Tourette's

Tourette's Syndrome

Tourette’s Syndrome (TS) is a neurological disorder that causes rapid, frequent, uncontrollable, repetitive movements of the muscles, referred to as “tics.” Tic occurs randomly over a continuum of time with changes in frequency and location for an individual. Typically, tics last for a few seconds with involuntary motions starting at the head and traveling down the body to extremities. TS usually occur in children between the ages of 7 and 10, but they can begin as early as 2 years or as late as 18 years.

TS does not have serious complications, but it may be accompanied by other conditions, such as ADHD, and these can cause learning difficulties. Symptoms that are made worse by stress. Treatment includes medication and behavioral therapy. 

TS may present as:

✅ repetitive movements
✅ unwanted sounds
✅ repeatedly blinking eyes
✅ shoulder shrugging
✅ blurt out unusual sounds or offensive words

Causes of Tourette's Syndrome

While scientific research has begun to rule out some factors, there isn’t enough inconclusive evidence to conclude the causes of TS. This diagnosis seems to be related to stress and  randomly occurring. Genetics can influence TS along with environmental factors to increase stress. 

Since there is no conclusive evidence, TS holds many stereotypical notions regarding symptoms, specifically since symptoms go against the social norms- such as, swearing in public, the inability to sit still, following commands, and adhere to polite manners. TS carries many stigma and shame for the inability to control tics and the significance in eliminating blame. Keeping in mind that allowing expression of tics will decrease the frequency, it is critical to eliminate the briefs related to the TS diagnosis.

The following are aspects that are thought to contribute and have been ruled out as causes of TS:

💡 genetics
💡  stressful pregnancy
💡  birth complications
💡  stressful environments
💡  traumatic events side effects
💡  medication side effects
💡  ADHD
💡  OCD

  gender
❌  beliefs, sexuality, race
❌  lack of discipline or parenting style
❌ bad behaviors
❌  diet
❌  vaccines
❌  violent TV shows or video games

💡 genetics
💡  stressful pregnancy
💡  birth complications
💡  stressful environments
💡  traumatic events side effects
💡  medication side effects
💡  ADHD
💡  OCD

  gender
❌  beliefs, sexuality, race
❌  lack of discipline or parenting style
❌ bad behaviors
❌  diet
❌  vaccines
❌  violent TV shows or video games

Misconceptions About Tourette's Syndrome

Though TS can be “controlled,” it does not decrease or change the behavior of experiencing tics. Tics will always be present in a person’s life and the best way to support is allowing expression of the tics. When tics are controlled, it can result in the person experiencing them to release the muscle motions or repetitive behaviors “against their will.” After suppressing for long periods of time, releasing the tics feels more harmful than helpful.

Here is a list of false symptoms and assumptions that are commonly mistaken as TS:

🚫 voluntary
🚫 aggressive
🚫 may not be forever
🚫 on purpose
🚫 harmful
🚫 always recognizable
🚫 seeking attention
🚫 hateful
🚫 awareness of behavior
🚫 disruptive
🚫 unnatural

Signs and Symptoms of Tourette's Syndrome

Typically TS is noticed early in childhood causing about 1 in 5 school-age children to experience the symptoms though may not persist into adulthood. TS can also be complicated to recognize, causing a large majority of individuals to go untreated. An individual experiencing tics may not recognize their change in behaviors and it may take a loved one’s support to assist in signs and symptoms.

Some common signs and symptoms of TS are as follows:

🚩 OCD tendencies
🚩  previous diagnosis of ADHD
🚩  aggression
🚩  concerns relate to germs, dirt, etc
🚩  uncontrollable swearing
🚩  impulsive
🚩  hyperactive
🚩  intrusive thoughts
🚩  worrying
🚩  tic “attacks”
🚩  repeated phrases or words

Diagnosing Tourette's Syndrome

A reason for TS being so under diagnosed is due to the inability to notice the onset of tics. Since TS can come and go based on environmental stressors, symptoms could be hidden for many years. In order to receive a formal diagnosis, tics must be present for at least a year. In most cases, tics have gone unnoticed for years.

In order to be diagnosed with TS, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), one must experience:

⚠️ persistent, uncontrollable motor movements
⚠️ persistent, uncontrollable vocal movements
⚠️ behaviors of tics present for at least 1 year or more
⚠️ inappropriate use of language
⚠️ history of ADHD or OCD

Conditions Commonly Mistaken for Tourette's Syndrome

The symptoms of other disorders can complicate the diagnosis and treatment of TS and create extra challenges for people with TS and their families, educators, and health professionals. Related conditions can be at higher risk for learning, behavioral, and social problems. The following are conditions often mistakenly diagnosed instead of TS or as co-occurring:

✳️ Dystonia is a movement disorder in which a person’s muscles contract uncontrollably. The contraction causes the affected body part to twist involuntarily, resulting in repetitive movements or abnormal postures. Dystonia tics and TS tics can be difficult to differentiate.
✳️ Attention-Deficit Hyperactivity Disorder (ADHD) is the most commonly co-occurring diagnosis with TS. However the presence of one doesn’t necessitate the other.
✳️ Obsessive Compulsive Disorder (OCD) behaviors are having to think about, say, or do something over and over. Sometimes it is difficult to tell the difference between TS tics and obsessive-compulsive behaviors.
✳️ Conduct Disorder (CD) is characterized by aggressiveness toward others and break rules, laws, and social norms. It is often mistaken for TS due to the impulsive nature of both diagnoses.

Treating Tourette's Syndrome

It is common for TS to follow as a symptom or side effects of other diagnoses. For example- OCD or ADHD, which tends to require medication management during serve episodes. For 

TS though, even during serve episodes, there is no medication administered to decrease or suppress tics. It is often recommended to decrease excitement and anxiety and increase calming tools. The following are some treatment that may help:

🧬 psychotherapy                                                 🧬 support groups
🧬 essential calming oils                                    🧬 normalizing the behaviors
🧬 calming / soothing activities                       🧬 expression of tics
🧬 decreasing lighting or harsh lights            🧬 hydration
🧬 avoiding areas where tics are located     🧬 cannabis  

🧬 psychotherapy
🧬 support groups
🧬 essential calming oils
🧬 normalizing the behaviors
🧬 calming / soothing activities
🧬 expression of tics
🧬 decreasing lighting or harsh lights
🧬 hydration
🧬 avoiding areas where tics are located
🧬 cannabis  

Healthcare Professionals Who Treat Tourette's Syndrome

For the best results in a successful treatment of TS, seek providers that have specialties in the assessment, treatment, diagnosis, and continuing support of patients diagnosed with TS. 

Many medical and mental health providers are familiar with the diagnosis of TS.  However if your chosen provider is not, they should always provide a knowledgeable referral source. Specialized providers will have the capabilities to diagnose using various testing methods to decrease the likelihood of misdiagnoses and unnecessary treatments. 

If you choose to utilize medication, psychotherapy should always be incorporated in treatment planning. 

The following are professionals involved in the treatment of TS:

🧠 physicians
🧠 social workers
🧠psychiatrists
🧠nurse practitioners
🧠pediatricians
🧠 licensed professional counselors
🧠neurologists
🧠 therapists
🧠psychologists
🧠marriage & family therapists

Recognizing Immediate Need for Tourette's Syndrome

​Since you are the expert on your body and mind, it is best to seek professional help when you are concerned for your wellbeing or daily functioning. If you are noticing the tics interfering with your daily life, it is best to seek help right away. If the tics seem manageable, use your best judgement to determine the appropriate time to seek support.

The following warning signs should alert you to the immediate need for treatment:

🚨 if symptoms lead to substance abuse
🚨disruptive machinery / motor vehicles operating
🚨 drastic change of mood and emotions
🚨 increased irritability, anger, and defiance
🚨 self harm

Tourette's Syndrome Professional Organizations

Provided are some resources to help the start of seeking support for Tourette’s syndrome. Though these are national links, consider narrowing options down by searching in your current location. 

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Tourette-Syndrome-Fact-Sheet#3231_1
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Tourette-Syndrome-Fact-Sheet
https://www.healthline.com/health/gilles-de-la-tourette-syndrome