Tourette’s syndrome could be one of the most underdiagnosed conditions in Hong Kong because it tends to subside over time. However, chances are that the underdiagnosis may let the symptoms slide and result in negligence of the needs of people with the syndrome. Research by Knight et al. and Charania et al. suggested that half of the children may not be diagnosed and given proper treatment in time due to parents failing to identify the conditions.
Learn more about the causes, symptoms and diagnosis of Tourette’s syndrome and get tips for managing the syndrome in Hong Kong.
What is Tourette’s Syndrome?
With reference to the definition by American Psychiatric Association (APA), Tourette’s syndrome is a disorder of the nervous system indicated by the behavior of tics, the sudden, repetitive and unwanted movements or sounds. People with tics may blink their eyes or produce grunting sounds repeatedly.
Tics typically emerge between the ages of 5 and 17. Although individuals cannot control tics easily, they require guidance through therapy to help with managing tics through various strategies. Tics often wane upon approaching adulthood.
Signs & symptoms of Tourette’s Syndrome
Individuals with Tourette’s syndrome exhibit two or more motor tics and at least one vocal tic. While the severity of tics varies and mild cases predominate, tics can be categorized with reference to 2 dimensions: mode and complexity.
Modes of tics
Tics occur in 2 modes: motor or vocal. Motor tics are the involuntary movements of the body, such as eye blinking and facial grimacing. Vocal tics involve sounds produced by individuals’ voices, for example, barking or repeating one’s own words or phrases. In most cases, motor tics occur before the onset of vocal tics.
Complexity of tics
In terms of complexity, simple tics involve fewer parts of the body, such as sniffing, whereas complex tics involve more muscle groups, such as stepping in a particular pattern. Usually, simple tics precede complex ones.
Tics can vary in frequency and severity, possibly subject to the environmental, psychological, temperamental or genetic experience patients encounter. Tics are often positively associated with one’s arousal level. They worsen under illnesses, stress, excitement and anxiety, but diminish with calmness or focused activities. Tics may sometimes also reduce after a night of light sleep and subside with deep rest.
People with Tourette’s syndrome often have an overwhelming increase in tension during the suppression of tics to the point where the expression of tics becomes unavoidable and against their will. Tics may appear to be deliberate or planned in response to an external trigger, but are not.
Many people with Tourette’s syndrome may experience other co-occurring conditions that often cause more impairment compared to the tics themselves. These conditions may remain through childhood, including but not limited to symptoms of Attention Deficit Hyperactivity Disorder (ADHD), Obsessive-Compulsive Disorder (OCD) and Anxiety.
Causes & risk factors of Tourette’s Syndrome
Currently, researchers are still studying the causes of Tourette’s syndrome to understand and manage the conditions better. Although its underlying causes are not well identified, scientists have confirmed the role of genes in the onset of Tourette’s syndrome. In particular, various genetic studies revealed that Tourette’s syndrome is inherited as a dominant gene, with parents having a 50% probability of passing it on to their children. Meanwhile, neurotransmitters, including dopamine and serotonin, also play a role in the disorder's onset.
Furthermore, Tourette’s syndrome is a genetically complicated condition catalyzed by the interactions of multiple genes with other environmental factors. Below are some potential risk factors that may contribute to the development of Tourette’s syndrome:
- Sex: It is 3 to 4 times more common for males to develop Tourette’s syndrome than females.
- Pregnancy and birth: Smoking during pregnancy and low birth weight may be associated with Tourette’s syndrome development.
- Family history: Family history of Tourette’s syndrome or other tics disorders can be used to predict Tourette’s syndrome development.
Diagnosis of Tourette’s Syndrome
To date, there is no specific test to diagnose Tourette’s syndrome. Therefore, a clinician would make a diagnosis based on whether the individual fulfills all of the following criteria:
- Presence of both multiple motor and one or more vocal tics — even if they do not occur concurrently — at intervals of several times a day, every day or intermittently for at least 1 year.
- Tics onset before age 18.
- Tics development is not caused by medications, other substances or medical conditions.
Treatments of Tourette’s Syndrome
Currently, the following treatments may be useful to help manage tics that interfere with daily functioning.
- Medications that block dopamine, such as haloperidol and pimozide, are useful in suppressing tics consistently.
- Central adrenergic agonists, including clonidine, are usually used to treat hypertension but can also be used for tics.
- Stimulant medications containing methylphenidate and dextroamphetamine can reduce ADHD symptoms in people with Tourette’s syndrome without worsening tics.
- Antidepressants, especially selective serotonin reuptake inhibitors, can soothe the symptoms of depression, anxiety and OCD.
Side effects of the above medications may include weight gain, restlessness and social withdrawal. It is highly recommended that you consult a clinician or healthcare provider to understand the possible risks and side effects of the drugs, before using medication. The listed medications are not available over-the-counter and require prescription by a qualified medical professional.
1. Behavioral Therapy empowers people with Tourette’s syndrome to manage their tics.
- Habit reversal training, including awareness training and competing response training, enables people with Tourette’s syndrome to identify each of their tics and master a new behavior incompatible with their current tic urges.
- Comprehensive Behavioral Intervention for Tics (CBIT) also focuses on habit reversal and is jointly used with other strategies such as education about tics and relaxation techniques.
2. Psychotherapy assists individuals to deal with the disorder by focusing on coping with the co-occurring conditions, such as ADHD, depression and anxiety.
Supporting people with Tourette’s Syndrome
Similar to ADHD, it is crucial to support and educate families of people with Tourette’s syndrome. Parent training can help parents better understand their children’s behavioral conditions and learn specific parenting skills targeting the issues, namely positive reinforcement and discipline.
Special education assistance may also be needed for the child. In this regard, closer communication or collaboration between the school and parents can help promote the quality of learning. As an example, an Individualized Educational Program (IEP) sets up a specific plan to meet your child’s needs.
While people with Tourette’s syndrome can often temporarily suppress their tics, they cannot control these tic urges at all times as voluntary suppression is stressful, often exhausting and may increase irritability. It is important they are treated with patience and care.
Although causes are not well identified, scientists confirmed the role of genes at the onset of Tourette’s syndrome. As stated in the article, Tourette’s syndrome is a genetically complicated condition catalyzed by the interactions of multiple genes with other environmental factors. Neurotransmitters, including dopamine and serotonin, also play a role in the condition onset.
This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.