Although the exact cause of Tourette Syndrome (TS) is still largely a mystery, genetics seem to play an enormous role in its development. In fact, a parent with TS has a 50% chance of having a child with TS. The odds are greater for male children than female, which corresponds with the higher prevalence of TS in boys. Here’s a look at what you can expect to see in a child with TS.
What is TS?
TS is a neuropsychiatric tic disorder. There are three tic disorders: TS (present for at least a year); Chronic Tic Disorder (present for more than a year); and Provisional Tic Disorder (present for less than a year). TS differs from these two in that both motor and phonic tics must be present. A tic is an overwhelming compulsion to carry out a movement (motor tic) or make a certain sound or say a particular word or phrase (vocal, or phonic, tic). Research suggests abnormal brain structure, connection, and neurotransmitters (norepinephrine, serotonin, and dopamine) contribute to the development of tics, but the exact cause has yet to be discovered.
Development and Diagnosis
TS generally begins in early childhood—most commonly around age 6 or 7, although it can appear anywhere between 2 and 18. Symptoms tend to get worse as the child approaches adolescence and then get better heading into adulthood—some patients even find their tics disappear all together.
Tics come in many different forms. Despite the popularity of coprolalia (a phonic tic utilizing vulgarity, inappropriate words, racial slurs, etc), it’s actually only present in less than 15% of TS patients. Motor tics may be simple (shrugging, blinking, twitching), or complex, involving multiple muscle groups and appearing almost choreographed (patterned steps, twirling, touching objects). Simple phonic tics include hooting, shouting, grunting, or barking, while complex phonic tics are words or sentences used out of context. This might be the same phrase (as in coprolalia), or repeating oneself or others (palilalia and echolalia). The diagnostic requirements for TS includes:
- At least two motor tics
- At least one vocal or phonic tic
- Presentation of tics for at least one year
Comorbidity
Unfortunately, TS patients tend to experience additional psychological or learning disorders in tandem with the tic disorder, called comorbid conditions. Obsessive Compulsive Disorder (OCD) and Attention Deficit Hyperactivity Disorder (ADHD) are two conditions commonly seen alongside TS. This makes sense, considering Obsessive Compulsive Disorder is an anxiety driven compulsion issue, while ADHD often encompasses impulse control. Other conditions are apt to appear as well, making it important to pay attention to any issues the child may be having with behavior, learning, or socialization.
Treatment and Coping
Not every TS patient needs treatment. Cognitive behavioral therapy can be useful for TS, as well as comorbid conditions and secondary symptoms (like depression or anxiety). The goal of therapy drive TS treatment is to figure out ways to intercept tics and find alternate sources of behavior to use as distractors or replacements.
There are a variety of medications that some TS patients find helpful, particularly when tics interfere with everyday functioning. Deep Brain Stimulation is a new method of treatment involving a medical device implant that sends pulses at parts of the brain associated with movement. Many people have found this helpful, although it still merits more research.
Having TS doesn’t mean your child isn’t normal or won’t develop alongside similarly aged children. It’s important to encourage socialization and independence, as these disorders can foster feelings of isolation, sadness, and “being different.” TS doesn’t mean your child can’t be a surgeon or an athlete or a movie star or anything else they choose.
