How to help a child with tourette syndrome
Tourette Syndrome (for Parents) - Nemours KidsHealth
What Is Tourette Syndrome?
Tourette syndrome is a condition that causes uncontrolled sudden, repetitive muscle movements and sounds known as tics.
Two types of tics are associated with Tourette syndrome:
- Motor tics: These are sudden, apparently uncontrollable movements such as exaggerated eye blinking, grimacing, head jerking, or shoulder shrugging.
- Vocal tics: These include repeated throat clearing, sniffing, or humming.
Tics can be simple or complex:
- Simple motor tics usually involve just one muscle group, such as eye blinking or grimacing.
- Complex motor tics usually involve more muscle groups and might look like a series of movements. For example, someone might touch a body part or another person repeatedly. In rare cases, people with Tourette syndrome might have a tic that makes them harm themselves, such as head banging.
- Simple vocal tics can be throat clearing, sniffing, or grunting.
- Complex vocal tics can involve calling out, repeating other people's words (a condition called echolalia), or involuntary swearing (called coprolalia).
At certain times, like when someone is under stress, the tics can become more severe, happen more often, or last longer. Or the type of tic may change.
Some kids can hold back their tics for a short time. But as tension builds, eventually it must be released as a tic. And if a person is concentrating on controlling the tic, it may be hard to focus on anything else. This can make it hard for kids with Tourette syndrome to have a conversation or pay attention in class.
The tics associated with Tourette syndrome tend to get milder or go away entirely as kids grow into adulthood. Until that happens, though, parents can help their child cope with the condition.
What Causes Tourette Syndrome?
Tourette syndrome is a genetic disorder, which means it's the result of a change in genes that's either inherited (passed on from parent to child) or happens during development in the womb.
Tourette symptoms typically appear in childhood, usually when kids are between 5–9 years old. It's not very common, and boys are more likely to be affected than girls.
The exact cause of Tourette syndrome isn't 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) might play a role.
Many kids and teens with Tourette syndrome have other behavioral conditions like ADHD, obsessive-compulsive disorder (OCD), learning problems, or anxiety.
How Is Tourette Syndrome Diagnosed?
To be diagnosed with Tourette syndrome, a child must have several different types of tics — specifically, multiple motor tics and at least one vocal tic for at least a year. They may happen every day or from time to time throughout the year.
A child with Tourette symptoms may need to see a neurologist, a doctor who specializes in problems with the nervous system.
The neurologist may ask the child's parents to keep track of the kinds of tics involved and how often they happen.
There isn't a specific diagnostic test for Tourette syndrome. Instead, the health care provider diagnoses it after taking a family history, medical history, looking at the symptoms, and doing an exam. Sometimes, imaging tests like magnetic resonance imaging tests (MRIs), computerized tomography (CT) scans, electroencephalograms (EEGs), or blood tests can rule out other conditions that might cause symptoms similar to Tourette syndrome.
How Is Tourette Syndrome Treated?
Just as Tourette syndrome is different for every person, treatment can be different too. There isn't a cure for Tourette syndrome, but most tics don't get in the way of day-to-day life. If they do, doctors may suggest medicines to help control symptoms.
Tourette syndrome is not a psychological condition, but doctors sometimes refer kids and teens to a psychologist or psychiatrist. Seeing a therapist won't stop the tics, but it can help to talk to someone about their problems, cope with stress better, and learn relaxation techniques.
A therapist also can help them with any other problems, like ADHD, OCD, and/or anxiety.
Tics usually are most severe before the mid-teen years. Most people see great improvement in their late teens to early adulthood, though some will have their tics continue into adulthood.
What Else Should I Know?
Many people don't understand what Tourette syndrome is or what causes it, so they might not know how to act around someone who has tics. If people stare or comment, kids and teens can feel embarrassed and frustrated. Someone who has it might have to explain the condition to others or deal with teasing or gawking.
These tips can help kids with Tourette syndrome cope:
- Get involved. Some experts say that when kids and teens are focused on an activity, their tics are milder and less frequent. Sports, exercise, or hobbies are great ways for kids to focus mental and physical energy.
- Lend a helping hand. Dealing with Tourette syndrome often makes kids and teens more understanding of other people's feelings, especially other young people with problems.
They might use that special sensitivity to volunteer. Knowing that they've helped others might help build confidence and ease any self-consciousness about feeling different. - Embrace creativity. Creative activities such as writing, painting, or making music help focus the mind on other things — and they help it develop.
- Find support. The Tourette Syndrome Association sponsors support groups with others who understand the condition's challenges.
- Take control. People with Tourette syndrome can feel more in control of their lives by researching the condition, asking their doctors plenty of questions, and taking an active role in their treatment.
Each person with Tourette syndrome will cope differently with its physical, emotional, and social challenges. Tourette syndrome doesn't have to disrupt everyday life, though, and kids who have it can enjoy doing the same things as other kids.
Reviewed by: Shirin Hasan, MD
Date reviewed: June 2020
Tourette Syndrome (for Kids) - Nemours KidsHealth
Reviewed by: Shirin Hasan, MD
en español Síndrome de Gilles de la Tourette
What Is Tourette Syndrome?
Tourette syndrome is a condition that affects a person's central nervous system and causes tics.
Tics are movements or sounds that a person can't control and that they repeat over and over.
Tics are kind of like hiccups. You don't plan them, and you don't want them. Sometimes, a kid might be able to hold back a tic for a short time. But tension builds, and eventually the kid must let the tic out.
What Are the Symptoms of Tourette Syndrome?
People with Tourette syndrome have two kinds of tics — motor tics and vocal tics.
- Motor tics are twitches or movements a person makes but can't control. They include eye blinking, head shaking, jerking of the arms, and shrugging.
- Vocal tics are sounds a person makes but can't control. They can include throat clearing, grunting, and coughing.
A person with Tourette syndrome sometimes has more than one type of tic happening at once. Tics can happen throughout the day. But they often happen less or go away completely when a person is concentrating (like working on a computer) or relaxing (like listening to music).
The type of tics and how often they happen often change over time. They're usually worse when a person is under stress (like when studying for a big test) or excited or very energized about something (like at a birthday party or a sports activity).
Sometimes a person with Tourette syndrome might have other conditions, like ADHD, obsessive-compulsive disorder (OCD), or trouble learning.
How Is Tourette Syndrome Treated?
To have Tourette syndrome, a person must have at least two motor tics and one vocal tic. The person has to have the tics every day or off and on for over a year — and they have to start before the person turns 18.
There's no cure for Tourette syndrome, but most of the time no treatment is needed. A kid can deal with the tics and still do normal stuff, like go to school and play with friends. If tics are making it hard to do normal stuff, a doctor may suggest medicine.
Stress or being upset can make the tics worse, and kids might feel upset because of the tics and the problems that go with them.
Talking to a psychologist or psychiatrist can help. A therapist can teach coping and relaxation skills, and help kids learn how to explain tics to others. They can also help kids with other problems that can be connected to Tourette syndrome, like ADHD and anxiety.
How Should I Act Around Someone Who Has It?
Kids who have Tourette syndrome want to be treated like everybody else. They can do regular stuff, just like other kids.
Many kids with Tourette syndrome get better as they get older. Some people will always live with Tourette syndrome, but they can enjoy themselves and pursue their dreams and goals just as their friends do.
Reviewed by: Shirin Hasan, MD
Date reviewed: June 2020
Tourette's syndrome - what kind of disease is it
Contents of the article
- Factors that provoke Tourette's syndrome
- How Tourette's Syndrome Manifests
- Disease stages
- Diagnostic features
- How is Tourette's syndrome treated in Moscow
- Traditional medicine
- Tourette Syndrome FAQ
Tourette's syndrome is a genetic disease that is most often passed from fathers to sons, it is much less common in women.
At the same time, women whose fathers suffered from this ailment are strongly prone to obsessive-compulsive disorder.
in a tenth of cases, Tourette's syndrome is also accompanied by coprolalia - this is a painful craving for obscene language, a desire to use swear words when it is inappropriate. Coprolalia is not a symptom of this syndrome exclusively, because such a problem occurs in schizophrenia and in some manic states.
It cannot be said that the disease itself is very rare - it occurs from 1 to 10 times per 2000 people, most often the diagnosis is made in childhood.
Factors provoking Tourette syndrome
Although the disease is genetic, some factors provoke it more actively. Therefore, we single out such causes of Tourette's syndrome:
- serious infections;
- poisoning with toxins;
- mental injury;
- severe and repetitive stress;
- use of psychotropic substances (including misuse of prescribed drugs).
How does Tourette syndrome manifest itself
Symptoms of Tourette's syndrome include:
- various involuntary tics. Twitching is observed on the neck, face, in the shoulder area;
- chaotic and frequent movements of the tongue, lips. Moreover, this may be accompanied by shouting out different words, sounds;
- repetition of individual movements several times, repetition of syllables, words or sounds.
The list shows that the manifestations of the disease are motor (associated with movements) and vocal (associated with sounds). Everything related to movement most often manifests itself from 2 to 8 years old, and vocal “bursts” are also characteristic of younger children.
Any tics in this disease are not controlled. These signs of Tourette's syndrome exist as if by themselves - the patient is unable to cope with them. At the same time, in a stressful situation, such reactions become aggravated, become more pronounced, vivid and frequent.
In conditions of complete rest and relaxation, tics are much less disturbing.
Disease stages
The syndrome has four stages. They are determined depending on how often tics occur. If not more than once a minute - we are talking about the first stage. Moreover, the patient often feels that the problem is approaching, and can somehow disguise it. The second stage is 2 to 4 ticks per minute. This gives a strong tension on the psyche, it is overexcited.
Further, the process goes on increasing: in the third stage, 5 or more ticks per minute are observed, and the fourth is characterized by very frequent ticks. In the latter case, serious mental disorders are not uncommon, since the central nervous system is in constant tension.
How does Tourette syndrome progress, is there a treatment
It is impossible to completely cure the disease with the help of specific programs, but often it can disappear on its own. For example, this happens during puberty.
If Tourette's syndrome persists with age, it often overlaps with various mental disorders such as panic attacks. This syndrome does not carry life-threatening consequences, however, it worsens the patient's quality of life - if only for the reason that the sick person feels uncomfortable, cannot communicate with others like an ordinary person.
Treatment of Tourette's syndrome involves smoothing out severe symptoms, improving the patient's quality of life.
Diagnostic features
Diagnosis of Tourette's syndrome consists in a set of measures:
- interview of the patient, his visual examination;
- CT scan of the brain;
- MRI. The choice of a specific research method is made by the doctor.
The problem of this nature is dealt with by psychiatrists, and the syndrome itself belongs to psychiatric diseases according to ICD-10.
Important! Parents will not be able to determine for themselves what kind of syndrome a child has.
The fact is that there are very dangerous conditions that disguise themselves as tics, so visually they look the same as Tourette's syndrome. But only a professional can verify this. If during the examination the specialist suspects a deviation, he may prescribe a number of additional examinations and analyzes (according to the situation). In this case, it is necessary to go through all the procedures and make sure the diagnosis is accurate.
How is Tourette's syndrome treated in Moscow
All methods that are used in the treatment of such diseases can be divided into drug and non-drug. The former involve taking sedatives, rarely tranquilizers. If they are prescribed, then in short courses and only after the doctor finds out that this is necessary.
Non-drug treatments for Tourette's syndrome:
- relaxing massage - manual and hardware;
- reflexology. The option is chosen depending on the situation. Such therapy is carried out with the help of hands, special needles, electrical impulses.
The point is to act on certain points of the body, which will help to relax, stabilize the nervous system; - aromatherapy. It aims to rest, calm, relax. After consultation with a doctor, aromatherapy is also available at home - this is a simple and often effective method;
- therapeutic sleep (electrosleep). Thanks to current pulses through special devices, such a dream normalizes the functioning of the brain and central nervous system. It usually lasts from 30 minutes to 2 hours;
- psychotherapy. It helps a person get rid of anxiety, complex conditions, psychological trauma, and also teaches you to accept your condition.
An important point in the treatment of Tourette's syndrome is the right environment at home, among close friends. A person with such a deviation should receive support, care, he must be protected from ridicule and inadequate reactions to tics.
Traditional medicine
With such an ailment, you can use folk remedies that are aimed at stabilizing the condition, maintaining calm.
These are teas and tinctures from herbs such as mint, chamomile, lemon balm. You can use any soothing fees if there is no allergy to the components. However, you should not rely on their healing properties - it's just easy support for the condition in addition to the main treatment (be sure to consult with your doctor).
Tourette's syndrome: questions and answers
Frequently asked questions answered by:
Chudinskaya
Galina Nikolaevna
Experience 30 years
Neurologist
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Why is the syndrome so called?
Chudinskaya Galina Nikolaevna
Neurologist, member of the Association of Interdisciplinary Medicine
It takes its name from Gilles de la Tourette. This physician published a major report on 9 patients with this syndrome in 1885.
Who is more likely to suffer from Tourette's syndrome?
Chudinskaya Galina Nikolaevna
Neurologist, member of the Association of Interdisciplinary Medicine
Symptoms of Tourette's syndrome are more common in men - 3-4 times more often than in women (according to various sources).
Also, the syndrome is more inherent in children - half of the patients get rid of it by the age of 18 (spontaneously).
How dangerous is Tourette syndrome?
Chudinskaya Galina Nikolaevna
Neurologist, member of the Association of Interdisciplinary Medicine
There is no direct danger to the life and health of the patient or others. It all comes down to the fact that because of the awkwardness and difficulty in communication, the sick person begins to withdraw into himself, to avoid people. Psychotherapy and competent treatment help to resolve this issue. Pr
"Joker" is harmful to parents whose children are diagnosed with Tourette's syndrome - neurologist Valery Zykov
In Moscow, the prevalence of Tourette's syndrome among children is one in a thousand. Head of the Department of Pediatric Neurology of the Russian Medical Academy of Continuing Professional Education, member of the International Association of Pediatric Neurologists Valery Petrovich Zykov told Olga Darfi about the treatment of Tourette's syndrome in Russia and how important it is to change public opinion towards patients.
In one film at an antique auction, the hero stood up, cursed for a long time, called everyone present, and then showed a sign: "Pay no attention, I have Tourette's syndrome." And after the release of the movie "Joker" now everyone knows that there is such a disease.
Creepy, very heavy film, why did I just watch it. And I didn't get the impression that the hero had Tourette's syndrome. I would call the film harmful to watch for parents whose children are diagnosed with Tourette syndrome - they will also live in stress, fearing such an outcome. According to our data, the children's form of Tourette's syndrome is favorable in up to 30% of cases; after 15 years, the symptoms decrease to normal tics with overwork or in stressful situations with complete social adaptation.
Isn't involuntary loud laughter really Tourette's syndrome?
Joker does not show the development of symptoms from childhood to adulthood.
In addition to attacks of sudden laughter, we see nothing, and this may be a mental illness. After all, how did it all end? The hero was no longer given drugs, and he went into aggression up to the murder, which is uncharacteristic of Tourette's syndrome. We observe in patients vocalisms in the form of swearing - the medical term "coprolalia" - with intensification against the background of emotions, cries occur in series. In adult patients, the vocal stage is possible, without motor tics. Vocalisms are often multiple: barking, grunting, shouting words, including curses, repetitions of one's own speech and the speech of others. In "Joker" the hero has severe behavioral disorders, and patients with ST tend to social adaptation.
Is this necessary for Tourette syndrome?
Attacks of violent laughter occur in dementia, schizophrenia, hereditary degenerative diseases. The very first film showing Tourette's syndrome is "Old Man Hottabych"!
I don't remember that at all!
The old man Hottabych punishes the child who deceived him with violent barking.
Here is a vivid example of vocalisms. Probably, the author of the work, Lazar Lagin, observed such a patient in his environment.
How to accurately recognize Tourette's syndrome?
These are multiple motor and vocal tics: blinking, closing eyes, twitching the head, shoulders, there may be squats and jumps. Patients sniffle, grunt, can bark and shout out separate words, often curses. An important condition for the diagnosis is that they interfere with schooling, and for adults to perform professional activities.
Just now, the mother of one patient told me that she saw a man in the metro who twitched his shoulders, and then began to shout out words and, in order not to shout them out, put his hand into his mouth. In adults, coprolalia leads to maladaptation. And it all begins in childhood, first there are involuntary blinking.
In other words, this disease cannot begin in an adult?
No. Tourette's syndrome begins before age 18.
There are certain stages in tics: the first stage of debut is at 3-7 years old, mainly motor tics, then the second stage comes at 8-12 years old, the expression of symptoms with multiple motor and vocal manifestations. The third stage is residual - at the age of 13-15, tics decrease in severity. If tics are observed at 18-20 years old, then they will remain for life. Many people are frightened by the sudden sounds, grunts and barks of patients with Tourette's syndrome. When coughing, children are taken to ENT doctors, sometimes they treat infections and allergies for six months before they turn to a neurologist. Therefore, knowledge of tics is useful for pediatricians, parents, and school teachers.
Are there many such patients in Moscow?
According to our population-based study in 2006, the prevalence of Tourette syndrome in Moscow is one in a thousand among children. Chronic tics - up to 1% of cases, and in Norway in 2019, four cases of patients with Tourette's syndrome per thousand children were registered.
Probably, this difference is related to the criteria for selecting patients for diagnosis.
Many people are frightened by the sudden sounds, grunts and barks of patients with Tourette's syndrome.
Adults have more serious symptoms: swearing and obscene gestures, which is exactly what screenwriters like to exploit in films. You remembered the "Joker", but obsessive laughter for Tourette's syndrome is uncharacteristic, in childhood, for 30 years of observation, not a single case. Quite often, attention deficit disorder joins - children do not perceive new information well, study poorly, cannot concentrate, and, accordingly, cannot perform some kind of difficult work. Children are restless, quickly switch from one topic to another, do not complete the task. They are characterized by aggression and anger, especially with exacerbation of tics. This disease is not only neurological, it belongs to psychoneurology.
Where does this disease come from? Is it genetic?
Yes, more data for genetics.
The CELSR3 genes associated with tics and Tourette's syndrome, which control receptor proteins on the neuron membrane and their sensitivity to biological substrates, have been identified, which will help develop new types of treatment in the future. But there are also psychogenic causes - a reaction to some kind of severe stress. According to my observations, 40% of patients have relatives who have tics. Another interesting thing is that since tics were in childhood, many adults forget what happened to them and do not immediately remember during the visit. All this is found out after the second or third visit of the parents with a sick child, or one of the relatives told them, or remembered that the grandfather had strange phenomena, he coughed, winked, but no one paid attention to it. There are genetic studies confirming that patients with Tourette's syndrome are at high risk of addiction to games, drugs and alcohol.
Is there a way to prevent this disease?
The issue of prevention for such patients is an individual education schedule so that the child is not overloaded, since any stress immediately provokes a worsening of the situation.
Plus, prevention of gambling addiction - they need to be distracted from games in all possible ways: sports, music, hobbies and walks. If after 15-20 years tics have not gone away, then there is a high risk that they will remain for life - after 20 years, the final maturation of the brain occurs. In half of patients, tics disappear by the age of 15, and after 20 years, 80% experience regression of symptoms, only 20% of them remain in an adult state.
If these tics have not gone away, then that's it, it's impossible to cure such a person?
In each case, we select an individual treatment. If a person screams so much that it interferes with everyone, he is given drugs, and if nothing helps, then some, only adults, after 21 years old, are sent to neurosurgical centers for deep brain stimulation operations, which can reduce tics and improve social adaptation, and in in some cases, refuse to take drugs. Of course, no one promises a complete cure, but the severity of tics is noticeably reduced.
Does this disease affect life expectancy?
I have not seen any publications about the impact of Tourette's syndrome on life expectancy. By the way, in adults they studied the effect of attention deficit disorder on mortality, it turned out that mortality was twice as high as in the population on average.
Is Tourette syndrome easy to diagnose? Parents see a child have tics and immediately run to the doctor?
Yes, purely clinical diagnosis. For the objectification of tics and assessment of the prognosis, for the first time in Europe, we used computerized electromyography on the basis of the 110th polyclinic of the DZ in Moscow. But, of course, we don’t put Tourette’s syndrome right away. I am a supporter of making a diagnosis after the age of 15, but if a child has severe tics, we also make a diagnosis at the age of 10-12.
Was this syndrome diagnosed in Soviet times? How has treatment and approach changed since then?
I do not allocate such time for neurology, let's estimate the period for 30 years.
At our department, associate professor Yuri Ivanovich Malyshev dealt with tics, may his memory be blessed, he used the term “generalized tic”, and used neuroleptics for treatment. Neurologists have always been afraid to do this, because neuroleptics are used by psychiatrists. Malyshev laid the foundation for long-term treatment, I have observed these patients for many years and indeed noted a pronounced clinical effect. We are the only neurology department that deals with tics and Tourette syndrome, and we continue the tradition of long-term neuroleptic therapy.
What has changed in these 30 years? We have developed a classification of tics, introduced the term "Tourette's syndrome", as it is used throughout the world. New drugs were added to the treatment regimens: rispolept and topiramate. That is, new forms of medicines have appeared, but the approaches themselves have been preserved, this is a long-term long-term observation and treatment.
We involve parents in monitoring tics, they keep a diary of observations, count tics for 20 minutes at home, and we see the picture for a day, a week, a month and decide whether to prescribe drugs or not.
That is, we went to analytics, introduced a method for self-counting ticks by patients.
In America there is an association of patients with Tourette's syndrome, its goal is to unite those in need, give advice online, by phone or in person. The association has lists of doctors who deal with the problem of tics, they distribute information about this disease to schools for teachers and parents so that no one is afraid of such patients and does not tease them. And we have…
We involve parents in monitoring tics, they keep a diary of observations, count tics in 20 minutes at home, introduced a method of self-counting tics by patients.
Parents tell me that the teacher yelled at the child, he had tics, and now the teacher wants to get rid of him, transfer him to another class. The teacher must understand that he can help the treatment by creating a comfortable environment for the child. Such an association has its own chat room, discussions are held there, and everyone can talk about their problems and get advice.
There is no such association in Russia, and its need is long overdue not only for sick children and their parents, but also for adult patients. If parents can help a child cope with such a condition, then it is very difficult for an adult with such a syndrome to socialize, such patients sometimes simply limit themselves to visiting the theater, exhibitions and concerts. The Association of Tourette's Syndrome Patients must be in such a large country as Russia, you, as a journalist, can start organizing. I constantly talk to parents at receptions about this, they answer: “Yes, yes,” but as the child gets better, they stop supporting this idea.
If, after this conversation, one of the readers wants to take part in the creation of an association for tics and Tourette's syndrome, please write to zykov_vpmail.ru.
Can the sick person fight his cries on his own? Although, it seems to me, this society should become more loyal and not strain because of such people.
I agree. For such patients, we use behavioral therapy techniques. Here, for example, he coughs angrily, and with the help of a specialist he can find such movements that will help extinguish unwanted manifestations and change the tension of certain muscle groups. Rapid nasal breathing helps to contain shouting in a crowded place. For a certain period of time, the patient can suppress movements by willpower, but in a home environment, tics may not be restrained by the patient. We also need to work with public opinion, there should be programs on TV on the problem of tics and Tourette's syndrome, we need to tell people about such patients, to develop tolerance.
