Biology 202
2004 Second Web Paper
On Serendip

Tourette's syndrome, though better known as the cursing disease, often manifests itself is much less extreme expressions. Though the media has created a sensationalistic portrayal of those individuals with TS who suffer from coprolalia, whose symptoms include excessive swearing and foul language, those who suffer from this disorder are only a small minority of individuals with TS (4) . In fact, less than ten percent of people with TS are though to have coprolalia (3). As those who suffer from Tourette's syndrome are usually diagnosed in their childhood, around ages five to eleven, the varying tics and abnormalities which TS encompasses can greatly impact their social development and educations. In addition, tics, which often result in alienation, can directly indirectly be the cause of psychological damage. The educators and parents of today must then address the question of how to teach and socialize their children, despite their disorder.

Tourette's syndrome, identified by the French physician Georges Gilles de la Tourette in 1885, is defined generally as a neurological disorder that results in repeated, involuntary body movements (known as tics) and uncontrollable vocal sounds (5). Tourette documented in his research nine individuals who experienced involuntary movements and compulsive rituals of behavior since childhood. The criteria for diagnosis of Tourette's syndrome, as defined by the Tourette's Syndrome Association (5), are as follows;
1) Both multiple motor and one or more vocal tics are present some time during the illness although not necessarily simultaneously.
2) The occurrence of tics many times a day (usually in bouts) nearly everyday or intermittently throughout a span of more than one year and
3) Periodic changes in the number, frequency, type and location of the tics, and waxing and waning of their severity. Symptoms can sometimes appear for weeks or months at a time.
4) Onset before the age of 18.

Though the average age that TS begins is 6-7 years old, and though almost all cases of TS emerge before the age of 18, there are exceptions. The most common tics among those who are diagnosed with TS involve movements of the neck, mouth, and eyes. Tics, particularly in childhood, vary in their severity and frequency, following what is known as a waxing and waning process (2). Often, tics are particularly noticeable for a finite period of time, after which they may subside for weeks or months. As a result of this waxing and waning period, parents or educators may either dismiss such actions as a phase, or else attribute actions to physical problems. A child who, for instance, continual sniffs their nose, may be thought to have a cold or an allergy to something in his or her environment. However, when brought to a physician, they cannot attribute the tics to an illness or allergy. After the tic has waned, parents tend to think that either the phase or unidentifiable sickness has run its course.

The urge to act out a tic is experienced as irresistible and, similar to the urge to sneeze, eventually must be expressed (3). Both the severity and frequency of tics are increased as a result of tension and stress and decrease during relaxation or when focused on a particularly absorbing task. A continual source of frustration for parents is the fact that their children are sometimes able to remain tic-free, something which would seem to suggest that they have a certain amount of control over the tick. It is not uncommon for children with TS to be "free" of their tics when engrossed in a particular task, such as playing Nintendo. This is generally misinterpreted as children having more control over their tics than they in fact do (4).

Tourette's syndrome appears to be a genetic, inherited predisposition, although outside factors do appear to have some affect upon the severity of the symptoms (4). Recent research presents a convincing case demonstrating the relationship between a parent's own status with TS and that of their children's. In 2003, researchers compared the onset of TS in children whose parents had TS compared to those children whose parents did not have the disorder (4). Children who were considered to be "at-risk" or prone to TS and "control" children, children whose parents did not have TS, were observed between the ages of 3 and 6 years and followed with yearly structured assessments over intervals of 2-5 years. The results of this study, conducted by McMahon, Carter, Fredine, and Pauls (2003) seem to indicate a definite genetic component to the onset of TS:

"Of the 34 at-risk children who were tic-free at baseline, 10 (29%) subsequently developed a tic disorder; 3 of those 10 met criteria for TS. None of the 13 control children developed a tic disorder" (4).

Research also suggests that gender is also a factor when considering who is prone to develop TS, as males are affected 3-4 times more than females. While the transmission of Tourette's syndrome does appear to be genetic, the "basic underlying defect" which causes TS remains unknown (2). There is speculation by a number of researchers who suggest that TS results from abnormalities of neurotransmitters, more specifically, the activity between dopamine within the basal ganglia. This conclusion has been tentatively made after observing biochemical brain analyses of those diagnosed with TS. Researches observe that dopamine-blocking agents often suppress tics in patients.

While TS, and the tics that result from it, are serious in and of themselves, often the most serious problems for those with this disorder are not caused by TS. Clinical populations o those who suffer from TS also have other behavioral problems, especially obsessive-compulsive behaviors (2). As many as sixty percent of children treated for TS have symptoms associated with attention deficit hyperactivity disorder (ADHD). Other conditions that are known to occur simultaneously with TS are mood disorders such as depression and Bi-polar (4). In the previously mentioned study, conducted by McMahon, Carter, Fredine, and Pauls (2003), they noted that:

"Obsessive-Compulsive Disorder (OCD) or features or OCD emerged in 11 of the at-risk cases, but not in any of the controls, while Attention Deficit Hyperactivity Disorder (ADHD) occurred in 14 at-risk children but not in any of the controls" (4) .

Tourette's syndrome may result in difficulties in the child's education, learning disabilities that may encompass, but are not limited to, difficulty reading or writing, problems with mathematical computations, or perceptual problems (5). Knowing this information, what is it that teachers can do to help and encourage their students with TS?

While there is no cure for TS, and though there are numerous options which attempt to chemically combat the effect of Tourette's syndrome, the parents of children who suffer from TS as well as their teachers are required to think beyond the scope of chemicals. It is of great importance that TS is diagnosed early on. Because tics can alienate children from their peers, it is just as important for the parents to recognize the problem as it is for the teacher to nurture understanding in the classroom. Generally speaking, those diagnosed with TS have the same intelligence level as those who are not affected by the disorder, thus, students with TS should be held to the same standards as other students. However, that being said, additional measures should be taken to lessen stress and anxiety. Untimed exams and/or a separate room for exams help in reducing stress for the student. It is also helpful to for the teacher to give directions in stages, as too much information at one time may be overwhelming. As the urge to express the tic may at times become unbearable, teachers should make it clear that the student can leave the class, possibly to go to a "safe place," where the tic can be freely expressed. Perhaps most importantly, teachers and parents alike need to give positive feedback when the child performs well in a social or academic setting. For children whose actions often seem out of place, positive feedback is invaluable. Though there is still hope for a cure for Tourette's syndrome, until then, both parents and teachers must realize that Tourette's syndrome, if understood and dealt with lovingly, does not have to be a debilitating disorder.

References

1) Health: Diseases, Database of various illnesses

2)MDVU Library, Good discussion of the causes of TS

3)SCoTENS, discusses special education needs

4) Tourette's Syndrome, Very good website for general as well as more in depth information on TS

5)Tourette's Syndrome Association , Helpful in reference to TS and education


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