By Abha Ranjan Khanna
Tourette’s syndrome is a relatively lesser known neurological disorder characterised by repetitive, stereotyped, involuntary movements and vocalisations called tics. In fact, although it was first described in 1885 by Doctor Georges Gilles de la Tourette, the pioneering French neurologist, it was only around 1985 — a hundred years later — that research in the syndrome was initiated.
Recent literature indicates that besides being just a movement disorder, about 50 per cent of children with Tourette’s Syndrome may develop obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), anxiety and/or problems with anger and impulse control.
Thus, Tourette’s Syndrome can present solely as a movement disorder, or as a complex array of motor dysfunction and issues with behaviours. The condition manifests largely during childhood and is known to affect more boys than girls. Tics typically emerge between the ages of four and six, then increase in severity and peak between the ages of 10 and 12. Thereafter, tics tend to decline during adolescence and by early adulthood, most children experience markedly reduced tics or become tic-free. It is currently debated as being a neuro-developmental disorder.
The exact cause of Tourette Syndrome is not known, but some research points to changes in the brain and problems with how nerve cells communicate. An upset in the balance of neurotransmitters (chemicals in the brain that carry nerve signals from cell to cell) may play a role.
The most common symptoms are uncontrolled muscle movements. They may occur in the face, neck, shoulders, torso, or hands. Examples include:
- Head jerking, shrugging
- Squinting, blinking
- Grimacing, nose-twitching
- Repeated foot tapping, leg jerking, scratching, or other movements
Complex tics include:
- Kissing, pinching, sticking out the tongue or lip-smacking
- Touching behaviours and making rude gestures
Tourette’s also includes one or more vocal tics such as:
- Grunting or moaning sounds
- Barking, tongue clicking, sniffing and hooting
- Saying rude things, throat clearing, snorting, or coughing
- Squeaking noises, hissing, spitting, whistling, gurgling
- Echoing sounds or phrases repeatedly
Tic behaviours change over time as does tic frequency. Since the symptoms of Tourette’s first manifest around 3-4 years of age, it coincides with the beginning of the child’s school life and this can lead to many difficulties early in the child’s social and emotional development. Many children may develop attention difficulties as their tics distract them and later may have trouble in school. Given the challenge of continuously dealing with the tics, children with Tourette’s may develop behaviour problems, mood changes, social challenges and trouble sleeping, but most have normal intelligence and don’t have a learning disability.
Children with Tourette’s need nurturing support and help with developing a strong self -esteem, sense of self, relationship with family and friends and most importantly an understanding of their condition.
Though the tics are involuntary, children can learn to suppress their tics through a kind of behaviour therapy called “habit reversal”. This teaches children to recognise their individual tics and control them each time the tic impulse is anticipated. Other psychotherapies, including cognitive behaviour therapy, can help children learn to cope with their Tourette’s syndrome as well as any co-existing disorders. Importantly peers and teachers can be educated about the condition so that they can provide caring support for a young person with the disorder.
Sensitising the school, teachers, principals, administrative and ancillary staff as well as peers is crucial to the success of the child’s wellbeing and development.
(The writer is an occupational therapist.)