Around a third of children and adolescents with obsessive compulsive disorder also have tics, which are sudden repeated movements or sounds a person finds hard to hold back. Parents often want to know whether that changes what treatment can achieve.
Hojgaard and colleagues examined 269 young people aged 7 to 17 with OCD who took part in a large Nordic treatment study. Tic symptoms were present in 29.9% of them. Compared with those without tics, this group were more often boys, their OCD had usually started at a younger age, and their obsessions and compulsions took somewhat different forms. They also showed more OCD-related impairment, and more symptoms of autism spectrum disorder, social anxiety, attention deficit hyperactivity disorder, and outwardly directed behaviour difficulties.
The two groups did not differ on the point that matters most to families. Their OCD was no more severe, and they responded to cognitive behavioural therapy just as well.
Tics can make a presentation look more complicated, and sometimes they mean more is going on that deserves attention in its own right. They are not a reason to expect less from treatment.
If your child is struggling with obsessions or compulsions, a psychologist can help you work out what would help.
Why tics come up in OCD research
Tics are sudden, repeated movements or vocalisations. They sit close to OCD in a way that has interested researchers for decades, partly because a compulsion and a tic can look similar from the outside, and partly because both involve an urge that builds until it is acted on. DSM-5 recognises this by allowing a clinician to add a tic-related specifier to an OCD diagnosis, a label noting that the person has a current or past tic disorder.
Some earlier studies suggested young people with tic-related OCD differ meaningfully from those without tics, including in how they respond to treatment. Others found no such differences. That disagreement is what this study set out to address.
What the study did
The sample came from the Nordic Long-term Treatment Study, a large multi-site study of paediatric OCD. It included 269 patients aged 7 to 17 whose primary diagnosis was OCD. Tic symptoms were assessed with the Kiddie Schedule for Affective Disorders and Schizophrenia, a structured diagnostic interview conducted with the child and family rather than a questionnaire, which makes the identification of tics more reliable than self-report alone.
Participants were then grouped by whether they had possible or definite tic symptoms under the DSM-5 specifier, or none at all, and the two groups were compared on how their OCD presented, on other co-occurring difficulties, and on how they fared with cognitive behavioural therapy.
What it found
Tic symptoms were present in 29.9% of participants, close to a third of the sample. Those with tics were more likely to be male and more likely to have had their OCD start at an earlier age, and their OCD symptoms took a somewhat different shape.
They also carried more alongside the OCD. This group showed more OCD-related impairment, meaning the disorder interfered more with daily functioning, and more symptoms of autism spectrum disorder, social anxiety, attention deficit hyperactivity disorder, and externalising behaviour, a term covering outwardly directed difficulties such as defiance and aggression rather than inward distress.
Against that, two comparisons showed no difference. OCD severity was not higher in the tic group, and treatment outcome after cognitive behavioural therapy was equivalent. The authors state that the results support the effectiveness of CBT for tic-related OCD.
How to hold these two findings together
The clinical picture differs, but the prognosis with treatment does not. That distinction is worth keeping clear, because a more complicated presentation is often read by families as a reason to expect a poorer result, and this study does not support that reading.
The added difficulties are still worth taking seriously on their own terms. Higher impairment and more co-occurring symptoms can mean a young person needs support in areas beyond the obsessions and compulsions, even while the OCD treatment itself proceeds as it would otherwise.
Two limits belong here. This was a study of young people aged 7 to 17, so it does not speak to adults with tic-related OCD. And the comparisons describe average differences between groups rather than predicting how one particular child will present.
If your child is caught up in rituals, repeated checking, or distressing intrusive thoughts, a psychologist can talk it through with you and explain what treatment involves.