Pediatric Tourette Syndrome – Conditions and Treatments

Key Points About Tourette Syndrome in Children

• Tourette syndrome is a neurological disorder. It affects more boys than girls.
• The disease causes repeated tics. These are sudden, uncontrolled vocal sounds or muscle jerks.
• Symptoms of Tourette syndrome often begin between ages 5 and 10.
• Tourette syndrome can occur differently in boys and girls. Boys are more likely to have long-term (chronic) tics. Girls are more likely to have obsessive-compulsive disorder (OCD).
• Some children may not need treatment. A child with Tourette syndrome can usually function well at home and in a regular classroom. In some cases, a child may need special classes, psychotherapy or medicine.
• A family with a history of Tourette syndrome should speak with a geneticist or a genetic counselor.

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  Tourette syndrome is a neurological disorder. It is also called Tourette disorder. The disorder causes repeated tics. Tics are sudden, uncontrolled vocal sounds or muscle jerks. Symptoms of Tourette syndrome often start between ages 5 and 10. They usually start with mild, simple tics of the face, head or arms. Over time, a child may have different kinds of tics that may happen more often. They may also involve more parts of the body, such as the trunk or legs. And they may be more disruptive to daily life.

   

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  Most cases of Tourette syndrome are caused by genes. It is an autosomal dominant disorder. Autosomal means that the gene is not on a sex (X or Y) chromosome. Dominant means that only one copy of the gene is needed to have the condition. A parent with Tourette syndrome or the gene for Tourette syndrome has a one in two chance to pass the gene on to each child.

  In up to one in 20 children with Tourette syndrome, the disorder is not caused by genes. Possible causes in these cases may be problems during pregnancy, low birth weight, head injury, carbon monoxide poisoning or inflammation of the brain (encephalitis).

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  Tourette syndrome affects more boys than girls.

   

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  The most common symptoms are uncontrolled muscle movements. They may occur in the face, neck, shoulders, torso or hands. Examples include:

  • Head jerking
  • Squinting
  • Blinking
  • Shrugging
  • Grimacing
  • Nose-twitching
  • Repeated foot tapping, leg jerking, scratching or other movements

  Complex tics include:

  • Kissing
  • Pinching
  • Sticking out the tongue or lip-smacking
  • Touching behaviors
  • Making rude gestures

  Tourette syndrome also includes one or more vocal tics such as:

  • Grunting or moaning sounds
  • Barking
  • Tongue clicking
  • Sniffing
  • Hooting
  • Saying rude things
  • Throat clearing, snorting, or coughing
  • Squeaking noises
  • Hissing
  • Spitting
  • Whistling
  • Gurgling
  • Echoing sounds or phrases repeatedly

  Tic behaviors change over time. They also vary in how often they occur.

  Tourette syndrome can occur differently in boys and girls. Boys are more likely to have long-term (chronic) tics. Girls are more likely to have obsessive-compulsive disorder (OCD). This is an anxiety disorder. With OCD, a child has a repeated thought, fear, or worry (obsession) that they try to manage through a certain behavior (compulsion) to reduce the anxiety.

  Not everyone with the gene will have symptoms of Tourette syndrome. If a parent passes the gene to a child, the child may not have any symptoms. If a daughter inherits the gene, there is a 7 in 10 chance that she will have at least one sign of Tourette syndrome. If a son inherits the gene, there is an almost sure chance (99%) that he will have at least one sign of Tourette syndrome.

  The symptoms of Tourette syndrome can seem like other health conditions. Have your child see their healthcare provider for a diagnosis.

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  A child with Tourette syndrome is usually diagnosed around the age of 7. A primary care provider, pediatrician, child psychiatrist or a mental healthcare provider may diagnose your child. The healthcare provider will ask about:

  • Your child’s symptoms and health history
  • Your family’s health history
  • Developmental problems

  The healthcare provider will also:

  • Watch your child’s behavior
  • Ask for a history of your child’s behavior from teachers
  • Assess your child’s psychological, social and educational status

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  Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is. Some children may not need treatment. A child with Tourette syndrome can usually function well at home and in a regular classroom.

  In some cases, a child may need special classes, psychotherapy or medicine. These may be choices if:

  • Tics cause problems with daily function or school
  • Your child has a problem such as OCD or attention deficit/hyperactivity disorder (ADHD)
  • Your child has another emotional or learning problem

  A treatment called comprehensive behavioral intervention for tics can help children deal with tics and reduce tics.

  Your child may need medicines if they have related conditions such as ADHD, OCD or a mood disorder. Talk with your child’s healthcare providers about the risks, benefits and possible side effects of all medicines.

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  Many children who have Tourette syndrome also have attention problems. Some have trouble in school. But most have normal intelligence and don’t have a learning disability.

  Other conditions commonly seen in children with Tourette syndrome include behavior problems, mood changes, social challenges and trouble sleeping.

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  Your healthcare provider may advise genetic counseling. You can discuss with a counselor the risk for Tourette syndrome in a future pregnancy.

   

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  Your child may need support and help with:

  • Self-esteem
  • Relationships with family and friends
  • Classroom participation

  Develop a strong, positive relationship with your child’s educational team. Depending on how severe the disorder is, they can both support your child in the classroom and also help with social situations. As your child gets older, pay attention to social media and possible issues with bullying. Seek professional counseling for your child and their siblings to help deal with the emotional impact of Tourette syndrome. Talk with your child’s healthcare provider and school staff about the best ways to support your child.

  Tourette syndrome has no cure, and the condition is lifelong. It does not get worse over time. And some children see their tic symptoms decrease in their late teens and early 20s. People with Tourette syndrome also have a normal life expectancy. Tic symptoms tend to decrease with age, but ADHD, OCD, depression, generalized anxiety, panic attacks and mood swings can continue and cause ongoing problems in adult life.

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  Call the healthcare provider if your child has:

  • Symptoms that don’t get better, or get worse
  • New symptoms

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Tourette Syndrome | Boston Children’s Hospital

What are the symptoms of Tourette syndrome?

Tic behaviors seen in Tourette syndrome change over time, and vary in frequency and complexity. The following are the most common tic behaviors associates with Tourette syndrome. However, each child experiences symptoms differently. Symptoms may include:

• involuntary, purposeless, motor movements (may involve different parts of the body, such as the face, neck, shoulders, trunk, or hands)
• head jerking
• squinting
• blinking
• shrugging
• grimacing
• nose-twitching
• any excessively repeated movements (i. e., foot tapping, leg jerking, scratching)

Some of the more complex tic behaviors associated with Tourette syndrome may appear purposeful, and may include the following:

• kissing
• pinching
• sticking out the tongue or lip-smacking
• touching behaviors
• making obscene gestures

In addition to some, or all, of the above symptoms, Tourette is also characterized by one or more vocal tics (meaningless sound), in order for a diagnosis to be made, including the following:

• grunting or moaning sounds
• barks
• tongue clicking
• sniffs
• hooting
• obscenities
• throat clearing, snorts, or coughs
• squeaking noises
• hissing
• spitting
• whistling
• gurgling
• echoing sounds or phrases repeatedly

Forty percent of children and adolescents who have Tourette syndrome also have attention problems, and 30 percent have academic difficulties. However, most have a normal intelligence and do not usually have primary learning disabilities. Twenty-five to 30 percent also experience symptoms of obsessive-compulsive disorder (OCD), which is an anxiety disorder in which a person has an unreasonable thought, fear, or activity (obsession) that he/she tries to manage through a ritualized activity (compulsion) to reduce the anxiety.

The symptoms of Tourette syndrome may resemble other conditions or medical problems. Always consult your child’s physician for a diagnosis.

What causes Tourette syndrome?

Tourette syndrome is an autosomal dominant disorder. Autosomal means that both males and females are affected, and dominant means that one copy of the gene is necessary to have the condition. This means that a parent with Tourette syndrome or a parent who has the gene for Tourette syndrome has a 50/50 chance, with each pregnancy, to pass the gene on. Tourette syndrome is associated with a non-genetic cause in 10 to 15 percent of children. Complications of pregnancy, low birthweight, head trauma, carbon monoxide poisoning, and encephalitis are thought to be associated with the onset of non-genetic Tourette.

Dominant disorders exhibit something known as incomplete penetrance, which means that not everyone with the gene will have symptoms of Tourette syndrome. In other words, if a parent passes the gene on to a child, the child may not have any symptoms of the syndrome. If a daughter inherits the gene, there is a 70 percent chance that she will have at least one of the signs of Tourette. On the other hand, if a son inherits the gene, there is a 90 percent chance that he will have at least one of the signs of Tourette.

Finally, dominant syndromes can also exhibit something known as variable expressivity. This means that there are differences in the expression of the Tourette syndrome gene in different people. For example, one person with Tourette syndrome may have obsessive-compulsive disorder, while another has a chronic tic syndrome, while another has full-blown Tourette syndrome. In addition, there are differences in expressivity between males and females: males are more likely to have full-blown Tourette syndrome or chronic tics, while females are more likely to have obsessive-compulsive disorder.

Autism symptoms, online autism test, questions about autism

How to treat a diagnosis?

Diagnosis is a tool to help move from thinking and hypothesizing about the human condition to action. As a general rule, diagnosis is a dynamic concept. And despite the fact that autism remains for life, life with autism can be quite independent under a combination of factors. That is why the diagnosis for specialists, the immediate environment of the family is a good reason to start early work with the child. The diagnosis also helps to clarify the understanding of the child’s behavior and the nature of the difficulties that he encounters.

Until the age of three, it is difficult to understand in which area the child’s problems lie. How can you help him then?

Thanks to the work of American, Canadian and British specialists, a number of behavioral markers have been developed by now, which, with a high degree of probability, can indicate the risk of autism affecting the development of a child as early as 6 months of age. If the risk of autism in the process of diagnostic work with a child is confirmed, then it is better to start work as if it were autism. This is important, because at the first stage, in any case, communication problems will be solved. In the future, if autism is not confirmed, then a specialist in the profile of specified problems can easily deal with the child, and the special classes done will only benefit this task. If later autism is confirmed, then early work with the child will increase the chance of his independent and independent adult life.

Why is it better not to delay contacting specialists and start working as early as possible?

First, because the psyche of any person develops due to information coming from outside, and autism blocks the flow of complete adequate information about the environment. With the normal development of the child, nothing needs to be taught purposefully, everything starts by nature itself: the child coos, babbles, turns, singles out loved ones, imitates, plays, jokes. With autism, all this must be specially taught, otherwise the potentially safe areas of the child’s development may remain unsuitable for his independent life. In other words, the sooner the impact of autism on a child’s development is mitigated, the better.

Secondly, at an early age, the child’s psyche has such properties as flexibility and plasticity. This allows you to make learning the most successful and effective.

What guides you in choosing a place to study?

• avoid offers related to “complete cure” for autism

• decisions on pharmacotherapy, drug support for the child are made only by an experienced child psychiatrist who examined the child (saw him in person!)

• when working with children with autism, individualized care is very important – a specialist should first study your child, your difficulties, and then suggest ways to work with him

• be careful about new or experimental methods of correction and treatment, rely on scientifically -reasonable approaches

• as a parent, you know your child best, which means that you are the “right hand” for specialists and are directly involved in the correctional process

What is the role of the immediate environment? What can grandma, grandpa, other relatives do?

In matters of applying for assistance, the right to represent the interests of the child lies with his legal representatives. As a rule, these are the parents of the child. Sometimes it can be other relatives of the child or guardians. In this case, there must be relevant documents that confirm the right of legal representation. When contacting our Center, an agreement is concluded with the legal representative of the child. This is the legal side of the issue.

At the same time, apart from legal issues, the role of the immediate environment is very large. First of all, the support of the parents of the child himself, who have to work ten times more, while it seems to others that they work ten times less, is extremely important. At the stage of voicing a diagnosis or the risk of a diagnosis, as a rule, any family feels confusion, resentment, fear, “doom”, guilt, and really needs support. The decision on what to do next may be delayed, not taken, due to the fact that the family does not feel that it can cope with the challenge, does not find places where it would receive help, does not want to believe that the child has difficulties. Love, understanding and care on the part of relatives can give an additional resource to parents and help them believe in their abilities. Acting as a “big family”, consistently following the recommendations of specialists, one can achieve much greater success in working with a child than one by one.

What is the forecast?

Autism is currently incurable. The issue is the quality of adulthood. In this regard, the prognosis can vary greatly: from an independent and independent life in society with little support as needed to complete dependence on the constant accompaniment and direct assistance of other people in the performance of daily activities. The prognosis is influenced by many factors: the severity and depth of disorders, the age at which the intervention began, its complex nature, sufficient volume and duration, the correct choice of the main and auxiliary methods, close cooperation between specialists and the family.

Due to the many factors that affect the prognosis, we recommend that when working with children with autism, set specific small goals for the next 4-6 months and achieve them while being “here and now”.

How many lessons do you need and how often?

On the one hand, life gradually becomes curative. On the other hand, the child needs special classes during which skills and abilities are developed that allow him to solve everyday problems and, ideally, learn new skills on his own. The volume of these classes is determined individually. Under the condition of homework, work with the specialists of the Center starts from 2 hours a week.

10.5 months. The seventh leap in child development: construction and consistency

Tatyana Chkhikvishvili

Tatyana Chkhikvishvili

Head of online programs, psychologist , sleep and breastfeeding consultant

Mother of two children

The child begins to understand that in order to achieve the goal, he needs to perform actions in a certain sequence. He is trying to add cubes or a pyramid – before he sometimes succeeded by accident, but now he acts completely consciously.

Probably, you are already used to the fact that the baby constantly scatters everything, and as soon as you build a turret, he immediately destroys it.

At about 10.5 months, the long-awaited time for self-construction begins. A new developmental leap will occur in the tenth month of a baby’s life and can last from 3 to 7 weeks.

Child’s crisis calendar

Mastering the sequences

Now the child understands that in order to achieve the goal, you need to perform several sequential actions. This characterizes the seventh growth spurt. You will increasingly see how the baby is trying to put cubes on top of each other or collect a pyramid.

Signs

As usual with developmental leaps, changes disturb the baby, which affects his behavior.

During a crisis period a child usually:

• is worried when you leave. Clings to your clothes;
• shows jealousy: acts up when you communicate with someone else;
• eats little, becomes very picky about food;
• may protest against dressing and diaper changes, resist disembarkation;
• can become very affectionate;
• shy of others;
• abruptly changes mood from laughter to tears;
• needs more attention.

Games to develop new skills

Dressing up
Change your baby in front of the mirror, ask him to help you: stretch your leg, raise your arm, turn around. At this point, you can explain to the baby the concepts of “left” and “right”.

Wash
Let the baby comb his hair in front of the mirror, wash, brush his teeth. Young children love to imitate adults or older siblings. The joint process of washing will be pleasant and fun.

Household help
Show your baby how you do household chores, say everything you do. Give him a cloth to wipe the toys. Or a piece of dough that he will knead while you bake the cake (this is a great warm-up for your fingers). Give pre-washed vegetables and ask them to wash them themselves.

Self-catering
Give the baby a spoon. Let him bring it to his mouth, eat something on his own. You can give a child’s fork. The baby will develop coordination, and the process of eating will become more interesting.

What else can you do with your baby?

Tell your little one short nursery rhymes. Touch your nose, ears, forehead and name parts of the body. Do the same with the objects around the baby.

During this period, kids perceive and memorize simple finger games well: “Magpie-crow”, “Goat is horned”, “Ladushki”.

Let the child touch fabrics of different textures, tear paper or cotton. Give him a “treasure” box that he can dig through and pull out interesting little items and then put them back in. You can put the pasta in a bottle with a narrow neck and mess around in the cereal. Everything that involves fine motor skills has a great effect on the development of the psyche and intelligence of the child.

Wrap the toy in pretty paper and have your child unpack it. Hide a small object in the palm of your hand or under an opaque cup, put the same one next to it and ask the baby to find a toy. Let him guess what needs to be done to find the item.

Now the baby can master a simple sorter, get acquainted with shapes and colors.

Sleep during a developmental leap

The child is very impressed with his new possibilities. As a result, he is agitated and sleeps worse. Both night and daytime sleep may worsen; or both at once. The time to fall asleep and the frequency of nocturnal awakenings increase, and the morning rise can become very early. Sleep can become very restless: the baby turns in bed, waving his arms and legs.

Don’t worry, this is a normal manifestation of a development crisis. When the baby gets used to his new skills, he will calm down and his sleep will improve again. Now it is very important that you give your child a sense of calm and security – this will help calm him down.

If the mother is worried and tense, this affects the baby and makes him even more nervous – because if the mother is worried, then something terrible is really happening.

Try to put aside everything for a while and focus on the baby, give him as much attention and contact as possible, especially before bedtime.