If your child has tics and struggles with anxiety, you’re not alone. Many parents notice that tics flare when their child is stressed, tired, worried, or overwhelmed. It can be confusing and heartbreaking to watch these two challenges appear side-by-side, but there’s a reason they’re connected—and there’s a lot you can do to support your child.

Before we dive in, here’s the most important thing to know:

Tics and anxiety are not your child’s fault.
They’re not doing it on purpose, and they’re not trying to be difficult. Their brain is sending powerful signals, and their body is responding.

Understanding the connection helps you respond with confidence, calm, and compassion.

What Are Tics? A Quick Overview

Tics are sudden, repetitive movements or sounds that happen because of a neurological process. Kids often describe an uncomfortable “urge” before a tic—a pressure, itch, or tension that temporarily goes away once they do the tic. This creates a urge → tic → relief cycle.

Tics naturally wax and wane, meaning they get stronger at times and lighter at others.

How Anxiety Fits Into the Picture

Anxiety and tics share several pathways in the brain, which is why they so often show up together. Here are the key connections:

1. Anxiety increases body tension and sensory overload

When kids feel anxious, their bodies shift into “alert mode.” Muscles tighten, breathing becomes shallow, and the nervous system starts scanning for anything that feels uncomfortable or out of place. This creates a surge of internal tension and sensory sensitivity.

For children with tics, this heightened state has a big impact. Increased muscle tension makes the body feel “full,” restless, or uncomfortable—which can intensify the sensations that come before a tic. At the same time, sensory overload (too much noise, light, movement, or internal stress) makes the brain more reactive and less able to filter out the urge.

All of this combines to create a perfect storm:

• Tense muscles make tic urges feel stronger.
• Shallow breathing reduces regulation and increases the “revved up” feeling.
• Sensory overload overwhelms the system, making self-control harder.
• A hyperalert brain becomes more tuned in to every twitch, urge, and sensation.

The result? Tics become more frequent and more intense—not because kids are doing anything wrong, but because their bodies are operating at a higher level of activation than they can comfortably manage.

Helping kids lower their baseline tension through breathing, movement, and calming routines can significantly reduce tic triggers.

2. Anxiety disrupts awareness of the pre-tic urge

Anxiety doesn’t always make kids more aware of their urges. In fact, it can do the opposite.

When a child is anxious, their body is flooded with stress hormones and their nervous system becomes overstimulated. For some kids, this heightens awareness—they notice every sensation, including the urge to tic. But for many others, anxiety actually reduces body awareness. They’re so overwhelmed or “amped up” that they don’t recognize the pre-tic urge at all.

When this happens, tics can happen more automatically and more frequently, because:

• the urge is harder to detect,
• the child can’t catch it early, and
• their body is reacting before they even realize it.

This is one of the reasons tics often increase during anxious or overstimulating moments—the urge is still there, but the awareness isn’t.

3. Stress hormones amplify the tic cycle

When a child is stressed or anxious, their body releases chemicals like adrenaline and cortisol. These hormones are designed to keep us alert and ready to react—but for kids with tics, they can accidentally make the tic cycle stronger.

Stress hormones increase overall arousal in the nervous system, which means:

• the body feels more tense,
• internal sensations (including urges) feel stronger, and
• the brain has a harder time using self-control skills to interrupt the tic.

As the urge builds, the tic becomes more automatic. And after the tic happens, the brief sense of relief reinforces the cycle—creating the familiar loop of urge → tic → relief.

During high-stress moments, this loop can become even more powerful and harder for kids to break on their own. That’s why calming strategies, body awareness, and relaxation techniques are so important: they reduce stress hormones, soften the urge, and give the brain a better chance to choose a different response.

4. Anxiety about tics makes tics worse

Worrying about a tic often increases it—and many kids feel this deeply. When children become anxious about how others might react, they may fear being judged, teased, or misunderstood. Some worry about getting in trouble at school or disrupting others.

In response, kids often try to hide the tic, hold it in, or over-monitor their body, hoping no one will notice. But this extra effort puts more pressure on their already sensitive nervous system. The tension builds, the urge grows stronger, and the tic becomes even harder to suppress.

This creates a challenging cycle:
the more they worry about the tic, the more the tic demands attention.

Helping kids feel safe, supported, and understood—not watched or judged—reduces this anxiety and makes tics easier to manage.

5. Avoidance reinforces both anxiety and tics

When kids try to avoid anything that feels uncomfortable—whether it’s a situation, a demand, or the possibility of someone noticing a tic—their anxiety grows stronger over time. Avoidance sends a message to the brain: “This is dangerous. I can’t handle it.”
So the next time the situation comes up, the fear is even bigger.

This applies to tics, too.

When a child works hard to avoid ticcing—by leaving the room, distracting themselves, refusing certain activities, or staying away from people—they unintentionally make the tic feel more powerful. Their brain learns:
“The tic is a threat. I need to escape it.”

Unfortunately, this increases both:

• anxiety, because the child never gets the chance to learn they can handle the discomfort, and
• tic frequency, because the urge grows stronger when they suppress or escape from it.

Avoidance becomes a loop:
Avoid → temporary relief → stronger anxiety → stronger urges.

Teaching kids to face situations gradually, with supportive tools and confidence-building strategies, helps break this cycle. When children learn that they can tolerate the urge—and still participate in everyday life—the brain slowly reduces both anxiety and tic intensity.

What Parents Often Notice

Parents commonly tell me things like:

• “Tics explode after school.”
• “When something stressful is coming up, the tics increase.”
• “On vacation? No tics.”
• “The more anxious he gets, the more the tics show up.”
• “She does great during the day… then at night they come out full force.”
  

Every one of these patterns has a physiological explanation.
And every one is manageable with the right tools.

What You Can Do to Help Your Child

The good news? There are effective strategies that reduce tics and help kids feel calmer and more in control.

Here’s what actually works:

1. Reduce the pressure around the tic itself

Kids make the most progress when they don’t feel like they have to constantly “stop” or control their tic in the moment. Pressure increases anxiety, tightens the body, and puts their nervous system into a state that actually makes tics more likely. Even well-intentioned reminders—“Stop doing that,” “Calm your body,” “Try not to tic”—can backfire.

Instead, the goal is to create an environment where the child feels safe, supported, and not judged for something they can’t fully control.

Shift your focus to:

• Staying neutral: Avoid reacting with frustration, surprise, or concern. A neutral response communicates, “This is okay. You’re okay.”
• Keeping your tone calm and steady: Your tone regulates their nervous system. When you stay calm, their body follows.
• Normalizing tics as something their brain does: Reassure them that tics are involuntary, common, and manageable—nothing to hide or feel ashamed about.

Reducing this pressure can produce an immediate difference. When kids feel less watched, corrected, or stressed about the tic itself, their nervous system relaxes—and tic frequency often decreases naturally. The brain has more space to learn skills like awareness and competing responses later, without the emotional weight of trying to “perform” perfectly.

2. Support sensory and regulation needs

Many kids with tics also experience underlying sensory processing differences—especially in areas like proprioception (body awareness) and low sensory registration (needing more input to feel grounded). When their sensory systems are under- or over-stimulated, the nervous system becomes less regulated, and tic urges can feel stronger or harder to manage.

Supporting a child’s sensory and regulation needs helps create a calmer, more organized internal state. This gives their brain and body the input they need so the urge-to-tic signal doesn’t feel so intense.

Helpful tools include:

• Heavy work (pushing, pulling, carrying, climbing):
  Activities that activate big muscle groups help kids feel grounded, calm, and more in control of their bodies.
• Deep pressure input (hugs, weighted items, firm squeezes, compression clothing):
  Deep pressure lowers arousal, reduces anxiety, and provides the proprioceptive feedback many kids crave.
• Movement breaks (jumping, stretching, walking, swinging):
  Movement releases built-up tension and helps reset the nervous system when kids feel restless or “revved up.”
• Rhythmic activities (rocking, drumming, pacing, humming):
  Repetitive, predictable rhythms soothe the brain and help settle the internal energy that often fuels tic urges.
• Predictable routines
  Routine gives kids a sense of control and reduces anxiety spikes that can trigger more tics.

When kids receive the right type of sensory input throughout the day, their nervous system stays steadier and more organized. As a result, urges feel less overwhelming and tics often decrease in frequency and intensity. This is a foundational part of helping kids feel calmer, safer, and more regulated overall.

3. Build skills for anxiety (Brave Part vs. Worry Part of the Brain)

Kids feel more confident—and have better control over their tics—when they understand what’s happening inside their brain. One of the most helpful ways to teach this is by explaining that the brain has different parts with different jobs, almost like the characters in Inside Out 2.

There’s the Worry Part of the brain
—the part that tries to protect them, but often sounds the alarm too quickly or too loudly. It notices everything that might go wrong and sends strong signals through the body: tight muscles, fast breathing, stomach flips, or restlessness.

And then there’s the Brave Part of the brain
—the calm, thinking part that helps them problem-solve, take action, and try hard things even when they feel unsure.

Helping kids understand these two parts—and how to strengthen the Brave Part—gives them real tools to manage both anxiety and tics.

Teach your child:

• How their body feels when the Worry Part gets louder
  Noticing early signs (tight shoulders, fidgets, tummy flutters) helps them act before the tic or anxiety peaks.
• How to breathe with their belly to activate the Brave Part
  Belly breathing quiets the Worry Part and sends a “you’re safe” message through the whole nervous system, reducing the intensity of tic urges.
• How avoidance makes the Worry Part louder
  Avoiding schoolwork, new situations, or social settings teaches the brain that those things are dangerous. This strengthens anxiety—and often increases tics.
• How small steps strengthen the Brave Part
  Every tiny act of bravery helps the brain learn, “I can do this.” Over time, the Brave Part gets stronger and the Worry Part becomes less reactive.

When kids understand these parts of the brain, they feel less overwhelmed by their anxious thoughts or tic urges. They realize, “Nothing is wrong with me—my Worry Part just needs help, and my Brave Part can lead the way.”

4. Try CBIT (Comprehensive Behavioral Intervention for Tics)

If your child struggles with tics, CBIT (Comprehensive Behavioral Intervention for Tics) is the gold-standard, evidence-based treatment proven to reduce tic frequency and intensity. CBIT helps kids gain awareness, learn coping strategies, and build confidence in managing their tics.

CBIT teaches children to:

• Notice the urge: Recognize the early physical sensations that come before a tic.
• Understand triggers: Identify stressors, sensory inputs, or environments that make tics more likely.
• Use a competing response: Replace the tic with a gentle, intentional movement to interrupt the cycle.
• Rewire the tic cycle with consistent practice: Strengthen the brain’s ability to manage tics over time.

CBIT combines awareness training, sensory strategies, behavioral tools, and family guidance, empowering kids to feel less anxious, more confident, and in control.

At Three23 Therapy, CBIT is offered in two ways:

1. Individual CBIT therapy: Personalized, one-on-one sessions tailored to your child’s specific needs, pace, and goals. This is ideal for families seeking focused, individualized support.
2. Tic Tamer CBIT Group Program: A group format that provides peer support, accountability, and skill-building in a fun, interactive setting. This program helps kids learn alongside peers who understand their experience.

Learn more about both options and find the right fit for your child here: https://three23therapy.com/cbit-program.

CBIT—whether delivered individually or in a group—helps kids feel empowered, confident, and ready to thrive at home, at school, and in everyday life.

When to Seek Extra Support

Reach out for therapy if:

• tics are increasing in frequency or intensity
• anxiety is affecting school, sleep, or daily functioning
• your child avoids situations or activities they used to enjoy
• the tics cause embarrassment or distress
• your family feels stuck or overwhelmed

You don’t have to navigate this alone—and your child doesn’t either.

Peace and Blessings,

Emily, OTR/L

Occupational Therapist

emily@three23therapy.com