Tourette syndrome

It is a disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations tics. The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who in 1885 first described the condition in an 86-year-old French noblewoman. The early symptoms of TS are typically noticed first in childhood, with the average onset between the ages of 3 and 9 years. TS occurs in people from all ethnic groups; males are affected about three to four times more often than females.

Tics are classified as either simple or complex. Simple motor tics are sudden, brief, repetitive movements that involve a limited number of muscle groups. Some of the more common simple tics include eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking.  Simple vocalizations might include repetitive throat-clearing, sniffing, or grunting sounds. Complex tics are distinct, coordinated patterns of movements involving several muscle groups. Complex motor tics might include facial grimacing combined with a head twist and a shoulder shrug. Other complex motor tics may actually appear purposeful, including sniffing or touching objects, hopping, jumping, bending, or twisting. Simple vocal tics may include throat-clearing, sniffing/snorting, grunting, or barking. More complex vocal tics include words or phrases.  Perhaps the most dramatic and disabling tics include motor movements that result in self-harm such as punching oneself in the face or vocal tics including coprolalia (uttering socially inappropriate  words such as swearing) or echolalia (repeating the words or phrases of others).   However, coprolalia is only present in a small number (10 to 15 percent) of individuals with TS. Some tics are preceded by an urge or sensation in the affected muscle group, commonly called a premonitory urge. Some with TS will describe a need to complete a tic in a certain way or a certain number of times in order to relieve the urge or decrease the sensation.

Tics are often worse with excitement or anxiety and better during calm, focused activities. Certain physical experiences can trigger or worsen tics, for example tight collars may trigger neck tics, or hearing another person sniff or throat-clear may trigger similar sounds. Tics do not go away during sleep but are often significantly diminished.

Although the cause of TS is unknown, current research points to abnormalities in certain brain regions (including the basal ganglia, frontal lobes, and cortex), the circuits that interconnect these regions, and the neurotransmitters (dopamine, serotonin, and norepinephrine) responsible for communication among nerve cells. Many individuals with TS experience additional neurobehavioral problems that often cause more impairment than the tics themselves.  These include inattention, hyperactivity and impulsivity (attention deficit hyperactivity disorder—ADHD);   problems with reading, writing, and arithmetic; and obsessive-compulsive symptoms such as intrusive thoughts/worries and repetitive behaviors.

Management strategies that support the child with Tourette Syndrome (at preschool, school and/or home):

  • Medication can be used to decrease the effects of ‘tics’.
  • Psychologists can provide support to families for behaviour management and educating those involved in the care of the child about Tourette Syndrome.
  • Psychology can also help a person to manage the social and emotional problems that can occur with Tourette Syndrome.
  • Behavioural Treatments, such as Cognitive Behavioural Intervention for Tics (CBIT) can be used to help reduce the effects of tics – these treatments may help a person to develop better awareness and learn to control their tics better. However, the tics are not eliminated but may reduce in severity.
  • Development of a sensory diet.
  • Improving reading and writing difficulties.

 

Occupational Therapy approaches and activities that can support the child with Tourette Syndrome and/or their carers include:

  • Expanding abilities:Developing a gradually broadening range of skill areas.
  • Social stories:Providing ideas and education around social story development.
  • School transition:Advocating and professionally supporting the transition to school, and liaising with teachers, as required.
  • Visual cuescan be used to support routine and to introduce new activities, or a change in, tasks.
  • Gross and fine motor skills:Determining the current age level of a child’s gross and fine motor abilities.
  • Devise goals:Setting functional and achievable goals in collaboration with the child, parents and teachers so that therapy has a common focus beneficial to everyone involved.
  • Educatingparents, carers, teachers and others involved in the child’s care about Tourette Syndrome and the age appropriate skills a child should be demonstrating.
  • Direct skill teachingthrough a task based approach.
  • Management strategies:Providing management strategies/ideas to assist the child in the home, at school, and the community.
  • Task engagement:Providing alternative ways to encourage task engagement.
  • Developing underlying skillsnecessary to support whole body (gross motor) and hand dexterity (fine motor) skills, such as providing activities to support:
    • balance and coordination
    • strength and endurance
    • attention and alertness
    • body awareness
    • movement planning
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