Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states
My first introduction to Tourettes Disorder began many years ago when I was a post graduate student doing some research in the library of a neighboring university to where I lived at the time. The library was extremely quiet despite the fact that quite a few students sat at tables doing their school work. I settled down to work at a table where I was sure that I would be alone and uninterrupted by anyone. Suddenly, I heard a loud, screaching sound. I looked up from my papers but observed that nothing had changed and everyone remained silent and busy at work. This became a pattern that repeated itself three or four times with the same result. The librarian was seated at his desk in the front and he was unperturbed by what happened. I decided to remain alert, not looking down but trying to catch whoever or whatever was making the sound. It took a few minutes and to my shock, I saw the librarian make the screaching sound. Again, no one looked up, not even him, and everything remained calm and stable in the library. Later, I learned that he had Tourettes Disorder and everyone at the university was quite accustomed to this when they were in the library.
It is estimated that roughly one out of 1000 children have a tic diorder not necessarily Tourettes. Therefore, it is not a common diagnosis and not much can be done about it.
Tourettes is a neuropsychiatric disorder that appears to be inherited. However, it skips generations with the result that is does not come directly through the parents. The gene that causes this disorder has not yet been identified.
Tourettes is one of a spectrum of tic disorders. Its symptoms are that a person experiences multiple motor tics and at least one vocalization. A person must have been experiencing these symptoms for a minimum of one year. The first symptoms can begin early in childhood but most commonly erupts during early adolescence. Males and females both get this disorder but, for some reason, many more boys than girls seem to inherit this problem.
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While most cases of Tourettes are mild in nature, they are complicated by feelings of self consciouness, embarassment, rejection from others and feelings of depression and anxiety associated with the symptoms. The severity of the tics are made worse by psychosocial stressors but are not caused by these.
It is not uncommon for people with Tourettes to also experience either ADHD, OCD (Obsessive Compulsive Disorder, and Depression and Sleep disorders. In fact, these other features become the real targets of therapy more than the tics because these can be successfully treated and the tics can be mild. In other words, it is not necessarily the tics that impair functioning as much as ADHD or the other problems if they are present. Of course, there are cases of Tourettes that are quite severe and where the tics and result in impaired functioning.
While a variety of medications have been tried with this tic disorder, none offers any effective and permanent cure.
What is most troubling about the average case of Tourettes is the way in which it affects the individual, his family, friends and school participation. It is for this reason that cognitive behavioral therapy is most important for Tourettes patients. Families, friends and school children often have to be taught and trained to accept the indivual afflicted with this. There are situations where, because the tics are so very uncontrolled that the decision is made to provide home schooling until such time as symptoms alleviate.
It is also vitally important for parents and siblings to understand that the patient is not deliberately doing this. It can be difficult to believe this in those cases where curse words are involuntarily spit out by the patient and where the patient hits and even injures themselves. All of this can serve to make parents and friends feel utterly helpless.
If you have a child who is showing signs of having tics it is important that they be brought to the MD for a complete evaluation and possible diagnosis.
Tourettes is not a degenerative disease and, thus, will not get worse with time. There is also every reason to believe that this person will grow up to become a productive member of society in every way.
Your comments and questions are welcome.
Allan N. Schwartz, PhD.
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