Children and Teens with Tourette Syndrome · 2018-10-14 · episodes that can interfere with learning and classroom functioning. l Learning disabilities. These learning issues are
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Defining the ProblemTourette Syndrome (TS) is a chronic neurological
condition characterized by multiple motor and vocal
tics that persist for more than a year. The American
Psychiatric Association Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition (DSM-IV)
also states that significant distress or impairment in
functioning is necessary for a diagnosis of TS, but
these additional criteria are controversial.
The tics—sudden, rapid, recurrent, nonrhythymic,
stereotyped motor movements or vocalizations—are
described as simple or complex. Simple tics, usually
the first symptoms of TS, include blinking, shrugging,
head jerking, sniffing, grunting, and barking. Complex tics, which involve coordinated patterns of move-
ment or sound, may include hopping, jumping, twisting, or verbalizing words or phrases. The most dra-
matic complex tics are those that involve self-harm, such as punching oneself, and coprolalia, which is
the uttering of obscenities. Although this is a frequently publicized symptom, it occurs in less than 10%
of those with TS.
TS was once thought to be rare; it is now considered to be much more common. The transmission of
TS involves multiple genetic and environmental components, but ongoing studies have not identified
the specific gene responsible for vulnerability to TS. TS generally becomes evident in early childhood or
adolescence, and the onset is typically between ages five and seven. The condition is 1.5 to 3 times
more common in males than females. Although TS is chronic, its course waxes and wanes, and periods
of remission may last for weeks and even years. The symptoms of TS may be severe, moderate, or
mild. Most people experience their worst symptoms in their early teens. In many cases, the severity,
frequency, and variability of the symptoms may diminish, or disappear completely, by late adolescence
or early adulthood.
The most common associated symptoms that occur with TS are obsessions—persistent and
intrusive thoughts, ideas, or images—and compulsions—repetitive behaviors intended to reduce anxi-
ety. Hyperactivity, distractibility, sleep disorders, aggressiveness, and impulsivity are also linked to TS,
although the reported incidence of these concurrent symptoms varies widely. Self-consciousness, social
isolation, depression, and anxiety may also be present, often as a
This chart is intended to provide a
summary of the critical information
available on helping children with
Tourette Syndrome to insure that
every child gets the most appropriate
and comprehensive consideration.
The d iagnosis of Tourette Syndrome is
based on the following:
l Observation of symptoms
l Patient history, including age of
onset, other medical concerns,
evidence of waxing and waning
course, and descriptions of reported
and observed behaviors
l Evaluation of the degree to which
the tics have interfered with
functioning with friends, at home, or
in school.
l Comprehensive family history
Because no laboratory test is specific for
TS, other disorders must be ruled out,
based on the following:
l Drug screen
l Electroencephalogram (EEG)
l Magnetic resonance imaging (MRI)
l Computerized tomography (CT)
l Blood tests
Children should also be assessed for
these co-morbid conditions:
l Learning disabilities (LD)
l Obsessive-compulsive disorder
(OCD)
l Attention deficit hyperactivity
disorder (ADHD)
l Oppositional defiant disorder (ODD)
l Depression
l Anxiety
Frequently, the child with Tourette
Syndrome will exhibit no tics on an initial
office visit and will experience an
exacerbation of symptoms after leaving
the office. Accurate diagnosis may
require assessment over multiple visits.
Diagnosing Tourette Syndrome
About Instant Help Charts
Counseling Children and Teens with Tourette SyndromeTreatment for children with TS should be focused on the most disabling symptoms and impaired
functioning. A variety of therapeutic options have been found useful. These include:
• Support groups for children and adolescents with TS that can help them to understand the con-
dition, improve social skills, have a supportive peer experience, and feel less socially isolated.
• Psychotherapeutic counseling to develop self-esteem and self-correction.
• Specific treatment techniques to address specific problem areas. These may include:
4 Social skills training that provides the child with social, emotional, and behavioral tools
and strategies.
4 Habit reversal that teaches the child to substitute less obvious actions for more noticeable ones.
4 Relaxation training to provide relief during periods of high stress.
Parents or other guardians may benefit from educational and support groups as well as