2. What is Tourette’s
Syndrome
A chronic disorder that has both motor
and vocal tics. It is usually inherited,
and starts between the ages of 6 and
10 years old. Tourette’s syndrome
tends to progress and become most
severe during puberty and then
stabilizes in adulthood.
(Postgraduate Medicine, 2000)
3. How is it diagnosed?
Criteria according to the DSM-IV:
1. Both multiple motor and one or more vocal tics have been
present at some time during the illness, although not
necessarily concurrently.
2. The tics occur many times a day (usually in bouts) nearly
everyday or intermittently throughout a period of more than
one year, and during this period there was never a tic-free
period of more than three consecutive months.
3. The disturbance causes marked distress or significant
impairment in social, occupational, or other important areas
of functioning.
4. The onset is before 18 years of age
5. The disturbance is not due to the direct physiological effects
of a substance (e.g. stimulants) or a general medical
condition (e.g. Huntington’s disease or a post viral
encephalitis)
4. What are Tics?
Tics are any sudden, rapid, recurrent, nonrhythmic,
involuntary actions or vocalizations. There are two
types:
– Motor tics
– Vocal tics
Motor Tics: Any involuntary, rapid, sudden
movement (usually of muscles). There are both
simple and complex motor tics.
Vocal Tics: Any involuntary, rapid, sudden
vocalizations. They are any tics that involve the
larynx, tongue, throat, sinuses, or mouth. There are
both simple and complex vocal tics.
5. Motor Tics
Simple Tics
Are completely
meaningless and are
sometimes mistaken
for muscle spasms.
They usually involve
only one muscle group
per tic. Examples:
– Eye blinking, head
swaying, foot tapping,
and shoulder shrugging.
Complex Tics
Use more than one
muscle group and
often appear to have a
purpose. Quite similar
to the compulsions of
Obsessive Compulsive
Disorder (OCD).
Examples:
– Pulling at clothes,
punching, and kicking.
(http;au.geocities.com/
jones_kacm/tictypes.htm)
6. Vocal Tics
Simple Tics
Are completely
meaningless and
usually use only
one muscle group.
Examples:
– Grunting, snorting,
clicking, coughing,
and sniffing.
Complex Tics
Tics that are long
and intricate.
Examples:
– Barking, whistling,
coprolalia, echolalia,
and palilalia.
7. What is coprolalia,
echolalia, and palilalia?
Coprolalia: Performing obscene or
forbidden gestures.
Echolalia: The imitation of a series of
movements that have just been
observed.
Palilalia: The repetition of any
movement or behavior the person just
performed.
8. What causes the
problem?
Tics seem to be related to an abnormal
transmission of messages from the brain. They
have been compared to an itch that cries out for a
scratch or a sneeze that can be held in but feels so
much better when it is let out.
In quite a few cases, Tourette’s is associated with
other problems such as attention-
deficit/hyperactivity disorder (ADHD), obsessive-
compulsive disorder (OCD), and depression.
Over 50% over people with Tourette’s also have
ADHD and 30-40% have OCD.
www.intelihealth.com
9. How does the individual
experience tics and can the tics
be suppressed?
Tics are involuntary, they will eventually be
released.
If tics are suppressed—it depends on the
control of the individual for how long it is
suppressed. Most adults report that their
ability to modify or suppress their tics
improved as they matured.
10. Should we ask an individual
to suppress tics?
NO!!
– The effort involved in suppressing the tics will
distract the individual from whatever else is
going on that they should be paying attention to.
– The effort spent in suppressing tics is stressful
and can produce fatigue and/or irritability, and
when the tics are eventually released, they will
be more explosive.
11. Working with students in the
classroom…
When someone who has Tourette’s is totally
engrossed in something, the tics may stop
altogether. This is NOT a stressful form of
suppression.
So…if they are ticcing a lot, and the teacher waits
until they stop ticcing to try and teach, they will
probably continue ticcing
But…if the teacher ignores their tics, and presents
something novel and/or fascinating their tics may
stop as their neurochemistry shifts in response to
the new situation or activity.
12. Should tics be pointed
out to the child?
Talking to children about their tics is likely to lead to
increased ticcing, particularly in the form of vocal
tics (Woods et al., 2000)
This doesn’t mean it can’t be talked about but any
conversation about tics is likely to increase ticcing
and may make the individual feel more self-
conscious.
(www.tourettesyndrome.net)
14. The Article!
Roane, H., Piazza, C., Cercone, J., &
Grados, M. (2002). Assessment and
treatement of vocal tics associated
with tourette’s syndrome. Behavior
Modification, 26, 482-498.
15. Vocal tics…
This article researched the variations in tics
associated with body positioning.
It was found that higher levels of vocal tics
were associated when the patient was
sitting upright (chair and bed) compared to
the conditions when the patient was lying
down on a floor or on a bed.
It appeared that lying down effectively
reduced the occurrence of vocal tics.
16. Why in the world would
this work??
It was found that lying down might
have attenuated the sensory
stimulation produced by vocal tics
through sensory extinction.
Lying down may have functioned as an
abolishing operation by attenuating the
aversive stimulation that preceded
vocal tics.
17. What I really mean is…
Individuals diagnosed with TS
frequently report a feeling of tension
that is alleviated through emissions of
a tic.
So, an aversive internal event could
have been alleviated by either
engaging in a vocal tic or by lying
down.
18. In Summary…
This investigation provides an example
of a progression in the assessment
and treatment of tics associated with
TS. These results may provide a basis
for future investigators in developing
treatments for tics associated with TS.
19. References
Roane, H., Piazza, C., Cercone, J., &
Grados, M., (2002). Assessment and
treatment of vocal tics associated with
tourette’s syndrome. Behavior Modification,
26, 482-498.
www.postgradmed.com
www.intelihealth.com
www.tourettesyndrome.net
http://au.geocities.com
20. Just a thought for the day…
“Youth is the first victim of war; the first fruit of
peace. It takes 20 years or more of peace
to make a man; it takes only 20 seconds of
war to destroy him”
-King Baudouin I, King of Belgium
