24 Tourettes s

8/11/2019 24 Tourettes s

1/36

1


2/36

2

Vocabulary1. Tics are repetitive brief, stereotypical movements or vocalizations

2. SLD is specific learning disability (e.g., in math, reading)

3. TS is tourette syndrome

4. Invariant mean without change

5. Prescient feelings are warning signs that are thought to be

perceptive or clairvoyant6. Copralalia is using obscene or socially inappropriate words

7. Palilalia--the repetition or echoing of one's own spoken words, andmay sound like stuttering.Do my work work work

8. Echopraxia is involuntary repetition or imitation of the observed

movements of another9. Echolalia is the repetition or echoing of the last sounds, words,

phrases of another; these can be immediate or delayed

10. Dopamine is a chemical which helps transmit signals from onenerve cell in the brain to the next.


3/36

3

Look at these links

Self-reports:I was devastated when I found out I had TS. I thought I was going to be anormal boy. But Im not. My life is awful. I feel like Im missing out on a lot of

things because of my tics. I will feel a lot better if my tics go. If they dont Iwill learn to put up with them. (Neil, 9yrs)

My teacher treats me like an angel and manages my TS really well. Theother students try to be understanding as my teacher has told them all aboutTS. (Neil, 9yrs)

I used to get asked why I blinked all the time and everyone used to get angryat me because I couldnt help looking at them and I always get harassed.

Lyle who is 9 years has Aspergerg and TS, and says he feels like hes inprison when he is at school.

http://www.tsa-usa.org/

http://www.tsa-usa.org/news/HBO_Release_apr06_update.htm
http://www.tsa-usa.org/http://www.tsa-usa.org/news/HBO_Release_apr06_update.htmhttp://www.tsa-usa.org/news/HBO_Release_apr06_update.htmhttp://www.tsa-usa.org/news/HBO_Release_apr06_update.htmhttp://www.tsa-usa.org/news/HBO_Release_apr06_update.htmhttp://www.tsa-usa.org/http://www.tsa-usa.org/http://www.tsa-usa.org/


4/36

4

Definition

A physical disorder of the brain characterized by multiform,frequently changing motor and phonic tics:

1. involuntary movements (motor tics)

2. involuntary vocalizations (vocal tics)

First described by Gilles de la Tourette:
http://www.tsavic.org.au/info.html


5/36

5

Tourette Syndrome (TS)

Diagnostic CriteriaDSM IV diagnostic criteria:

1. Presence of both motor and phonic (vocal) tics

2. Occurrences many times a day, nearly every day,usually in clusters, for longer than 1 year and not due tosubstance abuse or medications

3. Onset before 18 years

4. The disturbance is not due to the direct effects of asubstance or general medical condition (must rule outTBI, brain tumors, epilepsy, autistic disorders, musculardystrophy, CP, Parkinsons, etc.)


6/36

6

Idea Category

Tourette Syndrome (TS) is now listed as a disability under the

category of Other Health Impaired (OHI).


7/36

7

Prevalence

1. 1 in 1000 children; 10 times morefrequent in childhood than adulthood.

2. Symptoms visible by 7, but signs asearly as 2-5 years (Crawford et al.,2005)

3. Boys outnumber girls 3 to 1(Clarke et

al., 2001)


8/36

8

CO-OCCURRENCE

When TS accompanied by other disorders it iscalled Tourettes Plus (Lue, 2001).1. 50% have OCD symptoms

2. 50% have ADHD

3. 25-35% have tantrums and aggression(aggression occurs more frequently in TS, if thechild already has hyperactivity, impulsivity, or

ADHD)

4. 33% have SLD

Boys more likely to have tics, and girls to have OCDsymptoms;

Sleep disorders are fairly common

Frequent awakenings

Walking or talking in ones sleep


9/36

9

ETIOLOGY1. Heredity:

50-70% of diagnoses of TS have hereditarybaseWith one parent with TS, a child has a 50% chance of inheritingTS

Identical twins may have tics that differ in intensity and frequency

and non-genetic factors underlie these differences.2. Biochemistry:

An excess of, or oversensitivity, to dopamine.

3. Environmental factors:

a. Caffeinated beverages, cough syrup, recreationaldrugs, diet medication, hay fever, allergies, or viralillnesses increase tics, which occur less frequentlyduring sleep or activities that absorb the childs

concentration.b. Anxiet an er fear or frustration increases tics


10/36

10

MOTOR CHARACTERISTICS

Motor ticsare defined as purposeless movementsthat range from simple to complex:

MOTOR Simple:

1. blinking eyes (most

common)

2. jerking neck3. shrugging shoulders

4. flipping head

5. kicking

6. tensing muscles

7. sticking tongue out

8. finger movements

MOTOR: Complex:1. facial gestures (eye rolling)

2. grooming behaviors

3. smelling things

4. touching (other people or things),

5. tapping

6. jumping, squatting, retracing steps,deep knee bends, twirling whenwalking

7. hitting, biting8. rarely are there self injurious actions

such as hitting or biting ones self.9. Echopraxia

10.Copropraxia (Woods et al., 2003)


11/36

11

Motor Characteristics

MOST develop:

1. eye tic first

2. facial tics or involuntary sounds

3. others within weeks or months

common examples: head jerks, grimaces, hand-to-face movements

Symptoms can:

1. change over time

2. vary (frequency, type, location, or intensity)3. increase in intensity during early adolescence (12-15

years)

4. improve in less extreme cases during adulthood


12/36

12

VERBAL CHARACTERISTICS

VOCAL: Simple:

1. throat-clearing

2.sniffing

3.coughing

4.grunting

5.spitting

6.yelling

7.belching

VOCAL: Complex:

1.animal sounds2. repeating words or

phrases out ofcontext oh boy I

dont know3.Coprolalia

4.Palilalia

5.Echolalia

They may hear a word or sound coming into their

mind and feel they have to say it.


13/36

13

Communication

Stuttering

Coprolalia (fewer than 15% have this)

Occurs in late childhood

Most disruptive and disturbing (Jay, 2000)


14/36

14

Social Emotional CharacteristicsThe social and emotional difficulties that accompany TS are moreproblematic in day-to-day adaptations than are the motor and phonictics (Carter et al., 2000). Children are teased and made to feelstupid, different and unwanted. Peers negative responses to tics cancause anxiety, which in turn increase tics and generate self-doubt.

Adolescence is a period with strong emphasis on physical

attractiveness. TS results in greater psychopathology during thisperiod than any other (Chang et al., 2004)

Children also report uncomfortable, nervous, weird feelings (fear,disgust, doubt) or like they are going to explode before an onset oftics (Walter & Carter, 1997).

Overall there is a higher risk of:

1.poor peer relationships

2.no relationships

3.withdrawn or aggressive social behavior


15/36

15

Cognitive CharacteristicsSame IQ

Visual-Motor and Perceptual Difficulties1. Writing difficulties2. Perceptual problems

(Chui et al., 2000; Shannon, 2003))


16/36

16

Academic Characteristics

Tics potentially affect control of muscles involvedin task performance.

Children are able to suppress for limited periods oftime, which increases as they age, but it doestake great effort away from the task at hand (Walter& Carter, 1997)


17/36

17

Academic cont.Tics can make simple routine activities difficult

(Chui et al., 2000)

Difficulties with:1.organization

2.long written assignments

3.copying from the black board4. completing assignments on time and neatly (Walter & Carter, 1997)

More likely to have SLDs:

1.Reading difficulties

2.Mathematical difficulties


18/36

18

Academic AccommodationsGeneral Principals:

1.Tics increase as a function of stress and calling

attention to tics increases them.2. Tics decrease with relaxation or when focusingon an absorbing task (Shannon, 2003).


19/36

Accommodations

1. Model tolerance and do not allow teasing by peers

2. Try various seating arrangements(Wilson, Jeni. Shrimpton, Bradely. 2003).

Allow:1. short breaks (e.g., break long assignments into smallerparts)

2. movement around the room or outside the room (e.g., afictitious note to the office)

3. access to a private room with a bean bag chair--have a

private signal4. exams in a private room for tension and tic release and

allow more time

5. child to tape oral presentations & reports (Lue, 2001)

19


20/36

20

INTERVENTIONS

Pharmacological interventions increase success(Clarke et al.,2001).

1.Anti-tic drugs block the activity of theneurotransmitter dopamine.

2.Anti-OCD drugs help to restore the brainchemical serotonin, which reduces unwanted,thoughts.

(Many people choose tics over the medicationsbecause of side effects, which are sleepy, gainweight. In addition no medication has been foundthat eliminates tics completely.)


21/36

21

Functional nalysis of a Student with

Tourette Syndrome and a Mild

Intellectual Disability


22/36

22

1. 16 years old

2. Originally diagnosed with ADHD and still carriesthat label

3. Diagnosed with Tourettes in early elementary

school. Showed noticeable tics such as eyeblinking and barking like a dog.

4. Diagnosed in the 5thgrade as a child with a mildmental disability

5. In his school work, Chris always completes anyactivity or assignment given to him. Almost

compulsive about completing assignments

6. Chris does not interact with his peers. Seeks adultinteraction


23/36

23

1. Enjoys helping others

2. Takes initiative in completingtasks

3. Good memory4. Good attention to details

5.Has a strong desire to learn and

do what is right


24/36

24

1. Difficulty with peer relationships

2. Poor fine motor skills includinghandwriting

3. Struggles with math and language

arts


25/36

25

1. Random talking that is

unrelated to subject or task

and includes asking

questions about upcoming

events

2. Pacing3. Withdrawn and Pouting

4. Yelling


26/36

26


27/36

27

1. Changes in students daily schedule: 2-hr.

school delays, lack of aide in class, early

dismissals, late bus arrivals.

2. Unstructured activities (breaks and timeswhen waiting to load buses)

3. Structured but stressful activities: working

on art project, visit to the high school,academic work in the resource room


28/36

28


29/36

29

Antecedent that caused the most behaviorChanges in Students Daily Schedule 46%

Behaviors that were seen the most

Random talking/asking questions 58%

Pacing 21%

Payoffs earned the mostGet self-determination (predictability) 85%


30/36

30

Diagnosis of Tourettes?

Chris diagnosis of Tourettes syndrome is correct.

He meets all of the criteria for a diagnosis

a. Although his tics have dissipated, he still shows motor tics includingeye blinking and head jerking.

b. Research shows that it is common for children to see a reduction in

the tics as they get older. Chris onset was in his early elementary

years.

c. Chris shows TS, which includes social and academic impairments


31/36

31

Diagnosis of ADHD?

Although ADHD can be a comorbid condition of TS, we must firstdetermine whether his co-occurring learning disabilities and mild

mental retardation might notbetter explain his inattentive

behavior.

Follow-up:a. Now that he is given schoolwork based on his level of

reading, language, and math, Chris is able to listen and sustain

attention during his academics periods.

b. He remains in his seat during class, never runs about theroom, does not blurt out answers, and is able to wait his turn.

Conclusion: Chris is not ADHD; he has a mild intellectual

disability


32/36

32

Diagnosis of OCD?

Chriss OCD is a comorbid condition of the TS

Chris obsessions and compulsions have to do with checking,

ordering, repeating, and getting things just right rather than

trivial concerns with contamination, something bad happening, orbeing neat and clean.

Chriss obsessive/compulsive behaviors are connected to an

event in a realistic way and help him to neutralize the

unpredictability of the event.


33/36

33

To address the childs need for predictability and

self-determination, teachers must provide:

1. A stable daily routine/schedule

2. Advance warning of any changes

3. Opportunities to ask questions as this is his way

to reassure himself about a situation that is

making him feel stressed and anxious4. An escape, if needed, to regain control

ccommodations


34/36

34

Interventions

To address the Chris need for self-determination, Chris

must learn:

1. That when he cannot regain control, to be patient

and ask for short breaks2. To use scripts to interact with his peers. (For

example, Chris does not know how to initiate a

conversation; he only uses statements and needs to

learn to ask questions.)


35/36

35

ReferencesBagheri, M. M., Kerbeshian, J., & Burd, L. (1999). Recognition and management of Tourettes

syndrome and tic disorders.American Family Physician, 59,2263-2274.

Budman, Cathy, (2000, Oct.). Explosive outbursts in children with Tourettes Disorder. Journal ofthe American Academy of Child and Adolescent Psychiatry,(need volume and pagenumbers)

Carter, A., ODonnell, D., Schultz, R., Scahill, L., Leckman, J., & Pauls, D., (2000). Social andemotional adjustment in children affected with Gilles de la Tourettes Syndrome:Associations with ADHD and family functioning. Journal of Child Psychiatry, 41,need pagenumbers

Chang, H., Tu, M., & Wang, H., (2004). Tourettes Syndrome: Psychopathology in adolescents.Psychiatry and Clinical Neurosciences, 58, 353-358.

Chiu, N., Chang, Y., Lee, B., Huang, C., & Wang, S., (2001). Differences in Tc-HMPAO brainSPET perfusion imaging between Tourettes Syndrome andchronic tic disorder in children.European Journal of Nuclear Medicine, 28,need page numbers

Chowdhury, Uttom, & Christie, Deborah, (2002, Sept.). Tourette's Syndrome: A training day forteachers. British Journal of Special Education, 29,123-26.

Clarke, M., Bray, M., Kehle, T., & Truscott, S., (2001). A school-based intervention designed toreduce the frequency of tics in children with Tourettes Syndrome. School PsychologyReview, 30,need page numbers

Crawford, S., Channon, S., & Robertson, M., (2005). Tourettes Syndrome: Performance on testsof behavioral inhibition, working memory and gambling. Journal of Child Psychology andPsychiatry, 46,1327-1336

Evidente, Gerald Virgillio, (2000, October). Is it a tic or Tourettes? Postgraduate MedicineOnline, 108, need page numbers

Hendren, Glen, (2002). Tourette's Syndrome: A new look at an old condition. Journal ofRehabilitation,Need Volume and April-June need page numbers


36/36

36

References cont.Jay, T., (2000). Why we curse.Philadelphia, PA: Benjamins, need edition and page numbers?

Lue, M. S., (2001).A Survey of Communication Disorders for the Classroom Teacher. Needham Heights, MA: Allyn, need

edition and page numbers?Rowland, Belinda, (need year). Tourette's Syndrome. Gale Encyclopedia of Alternative Medicine, (need edition and page

numbers)

Shannon, J. B., (2003). Movement Disorders Sourcebook. Detroit, MI: Omnigraphics, need edition and page numbers?

Sukhodolsky, Denis (2003, Jan.). Disruptive behavior in children with Tourettes Syndrome: Association with ADHDcomorbidity, tic severity, and functional impairment. Journal of the American Academy of Children and AdloescentPsychiatry, (need edition and page numbers)

Truscott, S. (2001). A school-based intervention designed to reduce the frequency of tics in children with TourettesSyndrome. School Psychology Review, 30,11-21.

Van Borsel, John, & Vanryckeghem, Martine, (2000, May). Dysfluency and phonic tics in Tourette's Syndrome: A case

report. Journal of Communication Disorders, 33(3), pp. 227-240.Walter, A. L., & Carter, A. S., (1997). Gilles de la Tourettes Syndrome in childhood: A guide for school professionals.

School Psychology Review, 26 (1),need page numbers

Wilson, Jeni, & Shrimpton, Bradley (2003). Planning learning for students with Tourette's Syndrome. Student DisabilityConference.

Wodrich, David (1998, autumn). Tourettes Syndrome and tics relevance for school psychologists. Journal of SchoolPsychology,36(3), pp. 281-294.

Woods, D. W., Koch, M., & Miltenberger, R. G., (2003). The Impact of tic sverity on the effects of peer education aboutTourettes Syndrome. Journal of Developmental and Physical Disabilities, 15(1),page numbers

Woods, D. W., Twohig, M. P., Flessner, C. A., & Roloff, T. J., (2003). Treatment of vocal tics in children with Tourette'sSyndrome: Investigating the efficacy of habit reversal. Journal of Applied Behavior Analysis, 36, pp. 109-112.

24 Tourettes s

Documents

Transcript of 24 Tourettes s