Abstract Details

Functional neurologic disorders are increasingly recognized in the pediatric population, with prior case series suggesting a higher prevalence during times of societal stress or trauma. Of the functional movement disorders, tics are uncommonly reported.

To investigate whether the prevalence of functional tic disorders in children increased during the COVID-19 pandemic and to identify clinical features consistent with functional versus organic tic disorders. 

This retrospective study included all new outpatient encounters in the MGH Tic Disorders Clinic where children ages 9-17 were given an ICD-10 diagnosis of Functional Movement Disorder or Tic Disorder NOS during the first 18 months of the COVID-19 pandemic and in the 18 months preceding the pandemic.  Individual cases were excluded if on chart review the presentation was not supportive of the diagnosis of a functional tic disorder. Patient demographics, a description of the reported tics, and clinical course were extracted from the medical record. 

In the 18 months preceding the COVID-19 pandemic and in the subsequent 18 months, there were 190 and 168 new presentations for tic disorders, respectively. The percentage of these patients diagnosed with functional tic disorders nearly doubled from 11% to 21% during the COVID-19 pandemic. In comparison to patients with organic tic disorders, patients with functional tic disorders had an older age of onset, were more often female, and more frequently presented with complex motor and/or vocal tics at onset.

There was a marked increase in pediatric patients presenting with functional tic disorders during the COVID-19 pandemic compared to the equivalent pre-pandemic time period. Societal stress impacting individual mental health as well as increased utilization of social media are likely contributory. Continued data collection post-pandemic may further clarify the role of social media in pediatric functional tic disorder presentations.