Tourette Syndrome

For a successful treatment of fluency disorder to be achieved, one has to undergo some differential diagnosis. Most people hold the belief that the disorders associated with fluency should be categorized as stuttering. There are however other types of fluency disorders that are best known to professionals who hold a specialty in disorders linked to fluency. One such disorder that has captured the attention of many is that which is related to the Tourettes syndrome. A case was reported of James Q. Public, an 11year old boy who got a referral for speech evaluation by his mother. His was school, however, had been adamant about the boys case and were not keen to see that he got help. According to his mother, James had stuttered since the time he started speaking, but there was a progressive increase despite the fact that the condition did not exist in the family history. When James was finally diagnosed with a mild Tourette syndrome, they opted for speech therapy instead of pharmacological intervention. The primary objective from the therapy sessions was to increase the awareness of vocal tics, the ability to control disfluencies through cancellations and preparatory sets. With time, there was a significant decrease in the disfluencies and a decline in the symptoms that are linked to Tourettes syndrome.

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At first, the physicians thought that the Tourette disorder was a rare syndrome. Researchers have however identified patients with this kind of syndrome in almost all the geographical areas that they have sampled. All ethnic groups feel the effects of this syndrome. Recent studies have shown that the males are likely to be affected about three to four more times than their female counterparts. The immediate symptoms of this disorder are experienced first at childhood and are most prevalent between the ages of three to nine years. An estimation of about two hundred thousand Americans has been diagnosed with the most severe form of the syndrome. There are as many as another one in one hundred people who present less complex symptoms that include vocal tics or chronic motor. Despite the fact that the disease can be considered chronic with its symptoms lasting up to a lifetime, the worst tic symptoms tend to be experienced in the early stages. Any significant progress is thought to occur in their later stages of adolescence and continues into their adult life.

Long ago, people believed that the Tourette syndrome resulted from psychological problems or even the possession by evil spirits. With time, they came to realize that it is a neurological disorder that was caused by a brain malfunction. The disorder is thought to have a genetic basis based on the scientific evidence that has been presented so far. One of the primary symptoms is a repeated display of tics. The motor or physical tics are irregular, brief, involuntary movements of parts of the body, more specifically the legs, face, neck or head. Vocal or phonic tics are repeated involuntary noises that range from grunts and coughs to complex phrases and sentences.

Persons suffering from the syndrome exhibit both vocal and motor tics. It is hard to predict tics though certain triggers such as sickness or anxiety can elevate them. The symptoms presented vary widely from mild and at times may be so severe that it interferes with daily activities. Tics are in most cases rapid while others cause a sudden freeze in position. Some of the observable mild physical tics as suggested by Eddy& Cavanna (2013) include shrugging of the shoulders, twitching of the head or even the blinking of eyes. The mild vocal tics are characterized by the clearing of the throat, sniffing, spitting, grunting and coughing. Severe cases of the Tourette syndrome are very rare. The serious the motor tics cause complex muscle movements such as kicking and spinning, imitating other peoples behaviors and other obscene gestures. For more severe vocal tics, people have been observed to produce animal sounds or even uttering words out of context.

The etiology of the Tourette syndrome is mostly linked to genetic factors and alterations of the neural chemicals of the brain. Metabolic and pharmacological evidence has defined most of the neurochemical systems. The mechanisms linked to serotonin have been proposed based on the beneficial effects of the serotonin uptake inhibitors in treating the obsessive compulsive disorders. The systems that rely on neurotransmitters send their projections to the substancia niagra and hence contribute to the pathophysiology of the syndrome. The basal ganglia have been observed to play a significant role in complex brain functions such as making decisions and motivation. People with Tourette syndrome usually have problems that result in tics which eventually distort the decision-making process. The possibility of an elevated level of dopamine may be the cause of the urge to perform unconsciously actions that may otherwise be regarded by the brain as unwanted. Another theory links tic development in children with a streptococcal infection in children that make the childs immune system to release antibodies which interact with brain tissues and in the process affects normal development

The Tourette syndrome is a familial as well as genetic disorder. There is more likelihood that the condition could be transmitted through generations although the level of severity may be different. The kind of pattern of inheritance exhibited by this syndrome is referred to as autosomal dominant (Phelps, 2008). There are also other genes in addition to the defective one that could play a role in determining a persons vulnerability. It is, however, evident that not all the individuals who inherit the defective gene show any of the symptoms related to the syndrome. Studies have shown that the female gene carriers have a seventy percent chance of expressing the TS gene. The male counterparts, on the other hand, have a percentage as high as ninety or even more of expressing the gene. Researchers are tasked with identifying the location of the chromosome that carries the Tourette gene in the affected individuals. As of now, there are no prenatal tests to confirm a persons vulnerability to the syndrome. It is only until the gene a locus is located that such tests can be put into a reality.

Despite the fact that the Tourette syndrome is considered a neurochemical disorder, the field of psychology can offer much more to those individuals with tics regarding effective treatment. Corporal punishments or negative practices and suppression are not the best options for handling patients. Some studies have shown that psychological interventions can be an effective way to reduce tics. The fact that there are only a limited number of competent clinicians who can administer the psychological therapies is a significant disadvantage. This is a major blow for parents who usually prefer psychological intervention to medication. Stressful situations are much more likely to worsen only exacerbate tics and should be avoided at all costs. When carrying out psychological assessments t is important for the counselors to focus on the factors that contribute to stress. Most of the Tics that are observed in the Tourette syndrome cases do not have a definite pattern through stress has been listed as a precipitating factor. It is only through the identification of situations that are stressful that a person can be able to establish strategies that are focused on reducing stress at a particular situation.

Some of the therapies that have been recommended include relaxation, exercise, and reversal of habits. Some of the things that may help a child relax include massages or listening to some soothing music (Frank & Cavanna, 2013). Creating a relaxed environment for them will assist in reducing the severity of tic symptoms. Also, exercises help in releasing pent-up energy. Children can be given breaks in schools that they can release energy and also manage their anger in the process. Monitoring does the habit reversal process and assessing the tics. The second process ensures that more attention focused training is done to create an awareness of the Tic for the child. It is also crucial that the child is guided in the selection of an alternative response to Tic besides that which he or she is used to. The final part is that of carrying out a motivational training and finally creating time for relaxation.

It is not necessarily true that those people who have tics also have the Tourette syndrome. Ticks may appear and disappear voluntarily during childhood as the nervous system keeps developing. The tics are usually mild and are hardly noticeable. Those whose symptoms can be observed have negligible effects on the daily life routine and as such do not warrant any concern (Blacher ,2002). As of now, no medical tests have been established to confirm the diagnosis of the syndrome. As such, the physicians can only offer a diagnosis by observing the symptoms presented and ruling out other suspected health conditions with blood tests and body scans. They also analyze the patients medical history and give a description of the childs behavior based on the history of the family. The exact cause of the syndrome is yet to be fully established. This is the reason it is often referred to as a syndrome instead of a disease.

According to Gilbert (2006), Tics has no definite cure but instead the drugs are targeted at the symptoms. Medication is useful in reducing the intensity of the symptoms manifested. Parents should, therefore, understand that the drugs administered only help their children to function with minimal impairment. The clinicians, on the other hand, should be aware that not all the medications will treat all symptoms as it is dependent on the patients reaction to drugs. Lower dosages should be used at all times and only adjusted when it is necessarily for a therapeutic effect to be achieved.

References

Blacher, Jan (2002) The double whammy: Tourette syndrome and associated disorders as they impact families. Blacher, (2002)

Eddy, C., & Cavanna, A. (2013). On being your own worst enemy: An investigation of socially inappropriate symptoms in Tourette syndrome. Journal Of Psychiatric Research, 47(9), 1259-1263. http://dx.doi.org/10.1016/j.jpsychires.2013.05.019

Frank, M., & Cavanna, A. (2013). Behavioural Treatments for Tourette Syndrome: An Evidence-Based Review. Behavioural Neurology, 27(1), 105-117. http://dx.doi.org/10.1155/2013/134863

Gilbert, D. (2006). Treatment of Children and Adolescents With Tics and Tourette Syndrome. Journal Of Child Neurology, 21(8), 690-700. http://dx.doi.org/10.1177/08830738060210080401

Phelps, L. (2008). Tourette's disorder: Genetic update, neurological correlates, and evidence-based interventions. School Psychology Quarterly, 23(2), 282-289. http://dx.doi.org/10.1037/1045-3830.23.2.282