Tourette Syndrome

A multi-ethnic group of elementary-school-age children are listening to their teacher read a storybook in class.Tourette syndrome (also referred to as Tourette’s disorder) is a condition characterized by the presence of tics, or sudden and recurrent nonrhythmic movements or vocalizations. It is a hereditary condition for which there is no cure.

What Is Tourette Syndrome?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) characterizes this condition under the broad category of neurodevelopmental disorders, which means that its onset occurs during the developmental period. It is one of three tic disorders listed, the others being persistent motor or vocal tic disorder and provisional tic disorder.

Tourette syndrome typically develops between the ages of 4 and 6 and increases in frequency and severity between the ages of 10 and 12. Many people experience a decrease in the symptoms of Tourette syndrome in late adolescence, though some continue to have persistent and severe tics throughout adulthood. Tics can range in severity from mild to severe. Sometimes, severe tics can cause injury and can even be debilitating (though such severity is rare). The presence and frequency of tics can change over time, and they may be influenced by factors such as stress, fatigue, anxiety, and illness.

Tourette syndrome affects approximately 1 out of every 160 children in the United States, and the condition is 3-4 times more common in boys. It is not yet known what causes Tourette syndrome or similar tic disorders. As they are hereditary conditions, genetics play a significant role in their development. Other factors may include environmental or developmental circumstances.

Symptoms and Diagnosis

The primary symptom of Tourette syndrome is the presence of both motor and vocal tics:

  • A motor tic is an involuntary and nonrhythmic movement that can include eye blinks, jaw movements, grimaces, shrugs, and jerks.
  • Vocal tics are involuntary sounds, such as sniffs, grunts, and shouts.
  • About 10 to 15% of people who have this condition experience coprolalia, a vocal tic characterized by the uncontrollable use of swear words or other socially unacceptable words or phrases.

In order to be diagnosed with the condition, an individual must exhibit both motor and vocal tics for at least one year, before they reach the age of 18. The presence of tics must also not be better explained by the effects of substance use or some other medical condition.

Treatment for Tourette Syndrome

In many cases, the tics a person experiences are mild, and they may not require treatment. Some individuals diagnosed with Tourette syndrome, however, are affected by tics severe enough to impede daily functioning and cause significant distress. In such cases, an individual may benefit from treatment, which can include medications and therapy.

Several different types of medications can be used in treatment, including those that block or reduce dopamine (Haldol or Orap, for example), Botox injections, and antiseizure medications, among others.

Behavior therapy can also be helpful in the treatment of Tourette syndrome, as it can help individuals learn to monitor their tics, identify the somatic sensations (premonitory urges) that precede tics, and move in voluntary ways that are incompatible with the tic. For example, a person who has a tic that causes arm or hand movements might sit on their hands to prevent the movement. One such type of behavioral therapy, comprehensive behavioral intervention for tics, has shown promise as an evidence-based treatment.

Another type of therapy often beneficial for the treatment of Tourette’s is deep brain stimulation, or DBS. In this type of treatment, a battery-operated device that delivers electrical stimulation to areas that control movement is implanted in a person’s brain. This treatment is typically only used to help treat severe tics that are not responsive to other types of treatment.

Living with Tourette Syndrome

Tourette syndrome can create challenges for those living with it, as they may feel embarrassed of the tics they experience and hesitate to engage in social interactions. Many children may face difficulties at school, bullying among them. Some who have this condition may find it impacts their self-esteem. People who have Tourette syndrome are also at increased risk for depression and substance abuse.

Families of those with this condition can also be affected. The parents of a child who has Tourette syndrome may experience guilt or blame themselves for passing on the condition. Parents may also feel helpless or unsure of how to best help their child, while siblings may express resentment if they feel like the child who is affected by the condition receives a larger amount of attention.

Counseling to Address Challenges of Tourette Syndrome

Therapy can be useful to treat both many of the symptoms of Tourette syndrome as well as the possible effects of it, such as depression, rejection by peers, decreased self-esteem, and anxiety about social interactions. Inattention and hyperactivity (ADHD) and obsessive-compulsive behavior are two conditions that commonly co-occur, and treating these issues can often have the benefit of reducing the frequency and severity of tics.

In addition, family members of an individual with Tourette syndrome might often benefit from counseling, as speaking to a trained and compassionate professional may help them both better understand the condition and learn ways to support their loved one. Parent training, one specific type of therapy used in the case of Tourette syndrome, and involves teaching parents skills that can be used to deal with the unique issues and challenges faced by their child and family.

Medical and Allied Professional educational training seminars are available throughout the U.S. to those wishing to learn more about Tourette syndrome. These seminars are free of charge.

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM 5 (5th ed.). Arlington, VA: American Psychiatric Publishing, Inc.
  2. Clinical and counseling perspectives. (n.d.). Retrieved from https://www.tourette.org/resource/clinical-counseling-perspectives
  3. Self-management. (2015, November 21). Retrieved from http://www.mayoclinic.org/diseases-conditions/tourette-syndrome/manage/ptc-20163637
  4. Treatment. (2015, November 21). Retrieved from http://www.mayoclinic.org/diseases-conditions/tourette-syndrome/diagnosis-treatment/treatment/txc-20163628
  5. Parent and family resources. (n.d.). Retrieved from https://www.tourette.org/about-tourette/overview/living-tourette-syndrome/parent-family-resources
  6. Treatments. (2016, December 7). Retrieved from http://www.cdc.gov/ncbddd/tourette/treatments.html
  7. What is Tourette? (n.d.). Retrieved from https://www.tourette.org/about-tourette/overview/what-is-tourette/#1461071652714-d94e3399-9295

Last Updated: 01-25-2018

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