My nephew, age seven, has been diagnosed with Tourette’s syndrome. My own son squints quite a lot. Could my son have Tourette’s? What is Tourette’s syndrome?
The hallmark of Tourette’s syndrome is tics or involuntary movements. Motor tics are often in the face and include eye blinks, squints, nose twitches or grimaces. However, minor tics are extremely common and most children who have tics do not have Tourette’s syndrome.
In Tourette’s, tics can affect any part of the body including the arms, legs, and trunk. I once saw a child who had tics in his stomach muscles. Sometimes the tics are quite complex. Verbal tics can include grunts, throat clearing, shouting and barking. Often the verbal and motor tics go together.
Tics are not under the control of the child. They come on suddenly and occur rapidly. Children over about 8 or 9 years of age can describe an urge to do a tic before it happens. The child may resist, but the urge to tic increases. There is relief once the tic occurs.
You should check with your family doctor or pediatrician to see if your son has Tourette’s.
Boys are much more likely to have Tourette’s than girls. Most children have mild cases. They may have tics that are not terribly obvious or not very frequent.
Children with severe Tourette’s tic frequently. Some shout out and bark loudly. Occasionally, the verbal tics are swear words and the motor tics can be rude gestures.
In the past, Tourette’s was wrongly thought to be psychologically caused. Now it is recognized that Tourette’s is a disorder of the basal ganglia (an area of the brain that links movements with our thinking processes). Dopamine, a neurotransmitter, seems to be important but it is unclear how.
Genetics play a role but several different genes are involved, and more than just genetics are involved. In some cases, one identical twin will have the disorder and the other will not. Early physical stress in the womb may be important.
Some researchers feel that streptococcal infection (the cause of rheumatic fever) is important in causing Tourette’s. The streptococcal hypothesis is quite controversial. Many scientists argue it is unproven.
Tourette’s can be made worse by stress and other psychological factors.
Children with Tourette’s are at higher risk for having attention deficit disorder (ADD) and obsessive compulsive disorder (OCD).
Medical treatment consists of using drugs that change dopamine in the basal ganglia. Newer drugs seem to have fewer side effects.
Psychological treatments are very helpful. Habit reversal is a very promising psychological treatment. There are 3 major steps in habit reversal:
- Awareness training in which the child is taught to be more aware of when he or she is going to have a major tic.
- Substitution or the replacement of the tic with some voluntary behaviour. An elaborate hand tic may be replaced with clenching of the hand. A verbal tic could be changed into a deep slow breath.
- Social support and encouragement for sticking with the program.
Training may occur over months and has been shown to be helpful.
The second psychological strategy is called functional analysis. In functional analysis, the situations that trigger tics are examined. The reinforcement for tics is determined. Then the child and parent are helped to change what happens before a tic and how tics may be reinforced.
Most children with Tourette’s do very well. Early treatment can help prevent social problems.
Check out the Tourette Society website at www.tourette.ca
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