Tourette’s SyndromeTourette’s Syndrome

What is Tourette’s SyndromeWhat is Tourette’s Syndrome

A chronic disorder that has both motor and A chronic disorder that has both motor and vocal tics. It is usually inherited, and starts vocal tics. It is usually inherited, and starts between the ages of 6 and 10 years old. between the ages of 6 and 10 years old. Tourette’s syndrome tends to progress Tourette’s syndrome tends to progress and become most severe during puberty and become most severe during puberty and then stabilizes in adulthood.and then stabilizes in adulthood.

(Postgraduate Medicine, 2000)(Postgraduate Medicine, 2000)

How is it diagnosed?How is it diagnosed?1.1. Both multiple motor and one or more vocal tics Both multiple motor and one or more vocal tics

have been present at some time during the have been present at some time during the illness, although not necessarily concurrently.illness, although not necessarily concurrently.

2.2. The tics occur many times a day (usually in The tics occur many times a day (usually in bouts) nearly everyday or intermittently bouts) nearly everyday or intermittently throughout a period of more than one year, and throughout a period of more than one year, and during this period there was never a tic-free during this period there was never a tic-free period of more than three consecutive months.period of more than three consecutive months.

3.3. The disturbance causes marked distress or The disturbance causes marked distress or significant impairment in social, occupational, significant impairment in social, occupational, or other important areas of functioning. or other important areas of functioning.

4. The onset is before 18 years of age4. The onset is before 18 years of age

5. The disturbance is not due to the 5. The disturbance is not due to the direct physiological effects of a direct physiological effects of a substance (e.g. stimulants) or a substance (e.g. stimulants) or a general medical condition (e.g. general medical condition (e.g. Huntington’s disease or a post viral Huntington’s disease or a post viral encephalitis)encephalitis)

What are Tics?What are Tics? Tics are any sudden, rapid, recurrent, nonrhythmic, Tics are any sudden, rapid, recurrent, nonrhythmic,

involuntary actions or vocalizations. There are two involuntary actions or vocalizations. There are two types:types: Motor ticsMotor tics Vocal ticsVocal tics

Motor Tics:Motor Tics: Any involuntary, rapid, sudden Any involuntary, rapid, sudden movement (usually of muscles). There are both movement (usually of muscles). There are both simple and complex motor tics.simple and complex motor tics.

Vocal Tics:Vocal Tics: Any involuntary, rapid, sudden Any involuntary, rapid, sudden vocalizations. They are any tics that involve the vocalizations. They are any tics that involve the larynx, tongue, throat, sinuses, or mouth. There are larynx, tongue, throat, sinuses, or mouth. There are both simple and complex vocal tics. both simple and complex vocal tics.

Motor TicsMotor Tics Simple TicsSimple Tics Are completely Are completely

meaningless and are meaningless and are sometimes mistaken for sometimes mistaken for muscle spasms. They muscle spasms. They usually involve only one usually involve only one muscle group per tic. muscle group per tic. Examples:Examples:

Eye blinking, head Eye blinking, head swaying, foot tapping, and swaying, foot tapping, and shoulder shrugging. shoulder shrugging.

Complex TicsComplex Tics Use more than one Use more than one

muscle group and often muscle group and often appear to have a appear to have a purpose. Quite similar to purpose. Quite similar to the compulsions of the compulsions of Obsessive Compulsive Obsessive Compulsive Disorder (OCD). Disorder (OCD). Examples:Examples:

Pulling at clothes, Pulling at clothes, punching, and kicking.punching, and kicking.

(http;au.geocities.com/(http;au.geocities.com/jones_kacm/tictypes.htm)jones_kacm/tictypes.htm)

Vocal TicsVocal Tics Simple TicsSimple Tics Are completely Are completely

meaningless and meaningless and usually use only one usually use only one muscle group. muscle group. Examples:Examples: Grunting, snorting, Grunting, snorting,

clicking, coughing, and clicking, coughing, and sniffing.sniffing.

Complex TicsComplex Tics Tics that are long and Tics that are long and

intricate. Examples:intricate. Examples: Barking, whistling, Barking, whistling,

coprolalia, echolalia, coprolalia, echolalia, and palilalia. and palilalia.

What is coprolalia, echolalia, What is coprolalia, echolalia, and palilalia?and palilalia?

Coprolalia: Performing obscene or Coprolalia: Performing obscene or forbidden gestures.forbidden gestures.

Echolalia: The imitation of a series of Echolalia: The imitation of a series of movements that have just been observed.movements that have just been observed.

Palilalia: The repetition of any movement Palilalia: The repetition of any movement or behavior the person just performed.or behavior the person just performed.

What causes the problem?What causes the problem?

Tics seem to be related to an abnormal transmission of Tics seem to be related to an abnormal transmission of messages from the brain. They have been compared to messages from the brain. They have been compared to an itch that cries out for a scratch or a sneeze that can an itch that cries out for a scratch or a sneeze that can be held in but feels so much better when it is let out.be held in but feels so much better when it is let out.

In quite a few cases, Tourette’s is associated with other In quite a few cases, Tourette’s is associated with other problems such as attention-deficit/hyperactivity disorder problems such as attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and (ADHD), obsessive-compulsive disorder (OCD), and depression.depression.

Over 50% of people with Tourette’s also have ADHD and Over 50% of people with Tourette’s also have ADHD and 30-40% have OCD.30-40% have OCD.

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How does the individual experience tics How does the individual experience tics and can the tics be suppressed?and can the tics be suppressed?

Tics are involuntary, they will eventually be Tics are involuntary, they will eventually be released.released.

If tics are suppressed—it depends on the control If tics are suppressed—it depends on the control of the individual for how long it is suppressed. of the individual for how long it is suppressed. Most adults report that their ability to modify or Most adults report that their ability to modify or suppress their tics improved as they matured.suppress their tics improved as they matured.

Should we ask an individual to Should we ask an individual to suppress tics?suppress tics?

NO!!NO!! The effort involved in suppressing the tics will distract The effort involved in suppressing the tics will distract

the individual from whatever else is going on that they the individual from whatever else is going on that they should be paying attention to.should be paying attention to.

The effort spent in suppressing tics is stressful and The effort spent in suppressing tics is stressful and can produce fatigue and/or irritability, and when the can produce fatigue and/or irritability, and when the tics are eventually released, they will be more tics are eventually released, they will be more explosive.explosive.

Working with students in the Working with students in the classroom…classroom…

When someone who has Tourette’s is totally When someone who has Tourette’s is totally engrossed in something, the tics may stop engrossed in something, the tics may stop altogether. This is NOT a stressful form of altogether. This is NOT a stressful form of suppression.suppression.

So…if they are ticcing a lot, and the teacher So…if they are ticcing a lot, and the teacher waits until they stop ticcing to try and teach, they waits until they stop ticcing to try and teach, they will probably continue ticcingwill probably continue ticcing

But…if the teacher ignores their tics, and But…if the teacher ignores their tics, and presents something novel and/or fascinating presents something novel and/or fascinating their tics may stop as their neurochemistry shifts their tics may stop as their neurochemistry shifts in response to the new situation or activity. in response to the new situation or activity.

Should tics be pointed out to the Should tics be pointed out to the child?child?

Talking to children about their tics is likely to lead to Talking to children about their tics is likely to lead to increased ticcing, particularly in the form of vocal tics increased ticcing, particularly in the form of vocal tics (Woods et al., 2000)(Woods et al., 2000)

This doesn’t mean it can’t be talked about but any This doesn’t mean it can’t be talked about but any conversation about tics is likely to increase ticcing and conversation about tics is likely to increase ticcing and may make the individual feel more self-conscious.may make the individual feel more self-conscious.

(www.tourettesyndrome.net)(www.tourettesyndrome.net)

A little research…A little research…

The Article!The Article! Roane, H., Piazza, C., Cercone, J., & Roane, H., Piazza, C., Cercone, J., &

Grados, M. (2002). Assessment and Grados, M. (2002). Assessment and treatement of vocal tics associated with treatement of vocal tics associated with tourette’s syndrome. tourette’s syndrome. Behavior Behavior Modification, 26,Modification, 26, 482-498. 482-498.

Vocal tics…Vocal tics… This article researched the variations in tics This article researched the variations in tics

associated with body positioning.associated with body positioning. It was found that higher levels of vocal tics were It was found that higher levels of vocal tics were

associated when the patient was sitting upright associated when the patient was sitting upright (chair and bed) compared to the conditions (chair and bed) compared to the conditions when the patient was lying down on a floor or on when the patient was lying down on a floor or on a bed. a bed.

It appeared that lying down effectively reduced It appeared that lying down effectively reduced the occurrence of vocal tics. the occurrence of vocal tics.

Why in the world would this Why in the world would this work??work??

It was found that lying down might have It was found that lying down might have attenuated the sensory stimulation attenuated the sensory stimulation produced by vocal tics through sensory produced by vocal tics through sensory extinction.extinction.

Lying down may have functioned as an Lying down may have functioned as an abolishing operation by attenuating the abolishing operation by attenuating the aversive stimulation that preceded vocal aversive stimulation that preceded vocal tics.tics.

What I really mean is…What I really mean is… Individuals diagnosed with TS frequently Individuals diagnosed with TS frequently

report a feeling of tension that is alleviated report a feeling of tension that is alleviated through emissions of a tic. through emissions of a tic.

So, an aversive internal event could have So, an aversive internal event could have been alleviated by either engaging in a been alleviated by either engaging in a vocal tic or by lying down. vocal tic or by lying down.

In Summary…In Summary… This investigation provides an example of This investigation provides an example of

a progression in the assessment and a progression in the assessment and treatment of tics associated with TS. treatment of tics associated with TS. These results may provide a basis for These results may provide a basis for future investigators in developing future investigators in developing treatments for tics associated with TS. treatments for tics associated with TS.

ReferencesReferences Roane, H., Piazza, C., Cercone, J., & Roane, H., Piazza, C., Cercone, J., &

Grados, M., (2002). Assessment and Grados, M., (2002). Assessment and treatment of vocal tics associated with treatment of vocal tics associated with tourette’s syndrome. tourette’s syndrome. Behavior Modification, Behavior Modification, 26,26, 482-498. 482-498.

www.postgradmed.comwww.postgradmed.com www.intelihealth.comwww.intelihealth.com www.tourettesyndrome.netwww.tourettesyndrome.net http://au.geocities.comhttp://au.geocities.com

Works CitesWorks Cites

Powerpoint Created by Rebecca Horvath Powerpoint Created by Rebecca Horvath https://www.msu.edu/course/asc/823c/https://www.msu.edu/course/asc/823c/

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