Autism Comorbidities Week 5: Tourette’s Syndrome

Tourette’s Syndrome. The mere mention of the word conjures up images of children screaming cuss words and homeless people making faces in the subway. And while that is one aspect of Tourette’s Syndrome, it is nowhere close to the complete picture.

Tourette’s Syndrome is one of the four diagnoses that fall into a conservatie model of neurodiversity, with the other three being ASD, Epilepsy, and OCD. Often, individuals with one of these four diagnoses will also have one or more of the others, with the greatest overlap being between OCD and Tourette’s.

The diagnostic criteria for Tourette’s vary by country, but the agreed upon characteristics are:

• at least two motor tics
• at least one vocal tic
• exists for at least one year, without more than 3 months without a tic
• onset before 21 (18 in the DSM)

A motor tic is a nonpurposeful movement of the body. The typical first tic is excessive eye blinking, but not every Touretter exhibits this tic. Neck tics, shoulder jerks, and jaw movements are also rather common. Tics usally begin in the face and with time may move from part to part down the body. It is possible to have multiple tics at the same time, and to have body parts tic in synchrony. My current motor repetoire includes jaw adjusting, shoulder jerks, elbow jerks, stretching my right arm out and tapping three times on the surface in front of me, and slapping my hands on my thighs twice. Tics often appear and fade and then reappear again. My first motor tic was a neck jerk which has recently all but disappeared.

Vocal tics are misleadingly titled. They can include animal noises, grunting, sniffing, or speech. Releasing cuss words only occurs in rouhgly 10% of individuals with Tourette’s. I currently have two vocal tics: a sniffing/snorting, and a throat clearing, though these showed up several months after the motor tic onstart.

75% of individuals with Tourette’s Syndrome also meet the diagnostic criteria for OCD, suggesting that the two may be manifestations of the same underlying abnormality. Thus many Touretters also engage in other ritualistic behavior particularly counting and cleaning. There is some question about whether all the tics in Tourette’s may in fact be considered compulsions, but the jury is still out on that one.

The voluntary nature of the tics varies by individual. Some are able to stifle tics for much of the day and only express them in appropriate places, but many others cannot contain a tic for more than a few seconds. Many times an individual will be ticcing before it registers that a tic will occur, making the movement entirely involuntary.

There is some question about discriminating between Tics and Stims. Although there are some differences, many movements fall into the grey area, and the approach to both is so similar as to not really require distinguishing. You can find a previous post about this difference here.

The visibility of TS is both a curse and a blessing. If you brought a social worker into a classroom and asked her to identify the student with ASD she probably could in 10 to 30 minutes. If you asked her to find the kid with TS, her time would be reduced to 10 to 30 seconds. This is beneficial as many people are willing to be more accomodating when they can physically see your disability. At this time no professor would deny me a private testing facility or suggest my handling a scalpel. But it also opens the Touretter up to bullying and reproof. Many adults do not understand that the tics are involuntary and most kids enjoy shows which mock Touretter’s such as the infamous Tourette’s guy. I was lucky to have my onset once in college, as this allowed me to bypass most of the insensitive comments of middle and high schoolers.

If your child has a tic, do not immediately jump to the conclusion that he has TS. Roughly a quarter of all kids will experience a tic at some point in their lives, but only 1% of the population goes on to develop TS. The best way to respond to tics is to have the child examined by a neurologist to ensure there is no other underlying cause, and then to generally ignore the behavior. Remember that your child cannot control the tics, and punishing them will only make them more anxious and probably increase rather than decrease the frequency of their tics. Some articles suggest pointing out to a Touretter every time he tics so that he may be more aware of them. I would highly recommend against this behavior. Most Touretters are acutely aware of their tics and pointing each out will only worsen matters. Having a sense of humor however, particularly about funny tics, can never hurt. My friends and I have developed code meanings for many of my tics, which provide a great deal of amusement.

For more information about tics and Tourette’s, be sure to visit TSA and Tourette’s Plus, as well as the Quirk Factor. Mommy Dearest will be guest posting next Thursday on her son’s experience with Tourette’s and ASD.