaviors lasting >24 h after initial report with onset during September 26-October 30, 2021. All eight students were females aged 15-17 years. All students either had a history of depression or anxiety or scored as having more than minimal anxiety or depression on validated screens. Four students previously had confirmed COVID-19: the interval between prior COVID-19 and tic symptom onset varied from more than a year prior to tic symptom onset to at the time of tic symptom onset.

Conclusion: The onset of tic-like behaviors at one school in Minnesota appeared to be related more to underlying mental health conditions than recent COVID-19. These findings highlight the need to better understand functional tic-like behaviors and adolescent mental health.

Keywords: adolescent girls; functional neurologic disorders; mental health; tic disorder; tics and Tourette Syndrome.

Grants and funding

CC receives research support from National Institute of Mental Health, including NIMH-funded SBIR grants awarded to Posit Science (R43MH121209 and R43MH124542). She has received speaker honoraria and travel reimbursement from the Tourette Association of America for talks and trainings.