Tourette’s Syndrome (TS)
TS is a neurological disorder, where the messages in the brain are not getting through very effectively to stop certain movements. While it is a neurological disorder it is affected by the environment that we live in; tics tend to get worse when people are stressed, excited, hungry, too warm or sleep deprived. TS is not a degenerative disorder, people with TS can live a normal life span and achieve any of the goals that they set.
TS is characterised by an urge to perform rapid and repetitive muscle movements and vocalisations, known as tics. The tics will range in severity, from the simple to the complex. Simple muscle movements, involve a single muscle group and include movements such as eye blinking, nose twitching and eye rolling. Simple vocal tics, involve sounds, such as a cough, throat clearing or grunting. The simple tics last for short bursts of time and are generally the first experience people will have with tics.
The more complex tics, involve multiple muscle groups and complex vocalisations and will last for longer periods of time. Complex muscle movements, such as leg kicking, jumping and hitting can be more intrusive on day-to-day life. The complex vocalisations, involve language and present in 3 different ways: echolalia, repeating what other people say; paliphrasia, repeating the same phrase over and over again and coprolalia, which means uttering or shouting obscene words or phrases. Coprolalia is actually quite rare.
TS usually develops in childhood, around the age of 6, with simple tics and tends to wax and wane over time but will generally progress to more complex tics. Many people experience a tapering off of tics as they age. While the onset of TS is usually in early childhood, in the last 12 months in particular, we have seen older adolescents with a sudden onset of tics.
So…. What can done?
A big issue with TS is lack of understanding. Helping people to understand TS is crucial and in some cases, education is all that’s needed. Many people live with tics every day, but some tics can really get in the way of day-to-day life and if that’s the case, something can be done.
Cognitive Behavioural Intervention for Tics (CBIT)
CBIT, is an evidence-based therapy, that teaches people how to manage their tics. It’s a structured therapeutic approach that can take between 8 and 10 sessions, but it can be longer or shorter depending on the needs of the client.
CBIT consists of a number of important components:
First and foremost is education, to assist people who have tics and those who support them to better understand TS.
The next step involves teaching people to be more aware of their tics, to gain a better awareness and understanding of the mechanics of each tic from start to finish.
Next is teaching people to identify the first movement in the tic and developing a specific behaviour that effectively blocks the tic, making it more difficult to do. This can help to reduce and, in some cases, completely eliminate the tic. Consistent and repeated practice is really important.
The final step is to make changes to day-to-day activities in ways that can be helpful in reducing tics. Certain situation or reactions to tics can make them worse, so identifying them and making some simple changes can make a significant difference.
People with TS can at times suppress their tics for short percids of time, but this doesn’t mean that they can control them, and it can be extremely stressful to do. CBIT is not the same as supressing the tics, rather CBIT teaches people a very specific set of skills that they can use to manage the tics that they feel they need to.
CBIT is not as available as it could be, there are only a small number of practitioners throughout Australia. At PsychHelp, we have Angela Petrolo, a Clinical Psychologist who has been trained in CBIT and is available to work with clients and their families who are wanting to gain a better understanding of TS and who are interested in CBIT as a way of managing tics.
