Co-morbid disorders and Tourette Syndrome

"In children with Tourette's Syndrome, comorbid conditions such as attention deficit-hyperactivity disorder, obsessive-compulsive disorder, and anxiety have a far greater impact on the children's quality of life than the tics themselves...."

http://www.medscape.com/viewarticle/529621

What is Tourette Syndrome?

Tourette Syndrome, or TS, is more common than you might think. However, TS tends to be very poorly understood by people who do not have direct experience with it.

To learn about Tourette Syndrome, visit http://www.tsa-usa.org/. Here are a few quick facts: TS affects about one person in a thousand, although some people think that as many as one person in a hundred may have subclinical symptoms. Very few individuals with TS -- fifteen to twenty percent -- have coprolalia (http://en.wikipedia.org/wiki/Coprolalia), which is the obscene language most people associate with Tourette's.

Motor tics (blinking, twitching) and vocal tics (grunts, whistles) are characteristic of Tourette Syndrome. TS does not affect an individual's cognitive abilities, nor does it affect lifespan. TS is an inherited disorder; boys carrying the gene for Tourette's are much more likely than girls to display symptoms. Tourette's is a neurological disorder -- in other words, it is not contagious.

Useful links about Tourette Syndrome:

http://www.tsa-usa.org/ -- The website for the Tourette Syndrome Association.

http://www.tourettesyndrome.net/ -- Tourette Syndrome “Plus” website. Individuals with Tourette Syndrome frequently have co-morbid disorders such as ADHD, OCD (obsessive-compulsive disorder), Asperger Syndrome, bipolar disorder and depression. This website is dedicated to providing knowledge and support to individuals who have TS “plus.”

http://www.uniquelygifted.org/ocd.htm -- The Tourette’s/OCD page on Meredith Warshaw’s “Uniquely Gifted” site.

http://en.wikipedia.org/wiki/Tourette_syndrome -- Tourette Syndrome on Wikipedia, a “featured article.”

http://members.tripod.com/~tourette13/ -- “The Facts About Tourette Syndrome” – the first, unofficial, TS web page.

http://www.tourettes-disorder.com/dsm.html -- Diagnostic criteria

http://www.ocfoundation.org/ -- Obsessive Compulsive Foundation. 25-50% of individuals with TS also have OCD.

While the exact number of people with TS is not known, the most recent estimates suggest that one out every 200 school-age children has Tourette’s.

Books about Tourette Syndrome:

Uttom Chowdhury, Tics and Tourette Syndrome. (http://www.amazon.com/Tics-Tourette-Syndrome-Handbook-Professionals/dp/184310203X) – A concise, information-packed book. Extremely informative, yet short enough to read in one sitting.


Elaine Fantle Shimberg, Living With Tourette Syndrome. (http://www.amazon.com/Living-Tourette-Syndrome-Elaine-Shimberg/dp/068481160X) – A very good book about life as an individual with TS. As the book was published in 1995, refer to more recent publications for information on medications.

Marilyn P. Dornbush and Sheryl K. Pruitt, Teaching the Tiger. (http://www.amazon.com/Individuals-Education-Attention-Disorders-Obsessive-Compulsive/dp/1878267345) A practical guide to teaching children with TS, ADHD and/or OCD. This book also was published in 1995, so the appendices (reading lists, organizations, software) could use updating, but the core of this book remains very useful. A quick read despite its length.

Tracy Haerle, Children with Tourette Syndrome: A Parents’ Guide. (Brand new second edition! -- http://www.amazon.com/Children-Tourette-Syndrome-Parents-Guide/dp/1890627364) Another good book, especially for parents of children with TS. The updated second edition should contain more useful information about medications.

Adam Ward Seligman and John S. Hilkevich, Don’t Think About Monkeys: Extraordinary Stories Written by People with Tourette Syndrome. (http://www.amazon.com/Monkeys-Extraordinary-Stories-Tourette-Syndrome/dp/1878267337) A fascinating look inside the minds of individuals with TS. Very good for parents and relatives, not all essays are appropriate for children.

New tools to explore autism

From the MIT Technology Review:

"Mapping Genetic Abnormalities in Autism"
http://www.technologyreview.com/Biotech/20557/

The "P" word

Change is afoot. I can feel it, although I cannot quite put my finger on it. I can smell it at times, especially after a long run or a strenuous tae kwon do class. I can see it when I pay my grocery bill, and when I open my refrigerator door to find shelves full of empty containers.

Puberty is coming.

I do not know when it will strike with full force. While I am learning as quickly as I can, I am not quite sure how it will arrive, but it is on its way, and I am nervous.

I have spent the last eleven-plus years trying to understand my son and his brain. It has been hard work, but I have kept struggling to learn more, and I think my efforts have paid off. Now, just as I begin to feel that I am on top of my game, the rules are changing.

Tourette Syndrome is a funny thing. Nobody really seems to know just how common or uncommon it is. It waxes and wanes, just like the moon. When life is relatively calm, you wonder if your child has turned a corner in his treatment. Did the latest medication or intervention really work, or did it merely coincide with a waning of symptoms? Will this waning phase last a year, a few months, another week, or just ten more seconds?

Many parents of children with Tourette Syndrome wonder what will happen when a big bolus of testosterone -- most individuals with TS are male -- is injected into the mixture of tics, ADHD, obsessions, compulsions and occasional rages. We all know that puberty is a difficult time for everyone, but we cannot help but suspect that our children will face more challenges than most.

We wonder, will our child’s tics disappear as he reaches adulthood? Will he be able to lead a relatively normal life? The answers are uncertain, at best. Experts tell us that some children’s symptoms improve after puberty, some remain unchanged, and some become worse. There is no way of knowing beforehand which outcome your child will experience. One can only watch and wait with some combination of hope and anxiety.

So I watch, and I wait; and I buy more healthy snacks; and I retool the budget to accommodate the skyrocketing grocery bills; and I try to offer gentle reminders about the virtues of good hygiene; and I offer coaching on those few social skills that I possess multiple times each day; and I try to keep a mental checklist of good changes and not-so-good changes that I observe; and I hope, and I hope, and I hope that the “good” list turns out to be longer.

Why do children lie?

Thanks to Corin for bringing this story to my attention:
http://abcnews.go.com/Health/story?id=4566602&page=1

Premature babies and autism?

A small study suggests that babies born very prematurely may experience a much higher than average incidence of autism: http://news.yahoo.com/s/ap/20080402/ap_on_he_me/autism_preemies

Fixing NCLB

An article in today's Slate about fixing NCLB and education policy in general:
http://www.slate.com/id/2187680/