Tourette's Syndrome By: Cecilia Fern, Rachel Holtz Cecilia Fern, Rachel Holtz and Emilie Miller

What is Tourette’s Syndrome? Tourette’s Syndrome is an inherited, neurological disorder characterized by multiple involuntary movements Uncontrollable vocalizations called tics that vary over the years

History Dr. Georges Gilles de la Tourette, a French neurologist, first described an 86 year old woman with this condition in The disorder is named after him.

Statistics Like mental retardation, the symptoms of TS manifest before the age of 18. TS can affect any ethnic group Males are affected 3 to 4 more times than females. 100,000 Americans have full-blown TS.

What are the Symptoms? First symptoms are usually facial tics: mostly eye-blinking, but can include nose twitching and grimaces. Over time, motor tics can develop: head-jerking; neck stretching; foot stamping; body twisting and bending

Symptoms, cont. It is not uncommon for a person with TS to continuously clear his/her throat, cough, sniff, grunt, yelp, bark or shout.

Coprolalia People with TS may involuntarily shout obscenities They may also utter strange and unacceptable sounds, words or phrases.

Echolilia Individuals with Tourette’s Syndrome may also constantly repeat the word of others. They may touch other people excessively or repeat actions obsessively.

Rare Behaviors Few patients with severe TS demonstrate self-harming behaviors: lip and cheek biting and banging head against hard objects. Remember, these behaviors are extremely rare.

How are Tics Classified? There are two types of tics: Simple Complex

Simple Tics Simple tics are sudden, brief movements that involve a limited number of muscle groups. They occur in a single or isolated fashion and are often repetitive.

Simple Tic Examples Simple tics include: Eye-blinking; shoulder shrugging; facial grimacing; head jerking; yelping and sniffling.

Complex Tics Complex tics are distinct, coordinated patterns of successive movements involving several muscle groups.

Complex Tics Examples Complex tics include: Jumping; smelling objects; touching the nose; touching other people; Coprolalia; Echolalia; or self-harming behaviors.

Can People with TS Control Their Tics? People with TS can sometimes suppress their tics; however, the effort is much like holding back a sneeze. Eventually tension mounts to the point where the tic escapes.

Controlling Tics cont. Tics worsen in stressful situations They improve, however, when a person is relaxed or absorbed in an activity. Tics decrease in most cases during sleep.

What Causes Tourette’s Syndrome? The basic cause of Tourette’s Syndrome is unknown.

Causes of TS, cont. However, current research suggests that there is an abnormality in the genes affecting the brain’s metabolism of neurotransmitters, such as: Dopamine, serotonin, and norepinephrine

Disorders Associated with Tourette’s Syndrome There are many other disorders that can occur concurrently with Tourette’s Syndrome. Some include: Obsessive compulsive behavior; AD/HD; Learning Disabilities; sleep disorders.

Disorders, cont. In fact, the accompanying disorders can be more disabling than the tics themselves. Patients, families, and physicians need to determine which set of symptoms is most disabling so that appropriate medications and therapies can be administered.

Diagnosing TS Physicians get descriptions of the tics and evaluate family history. Motor and phonic tics must be present for 1 year in order for a diagnosis of TS.

Neuro-imaging Studies Neuro-imaging Studies that rule out other conditions include: Magnetic Resonance Imaging (MRI) Computerized Tomography (CT) Electroencephalogram (EEG)

Diagnosis cont. Tourette’s Syndrome is a clinical diagnosis. Therefore, there are no blood tests or other laboratory tests that definitively diagnose TS.

How is TS Treated? Since the symptoms do not impair the individuals, the majority of people with TS do not need medication. Medication is available if symptoms interfere with functioning.

Treatment, cont. There is no one medication to help all people with TS. Also, there is no one medication that completely eliminates symptoms. Most of these medications have side effects as well.

Treatment, cont. The medication is used to reduce the frequency and intensity of tic symptoms. One kind of drug used is Neuroleptic drugs, like Haloperidol and Pimozide. Though, these medications are given in very small doses.

Treatment, cont. Clonidine is a antihypertensive drug used in the treatment of tics. It is effective in reducing motor tics rather than reducing vocal tics. Although psychological problems do not cause TS, psychotherapy may help one cope with the disorder.

Is TS Inherited? Perhaps.

Inherited, cont. Genetic studies suggest that TS is inherited in a dominant mode, depending on which genes are involved. A person with TS has a chance of passing on the genes to the offspring.

Inherited, cont. However, that genetic disposition may not result in full-blown TS. Instead, it may be a milder tic disorder. Or, it could result in OCD, or AD/HD with few or little tics at all.

Inherited, cont. Gender is also important in determining TS gene expression. If the gene-carrying TS male has offspring, the odds are 3 to 4 times higher of the offspring developing TS.

Inherited, cont. Though, in some cases, TS inheritance cannot be determined. These cases are called sporadic and their cause is unknown.

What is the Prognosis? There is no cure for Tourette’s Syndrome. Though, the condition improves as the individuals mature. The disorder is generally lifelong and chronic, it is not a degenerative condition.

Interview with Maureen Delfeld, B.S.Ed. She team teaches a special education class in a general education school. She takes some of her students into general education classrooms, so she works directly with general education teachers and their classrooms.

What to do First… Introduce the student with Tourette’s to the rest of the students on the first day. Make sure the other students understand that tics will happen during the school day and it is something they are going to need to learn how to cope with.

First, cont. Whether or not the student with Tourette's is in the room at this point is up to the child and the parents. As instructors, do not encourage the child to hold tics in; this can make it much worse.

First, cont. Make sure the rest of the class understands that just because one child swears, that does not mean they can swear.

Material Presentation Use as few words as necessary when explaining. Check for understanding (have the child repeat directions for a task back to you). Present a syllabus for the whole quarter, so the student knows what is expected of him.

Presentation, cont. Use phrases like “This is important” and “Listen Carefully.” Don’t have a lot of visual distractions in the room, and don’t sit them near the door or window.

Presentation, cont. Have a cue (both you and the student know) that can be given if he/she needs to leave the room. And have a certain spot they are allowed to go.

Medication in the Classroom Record students’ behaviors when on medication (vs. when not on medication) for doctors. One of the major side effects of the medication is sedation, which can affect the student’s ability to learn.

Classroom Environment Use seating chart to allow for any movement tics. Eliminate all unnecessary items from the student’s desk to prevent distractions.

Environment, cont. Have a duplicate set of text books for the child to keep at home. (Great to use if child misses school, or is having a hard time concentrating.) Use a study carrel if needed

Transitions Give students ample warning that a transition is coming. Have a written schedule on the desk of the student who has TS. When walking through the hall, make sure the student with TS is at the front of the line.

Tests and Grading Give extra time to finish test or turn in homework if necessary Reduce amount of work (EG: odd numbers instead of all; sometimes up to 50%). Allow extra time, read the test to them, oral responses, etc.

Tests and Grading, cont. Provide movement breaks during the test if necessary Part of the grade could be based on individual effort or improvement Retake the test (rework problems) for a passing grade Avoid ALL timed tests

Math Allow the use of a calculator without penalty Have a table of math facts available Break story problems into shorter segments Use graph paper or notebook paper turned sideways to keep work in columns.

Classroom Behaviors Sit the student with TS next to a responsible student so it limits the distractions. (Be careful that this does not negatively affect the other student) Reward forgetful students for remembering, not punish them for forgetting. Ignore behaviors that are seriously disruptive.

Behaviors, cont. Modifications for any behavior that is disturbing (foam on desk if they tap they tap their pencil, tennis balls on chair legs). Have a code for the student when their behavior is unacceptable.

Reading Let the student sit comfortably. “Follow along finger” is fine. Tapes or reader for textbooks.

Reading, cont. Read out loud in a tape recorder to listen for improvement. Read questions first before reading story. Use Headphones to block out noise.

Organization Establish a daily routine and stick to it. Have clearly defined rules, and be consistent enforcing them. Write the due date at the top of worksheets/assignments.

Organization, cont. Highlight important stuff so worksheets aren’t so cluttered. Very organized, color coding, schedule always available, etc.

Handwriting Minimize writing on homework. Have a computer for that student. Copy another student’s notes at home. Printed outline if watching a movie. Print out what is written on the blackboard.

True or False 1) Most cases of Tourette Syndrome are categorized as mild. 2) Obscene language is typical symptom of TS. 3) TS is diagnosed by taking blood samples and other neurological tests.

True and False, cont. 4) Tics involved with TS are classified as Simple and Complex. 5) It is not that important if TS goes untreated for a lengthy period of time. 6) Many students with TS have the same IQ range as students who do not have TS.

True and False, cont. 7) TS is inherited. 8) There is a cure for TS. 9) People who have TS often get better as they get older.

References MEDLINEplus Health Information A service of the National Library of Medicine and the National Institutes of Health. Interview: Delfeld, Maureen. B.S. Ed.