Tourette’s syndrome, once believed to be an extremely rare neurological spectrum disorder, is now demanding increased attention in the field of medicine as more is learned about the condition, specifically focusing on its biological and environmental causes, developing affective treatments, and the associated astoundingly high comorbidity with other neurological disorders. An inherited, neurological disorder characterized by repeated and involuntary body movements and uncontrollable vocal sounds often manifested in situations that inappropriate in both time and location, Tourette’s syndrome was first assessed by Georges Gilles de la Tourette, a French neuropsychiatrist, in the late 1800s. According to the Tourette Syndrome Association, vocal outbursts that are a defining characteristic of the disorder, including coprolalia, a vocal tic containing socially unsuitable words, are neither intentional nor purposeful and often cause great anxiety in the patient with this disorder. Broadly resulting from a chemical imbalance in the brain, Tourette’s syndrome is one of the most misunderstood and perhaps misdiagnosed neurological disorders that significantly impacts a child’s educational performance and social and emotional well-being (Tourette Syndrome Association). Children with Tourette’s syndrome often develop poor peer relationships and are comparatively more withdrawn and aggressive particularly during adolescence when symptoms, specifically motor and phonic tics, peak. Although many people with this syndrome have not been diagnosed, one hundred thousand Americans are estimated by the National Institutes of Health to have full-blown Tourette’s.
The first symptoms of Tourette’s syndrome often manifest themselves during a child’s third year of life and will increase in severity and frequency throughout childhood, reaching greatest severity during puberty and up until twenty years of age when at this time, a small percentage of the affected population will begin to see a significant reduction in symptoms. To be diagnosed with Tourette’s syndrome according to the DSM-IV, an individual must fit within the following criteria: (1) age onset between two and fifteen years of age; (2) multiple involuntary muscular and verbal tics; (3) tic severity and frequency wax and wane (increase and decrease) but are present for more than one year. The first symptom to be recognized in small children with this disorder is the presence of phonic tics which can begin as early as the age of three. A phonic or vocal tic can be defined as the repeated uttering of a sound, word, or phrase and can be divided into two categories: simple vocal tics and complex vocal tics. Examples of simple vocal tics which frequently begin in toddlers include throat clearing, yelping and other noises, sniffing and tongue clicking (Tourette Syndrome Association). The complex variety of vocal tics include cases where an individual will utter words or phrases out of context or when one exhibits coprolalia, verbalizing socially unacceptable words, and are later present in middle childhood. Motor tics or rapid, repetitive movements of any voluntary muscle group in the body will begin to occur between the ages of three and eight years old and these again are classified into simple and complex variations. Simple motor tics are distinguished by eye blinking, head jerking, shoulder shrugging, arm flailing and/or finger tapping, and facial grimacing and can often be exhibited in bouts that sometimes seem quite purposeful. On the other hand, many individuals will develop complex motor tic symptoms later in childhood such as jumping, touching other people or things, smelling, twirling erratically and only rarely, self-injurious actions including hitting and biting oneself. Just before a tic occurs, sufferers may experience sensory symptoms, or the “premonitory urge that incessantly prompt tics. ” (Tourette Syndrome Association), or auditory and visual cues can lead to tics as well. Finally, tics often present themselves in a pattern known as waxing and waning, implying that tics change persistently over time, especially more frequently in children than in adults, and in severity depending on environmental circumstances such as stress and anxiety, excitement and fatigue.
Many neurological disorders occur in conjunction with Tourette’s syndrome suggesting a high degree of comorbidity. Attention Deficit Hyperactivity Disorder is often a precursor to Tourette’s syndrome in very young children and can result in increased irritability, impulsivity leading to rage attacks, depression and anti-social behavior, and increased tendencies towards drug use, leading to poor performance in school and personal low self-esteem. Obsessive Compulsive Disorder often occurs in combination with Tourette’s syndrome when symptoms begin to become apparent during the first two and a half years in a child’s life.