How should I approach the management of tics in a child who is experiencing significant social impairment?

When approaching the management of a child experiencing significant social impairment, particularly in the context of tics, a comprehensive assessment and a multi-faceted approach focusing on the social difficulties are crucial, as specific guidance on tics was not provided in the context ¹,².

Initial Assessment and Profile Development:

• Develop a detailed profile of the child to identify their specific needs and any further assessments required ¹. This should include the extent and nature of any social anxiety disorder or associated difficulties (such as selective mutism), coexisting mental health problems, and neurodevelopmental conditions like attention deficit hyperactivity disorder (ADHD), autism, or learning disabilities ¹.
• Assess their experience of bullying or social ostracism, friendships with peers, speech, language, and communication skills, and any physical health problems ¹.
• Evaluate their personal and social functioning to identify needs across personal, social, housing, educational, and occupational domains ¹.
• Consider the impact of the home, school, and wider social environments on the maintenance and treatment of social difficulties ¹.

Interventions for Social Impairment:

• If social anxiety disorder is identified, offer individual or group Cognitive Behavioural Therapy (CBT) specifically focused on social anxiety ¹. Involve parents or carers, especially for younger children, to ensure effective delivery of the intervention ¹.
• Maintain a focus on the child's emotional, educational, and social needs ¹. Work collaboratively with parents, teachers, other adults, and the child's peers to create an environment that supports the achievement of agreed treatment goals ¹.
• For autistic children and young people, offer support in developing coping strategies and accessing community services, including skills for public transport, employment, and leisure facilities ². Strategies should be adjusted to the child's developmental level and aim to increase understanding and responsiveness to their communication and interaction patterns ².
• If coexisting mental health or medical problems are present, offer psychosocial and pharmacological interventions in line with relevant NICE guidelines ².

Monitoring and Review:

• Use routine sessional outcome measures to monitor the effectiveness of interventions ¹.
• Regularly review the child's progress and adjust the care plan as needed ¹,².