Tourette's Syndrome

Practices

Surgery

Medication

Behavior Therapy

- for people who do not respond well to medication or therapy

- last resort for very severe cases

- Deep Brain Surgery – implanting electrodes in the brain, battery pack on the chest, then wiring the two together

Several medication options depending on the individuals needs and severity of the tics

No cure, meds can't take away tics but can help reduce intensity and frequency

Can also be used for reducing symptoms related to ADHD and OCD

Drugs that can do the following may be helpful

- block/deplete neurotransmitter of dopamine

- injection into affected muscle (botox)

- stimulant meds (Adderall, Ritalin)

- central adrenergic inhibitors (for high BP)

- antidepressants (Prozac)

- Habit Reversal - commonly used for TS

– first (awareness training) identify each tic out loud

– second (competing response training) learn to do a new behavior that cannot be done at the same time as the tic

Comprehensive Behavioral Intervention for Tics (CBIT)

CBIT includes habit reversal, education about tics and relaxation techniques

In CBIT, a therapist will work with a child (family) to better understand the types of tics and the situations when they are the worst

- changes to the surroundings

- habit reversal

- educate teachers

- work with a psychologist to learn techniques

Classroom Tips

Classroom Practices

Continued...

Modify written assignments

-every other math problem

-allowing the child to present a taped report

-allowing parent to act as "secretary" so the child can dictate his ideas

-focus on what the child has mastered

What is Tourette Syndrome?

- try to allow lot of time for tests

- seat child in front of teacher and away from windows, doors, any other potential sources of distraction

- provide a quiet workplace for the child, *not a punishment

- plan work in advance with student (short assignments with frequent checks is best)

- hand on a shoulder can help for listening

- short intense bursts of work, lots of breaks for movement

-change/rotate tasks frequently

Visual-motor problems

-assign a reliable "note-taking" buddy or "homework partner"

-work this out discreetly, so the child with TS does not feel different in yet another way

Definition / Explanation

Tourette Tics

Tourette Syndrome is a condition of the nervous system

Symptoms usually begin at 5-10 years old, tend to improve in adolescence / adulthood

Causes people to have "tics"

Similar to hiccups, cannot suppress them

Two kinds of tics; motor and vocal

Tourette Syndrome

These can be classified as "simple" or "complex"

Complex motor tics involve 2 or more movements at the same time

Complex vocal tics involve linguistically meaningful speech, not simply sounds

By Mark Ellison & Braden Cobb

Resources

ADHD / OCD

Continued.. TS

Program

education of peers

http://www.schoolbehavior.com/Files/PeerEducation2004.pdf

learn / donate / research / resources

http://www.tsa-usa.org/

information / school issues

http://www.tourettesyndrome.net/

Tourette Syndrome Association (TSA)

ADHD - Attention Deficit Hyperactivity Disorder

-in constant motion

-squirm and fidget

-do not seem to listen

-often talk excessively

-interrupt or intrude on others

-easily distracted

OCD - Obsessive Compulsive Disorder

-excessive double-checking of things

-counting, tapping, repeating certain words

-a lot of time washing or cleaning.

-arranging things “just so.”

When these conditions are mixed with uncontrollable tics, comes a kind of involuntary self-torment

Symptoms tend to improve when the person is focused

Regular IQs

No single test for diagnosis

Can be diagnosed if both motor and vocal tics persist for over a year

Not sure of cause, some research suggests it is inherited genetically

Affects 1/162 - 1/360 (6-17 yrs old), 37% moderate to severe

Boys are 3-5 times more likely to have TS

Many people also suffer from ADHD and or OCD along with TS

References

- funded and supported by CDC (10 years)

- for healthcare professionals, educators, and families

- information on recognizing tics and diagnosing TS

- up-to-date information about treatments for tics, including CBIT

- dispels myths and stigma associated with TS

- educates how it impacts children's lives, and provides learning strategies

- supports families and individuals affected by TS so that they can manage their condition

- TSA-CDC Program has conducted over 650 programs for over 35,000 professionals and community members in every US state. Over 100,000 more professionals have received TSA-CDC educational materials

- past 3 years, they held 53 CBIT programs with over 1700 attendees.

1) Bradley S. Peterson, MD, Pawel Skudlarski, PhD, et al, A Functional Magnetic Resonance Imaging Study of Tic Suppression in Tourette Syndrome, 1998

2) Debra L. Byler, MD, Lisa Chan, Erik Lehman, MS et al, Tourette Syndrome: A General Pediatrician’s 35-Year Experience at a Single Center With Follow-up in Adulthood, Clinical Pediatrics 20015. Vol. 54(2) 138-144

3) Mary M. Robertson, Tourette syndrome, associated conditions and the complexities of treatment, Brain (2000), 123, 425-462

4) Thomas B. Neveldine, Educating Children with Tourette Syndrome, The State Education Department, January 1995

5) Findley, Diane B, Tourette Syndrome: Information for Educators, October 2002 National Association for School Psychologists

6) http://brain.oxfordjournals.org/content/123/3/425.short

7) http://www.cdc.gov/ncbddd/tourette/families.html