Tourette Syndrome (TS) is a neurological disorder that is predominately diagnosed before the age of eighteen. TS is much more prevalent in children than adults; occurring in 5-30 per 10,000 children compared to 1-2 per 10,000 in adults. There is some indication that genetics play a part in the transmission of TS. TS is a dominant gene and there is an approximately 50% chance the gene will be passed from parent to child. According to the Tourette Syndrome Association (TSA), studies indicate that sons are three to four times more likely to exhibit TS than are daughters.
Tics Just One Symptom of Tourette's
The most common symptoms associated with TS are obsessions and compulsions. However, what most people associate with TS is motor and vocal tics. Media has presented vocal tics of yelling obscenities as the prominent characteristic of those with TS; but actually fewer than 15% of diagnosed people with TS manifest their symptoms by cursing and spewing obscenities and/or racial slurs.
Symptoms of TS change periodically in type, frequency and severity. Tics may be prevalent one day and then subside for weeks. Examples of motor tics:
- Eye blinking
- Shoulder shrugging
- Licking or smacking lips
- Flailing, flapping or jerking of arms
- Clapping, pinching, or hitting self
- Twirling in circles
- Chewing on clothes
Examples of vocal tics include:
- Throat clearing
- Snorting, coughing, or hiccupping
- Honking, squeaking, shouting, barking, or moaning
- Making unintelligible noise
- Calling out or squealing
Examples of more complex tics include:
- Repeating phrases, parts of words, or words
- Making animal sounds
- Stuttering
- Talking to self
- Echolalia (repeating others’ words or statements)
- Coprolalia (speaking obscenities or socially taboo phrases)
Furthermore, according to TSA, 60% of the children diagnosed with TS show signs of hyperactivity with or without attention deficit disorder before TS symptoms manifest.
Discipline for the Child With Tourette Syndrome
Because TS can be accompanied by Obsessive-Compulsive Disorder (OCD) and Attention Deficit Hyperactivity Disorder (ADHD); children may need to be placed in a special education program at school or at least have some accommodations in the regular classroom. Discipline at home and a school may be a challenge for parents and teachers.
While children with TS may not have the bodily control over their symptoms; it is important to help them instill some control over their behaviors; over the expression of those impulses that society finds unacceptable. Parents and teachers may have difficulties disciplining children with TS citing the symptoms as the cause of behavior and therefore implying that the child has no way to control the behaviors. Teaching children to control their impulses and redirect urges to other alternatives that will satisfy the impulses in an acceptable manner is helping the child gain confidence and self-esteem.
Redirection is Good Form of Discipline for Tourette's Child
Creatively brainstorming ideas of ways to redirect behaviors is beneficial for the TS child. Unacceptable impulsive behaviors can be redirected to those that are acceptable. If the impulses involve harmful behaviors, set limits around those behaviors; for instance restricting time in an area (such as a kitchen if this is where the harmful behavior occurs) only when it can be supervised.
Help the TS child’s obsessive actions with something that is more pleasant. When the child is repeating a negative phrase such as “I hate bugs” a positive phrase can be incorporated instead: “I love flowers.” To redirect explosive anger, use props such as a punching bag or pillow. Set limits with how long the child is allowed to express the anger so it doesn’t continue for excessive periods of time. Choose language and tone that is teaching rather than confronting, or condemning such as using positive phrases rather than negative ones (“you can…” instead of “you can’t…”).
Teaching is Discipline
Two things that all children must learn are cause and effect and responsibility for their choices. Children with TS usually take more time and patience than other children when trying to reason the possible outcomes of their behaviors. Parents and teachers can help with the thought process by directing the child to brainstorm possible outcomes and then guiding them step by step to the most appropriate or desired outcome. This takes practice and consistency. TS children who have problems with impulsivity need the consistent guidance that demonstrates there is a relationship between their choices of behavior and how others treat them.
Teaching responsibility for choices also takes time, consistency, and practice. TS children are no different from others in that it is wise to give them choices, stick by the agreed parameters and let the consequences play out naturally. The only difference with TS children is that parents and teachers may need to give more information as to the details for the choices.
For example, given the choice between A or B scenarios, parents and teachers may need to remind the TS child what would be the consequence of choosing either. Once the decision is made, parents and teachers must adhere to the parameters of the choice regardless of how much argument they might receive from the child. The natural consequence of the decision must stand as the rule.
Understanding Tourette Syndrome, aids in understanding the child who is diagnosed with TS. Using these redirection and discipline methods, parents and teachers can help TS children grow into adulthood with better tools to navigate their lives. TS children do not have to sacrifice self-esteem or social interactions because of their symptoms.
Sources:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, D.C.: American Psychiatric Association, 2000.
Tourette Syndrome Association. "What is Tourette Syndrome?" (accessed July 8, 2010).
Cheryl Weldon - I am a Licensed Marriage and Family Therapist with over 20 years experience in the mental health field. My speciality is working with ...
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