Tourette Syndrome Awareness Month: Let's Talk Co-Morbids

I have mentioned co-morbids several times in the past, and I thought it was time to explain more about what co-morbids are and how they affect those with Tourette Syndrome.  Co-morbids are other medical conditions (neurological, psychological, or behavioral) that can appear alongside a main condition, such as Tourette Syndrome.  You might see a person with TS state that they have TS+, a term used to generalize the diagnosis of TS with co-morbids.  Knowing more about co-morbids can help us to gain a better understanding of how much those with TS struggle to overcome just to function on a daily basis.

There are several types of co-morbids that can exist for those with TS.  Below are a few examples.  Please keep in mind that there could be more conditions not described here.

Obsessive-Compulsive Disorder: Intrusive thoughts, ritualized behavior, OCD related anxiety

Anxiety Disorders: Generalized anxiety disorder, panic disorder, and other non-OCD related anxiety

Mood Disorders: Disorders such as bi-polar and depression

Attention Deficit Disorder:  ADD or ADHD

Autism Spectrum Disorders:  Asperger's and other forms of autism

Rage Attacks:  These can also be known as 'meltdowns' or 'storms'

Sensory Disorders:  Sensory Processing Disorder and Sensory Integration Disorder

P.A.N.D.A.S.:  TS+ symptoms that can be related to infections such as strep

Sleep Disorders:  For example, insomnia

Other Learning Disorders:  Dyslexia, dysgraphia, discalculia, and more

Tourette Syndrome Awareness Month: Tics

You're at the grocery store and you notice a lady at the meat counter jerking her head to the side repeatedly.  You're out to eat and hear the child at the table next to you grunting throughout much of the meal.  While at the park, you hear someone yell 'fire' multiple times, despite the fact that there is no fire present. How do you respond?  Do you stop and stare?  Do you go to the people in question and ask if they are alright?  Do you walk away, assuming bad parenting, drug use, or even just the desire for attention are to blame?

Believe it or not, these are all situations that I have encountered in public places - situations that I am lucky enough to understand rather than to have a reaction like those I mentioned above.  For those of us blessed (yes, I did say blessed) enough to have experience with Tourette Syndrome, it's easy to understand that those situations are all examples of tics.  Rather than bring attention to the tics or assuming the worst, we're able to sympathize with the ticcers, understanding that they are struggling with the need to perform these actions, no matter how badly they want to control them.

Tics can come in many forms, motor and vocal, simple and complex.  The possibilities are endless.  Below are a few examples of each type of tic.  As you may notice, some tics can be unclear as to whether they are classified as simple or complex.  Please remember that these are just examples, and that for each example listed, there are many more that are not listed.  It is also important to remember that some children experience tics that show up for a short period of time and then disappear with no explanation, never to experience another tic again (in which case, wouldn't be indicative of a tic disorder such as Tourette Syndrome)

Simple Motor Tics - eye blinking, neck jerking, shoulder shrugging, facial grimaces

Complex Motor Tics - groaning behaviors, facial gestures, biting oneself, smelling things, stomping of feet, jumping

Simple Vocal Tics - throat clearing or coughing, grunting, sniffing, snorting, barking

Complex Vocal Tics - coprolalia (the use of inappropriate words, which is rather rare despite media portrayal of this being common with TS), palilalia (rapid repetition of a word or phrase), echolalia (repetition of words)

Some quick facts about Tourette Syndrome

I know I am a few days behind in my posts for Tourette Syndrome Awareness Month, but it is for good reason.  I wanted to share quite a bit of information that I thought would be better in one big post, rather than broken into daily posts.

Tourette Syndrome is not the result of bad parenting.  In fact, it is a neurological disorder which can be hereditary.  Symptoms typically occur before the age of 18, and most commonly start appearing between the ages of 2 and 15.  The most common characterization of Tourette Syndrome is the presence of tics, which are involuntary movements and/or vocalizations that repeatedly occur.  There is usually the presence of multiple tics, both motor and vocal tics, though they do not necessarily happen at the same time.  These can happen multiple times a day every day, or even coming and going over a course of time.  In order for the Tourette diagnosis to be given, the presence of these tics have to have occurred for at least one year.

With Tourette Syndrome, tics tend to follow a wax and wane pattern, meaning that they may suddenly appear, stay for a short period of time (or a long period of time), and then disappear, usually to suddenly return again at a later time.  They can also change in frequency and severity.  New tics can appear to replace old tics.  Tics can also increase in number and severity under certain circumstances, such as periods of high stress or exhaustion.

While tics tend to be involuntary, it is possible to control the tics for a period of time.  For example, some students can hold the tics in during the day at school.  However, when they reach their comfort zone (such as when they arrive at home), they must release the held back tics.  This can often result in outbursts of tics, and can even result in changes in mood.  Often times, holding in tics can also result in inability to concentrate.

It is important to remember that Tourette Syndrome is usually accompanied by a number of co-morbid disorders.  We will get into those in a future post.

Early signs of Tourette Syndrome

I often get asked how early on that I started seeing signs of Tourette Syndrome in Monster Man.  I always knew that he was a little 'different', but didn't quite know what was making him different until he was older.  Somewhere around the end of first, we do know that he started having some problems that we associated with allergies.  For a long time, we didn't realize that they could be anything else other than allergies, which he'd struggled with since he was a toddler.  For that reason, we're not really sure when the TS symptoms started and how many of his symptoms were TS related rather than allergy related.

It's with good reason that we so were so easily able to mistake signs of TS as being allergies.  Tics of the eye are often among the first motor tics, and the most common one is eye blinking.  Tics of the head and fact are often very common early motor tics.  Early vocal tics often include throat clearing and sniffing.  Monster Man had the eye blinking, throat clearing, and sniffing long before he had any other tics... all very common allergy symptoms.

There are also many complex motor tics that can be common closer to the onset of Tourettes symptoms.  These can include touching, thrusting of the arms and legs, and jumping.

It's important to remember that no two cases of Tourette Syndrome are exactly the same.  What can be early symptoms in some people may not show up at all in others.  Two people may share one or two of the same tics, but have a much larger list of tics that they don't have in common.  It's also important to realize that these early signs are just the most common, and that some people experience different tics than those listed early on.

It's That Time Again

It's that time of the year again.  Today officially marks the start of Tourette Syndrome Awareness Month, which runs from May 15 to June 15.  In the days to come, I will once again be sharing facts about Tourette Syndrome.  Please feel free to share my posts to help spread awareness of what TS really is.

To start us off for the month, here is the first fact:  Tourette Syndrome is not a swearing disease, as media often portrays it to be. It is a neurological disorder characterized by motor and vocal tics.  Coprolalia (the swearing often associated with TS) occurs in only about 10% of those with Tourette Syndrome.