Tourette Syndrome

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Tourette Syndrome

Introduction

Tourette Syndrome is a disorder involving involuntary movements or sounds known as tics. Movement tics are usually brief, repeating and can affect any part of the body. Vocal tics can vary from simple sounds to speech.

Tourette Syndrome or Tourette's as it is also known, begins in childhood with symptoms generally appearing from about 7 years of age. It is a life-long condition though often improves at the end of adolescence. The tics experienced by an individual may change and be replaced over time and there may be periods of greater or lesser intensity in the presentation of symptoms. This is sometimes referred to as waxing and waning.

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Tics

Simple motor tics include blinking, head jerking, shoulder shrugging and facial grimacing. More complex movement tics include touching other people or objects; hitting or biting themselves; smelling things; jumping or spinning. Sometimes these movements can appear ritualised and performance of them is both obsessive and compulsive.

Simple vocal tics include sniffing, coughing, clearing the throat, clicking the tongue. There is a common public misconception associating Tourette Syndrome with uncontrolled swearing. Though this can occur with Tourette's it happens in only a very small proportion of those diagnosed with the condition.

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Co-morbidity

Tourette Syndrome can occur on it own but can also be co-exist with other conditions and behaviours. These can include one or more of the following:

Attention Deficit Hyperactivity Disorder (ADHD)
Anxiety
Conduct Disorder
Coprolalia (bad language)
Copropraxia (rude gestures)
Depression
Echolalia (repeating the words of others)
Echopraxia (repeating gestures of others)
Obsessive Compulsive Disorder (OCD)
Oppositional Defiant Disorder (ODD)
Rage
Self-harming behaviours such as Dermatillomania or Ecoriation Disorder (skin picking) and Trichotillomania (hair pulling)
Sleep problems

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Diagnosis

Tourette Syndrome is diagnosed when motor and vocal tic symptoms have been present for at least a year. As tics can wax and wane diagnosis can be made even if symptoms are not continuous as long as their absence is no greater than 3 months. It affects more males than females with a ratio of about 3.5 to 1. Current incidence is considered to be 1% of the population though most individuals experience only mild symptoms and do not require any additional support.

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School problems

Children with Tourette Syndrome, particularly where there is some co-morbidity with other conditions, can often experience both academic and social difficulties in school:

Learning

Attention and concentration in lessons
Working under pressure in tests and exams
Specific learning difficulties such as dyslexia and dyscalculia

Social

Impulsive behaviour
Anger and rage
Vulnerable to teasing and bullying
Withdrawl and isolation
Negative relationships with school staff

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Strategies to support children with Tourette Syndrome

Every child has their own individual needs. It is therefore essential to carry out a full assessment of their strengths and areas of difficulty to determine how best to support them. Depending on their identified needs this may include:

counselling and pastoral support
regular movement breaks
opportunities to leave the classroom when tics are presenting
anger and/or anxiety management skills
individual reward systems to raise esteem and motivate
additional support with literacy and numeracy
tests and exams in a separate room
support with bullying
initiatives to encourage positive peer support e.g. Circle of Friends

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