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Tourette’s Syndrome Presented by: Rebecca Horvath.

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2 Tourette’s Syndrome Presented by: Rebecca Horvath

3 What is Tourette’s Syndrome  A chronic disorder that has both motor and vocal tics. It is usually inherited, and starts between the ages of 6 and 10 years old. Tourette’s syndrome tends to progress and become most severe during puberty and then stabilizes in adulthood. (Postgraduate Medicine, 2000)

4 How is it diagnosed?  Criteria according to the DSM-IV: 1. Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently. 2. The tics occur many times a day (usually in bouts) nearly everyday or intermittently throughout a period of more than one year, and during this period there was never a tic-free period of more than three consecutive months. 3. The disturbance causes marked distress or significant impairment in social, occupational, or other important areas of functioning. 4. The onset is before 18 years of age 5. The disturbance is not due to the direct physiological effects of a substance (e.g. stimulants) or a general medical condition (e.g. Huntington’s disease or a post viral encephalitis)

5 What are Tics?  Tics are any sudden, rapid, recurrent, nonrhythmic, involuntary actions or vocalizations. There are two types: –Motor tics –Vocal tics  Motor Tics: Any involuntary, rapid, sudden movement (usually of muscles). There are both simple and complex motor tics.  Vocal Tics: Any involuntary, rapid, sudden vocalizations. They are any tics that involve the larynx, tongue, throat, sinuses, or mouth. There are both simple and complex vocal tics.

6 Motor Tics  Simple Tics  Are completely meaningless and are sometimes mistaken for muscle spasms. They usually involve only one muscle group per tic. Examples: –Eye blinking, head swaying, foot tapping, and shoulder shrugging.  Complex Tics  Use more than one muscle group and often appear to have a purpose. Quite similar to the compulsions of Obsessive Compulsive Disorder (OCD). Examples: –Pulling at clothes, punching, and kicking. (http; jones_kacm/tictypes.htm)

7 Vocal Tics  Simple Tics  Are completely meaningless and usually use only one muscle group. Examples: –Grunting, snorting, clicking, coughing, and sniffing.  Complex Tics  Tics that are long and intricate. Examples: –Barking, whistling, coprolalia, echolalia, and palilalia.

8 What is coprolalia, echolalia, and palilalia?  Coprolalia: Performing obscene or forbidden gestures.  Echolalia: The imitation of a series of movements that have just been observed.  Palilalia: The repetition of any movement or behavior the person just performed.

9 What causes the problem?  Tics seem to be related to an abnormal transmission of messages from the brain. They have been compared to 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.  In quite a few cases, Tourette’s is associated with other problems such as attention- deficit/hyperactivity disorder (ADHD), obsessive- compulsive disorder (OCD), and depression.  Over 50% over people with Tourette’s also have ADHD and 30-40% have OCD.

10 How does the individual experience tics and can the tics be suppressed?  Tics are involuntary, they will eventually be released.  If tics are suppressed—it depends on the control of the individual for how long it is suppressed. Most adults report that their ability to modify or suppress their tics improved as they matured.

11 Should we ask an individual to suppress tics?  NO!! –The effort involved in suppressing the tics will distract the individual from whatever else is going on that they should be paying attention to. –The effort spent in suppressing tics is stressful and can produce fatigue and/or irritability, and when the tics are eventually released, they will be more explosive.

12 Working with students in the classroom…  When someone who has Tourette’s is totally engrossed in something, the tics may stop altogether. This is NOT a stressful form of suppression.  So…if they are ticcing a lot, and the teacher waits until they stop ticcing to try and teach, they will probably continue ticcing  But…if the teacher ignores their tics, and presents something novel and/or fascinating their tics may stop as their neurochemistry shifts in response to the new situation or activity.

13 Should tics be pointed out to the child?  Talking to children about their tics is likely to lead to increased ticcing, particularly in the form of vocal tics (Woods et al., 2000)  This doesn’t mean it can’t be talked about but any conversation about tics is likely to increase ticcing and may make the individual feel more self- conscious. (

14 A little research…

15 The Article!  Roane, H., Piazza, C., Cercone, J., & Grados, M. (2002). Assessment and treatement of vocal tics associated with tourette’s syndrome. Behavior Modification, 26, 482-498.

16 Vocal tics…  This article researched the variations in tics associated with body positioning.  It was found that higher levels of vocal tics were associated when the patient was sitting upright (chair and bed) compared to the conditions when the patient was lying down on a floor or on a bed.  It appeared that lying down effectively reduced the occurrence of vocal tics.

17 Why in the world would this work??  It was found that lying down might have attenuated the sensory stimulation produced by vocal tics through sensory extinction.  Lying down may have functioned as an abolishing operation by attenuating the aversive stimulation that preceded vocal tics.

18 What I really mean is…  Individuals diagnosed with TS frequently report a feeling of tension that is alleviated through emissions of a tic.  So, an aversive internal event could have been alleviated by either engaging in a vocal tic or by lying down.

19 In Summary…  This investigation provides an example of a progression in the assessment and treatment of tics associated with TS. These results may provide a basis for future investigators in developing treatments for tics associated with TS.

20 References  Roane, H., Piazza, C., Cercone, J., & Grados, M., (2002). Assessment and treatment of vocal tics associated with tourette’s syndrome. Behavior Modification, 26, 482-498.    

21 Just a thought for the day… “Youth is the first victim of war; the first fruit of peace. It takes 20 years or more of peace to make a man; it takes only 20 seconds of war to destroy him” -King Baudouin I, King of Belgium

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