Tourettes Syndrome

Background Information

Tourettes Syndrome (TS) is a neurological disorder characterised by tics - involuntary, rapid, sudden movements that occur repeatedly in the same way. The symptoms include:

• Both multiple motor and one or more vocal tics present at some time during the illness, although not necessarily simultaneously.
• The occurrence of tics many times a day, (usually in bouts), nearly every day, or intermittently throughout a span of more than one year; and periodic changes in the number, frequency, type and location of the tics, and in the waxing and waning of their severity. Symptoms can sometimes disappear for weeks or months at a time.
• The onset of symptoms before the age of 21.

The term "involuntary", used to describe TS tics, is sometimes confusing because some people with TS do have some control over their symptoms. However, that control, which can be exerted from seconds to hours at a time, may merely postpone more severe outbursts of symptoms. Tics are experienced as irresistible and (as the urge to sneeze) eventually be expressed. People with TS often seek a secluded spot to release their symptoms after delaying them at school or at work. Typically, tics increase as a result of tension or stress, and decrease with relaxation or concentration of an absorbing task.

TS tics can be split up into two main categories – Simple and Complex. Each of these can be categorised by a different range of Motor and Vocal tics. Simple can include the following Motor tics: eye blinking, head jerking, shoulder shrugging and facial grimacing, and the following Vocal tics: throat clearing, yelping and other noises, sniffing and tongue clicking. While Complex can include Motor tics such as: jumping, touching other people or things, smelling, twirling about, and only sometimes self-injurious actions including hitting or biting oneself, and Vocal tics such as: Uttering words or phrases out of context, coprolalia (vocalising socially unacceptable words), and echolalia (repeating a sound, word, or phrase just heard).

It is extremely difficult to sum up a typical case of TS. The expression of symptoms covers a spectrum from very mild, which is true of most people, to quite severe. Although some people with TS do not have any associated behaviours in addition to tics, many do have additional problems, which may include:

• Obsessive Compulsive and Ritualistic Behaviours, where a person will feel that something must be done over and over. Examples include touching an object with one hand after touching it with the other hand to "even things up" or repeatedly flicking the light switch on and off. Children sometimes beg their parents to repeat a sentence many times until it "sounds right".
• Attention Deficit Hyperactivity Disorder (ADHD). ADHD occurs in many people with TS. Children may show signs of hyperactivity before TS symptoms appear. Indications of ADHD may include: difficulty with concentration; failing to finish what is started; not listening; being easily distracted; often acting before thinking; shifting constantly from one activity to another; needing a great deal of supervision; and general fidgeting. Hyperactivity (e.g. fidgeting) and attention deficit (e.g. concentration problems) can be present independently of one another. Adults too may exhibit signs of ADHD such as overly impulsive behaviour and concentration difficulties.
• Learning Disabilities - such as reading and writing difficulties, arithmetic disorders and perceptual problems.
• Difficulties with impulse control - which may result, in rare instances in overly aggressive behaviours of socially inappropriate acts. Also, defiant and angry behaviours can occur.
• Sleep Disorders - these are fairly common among people with TS and can include frequent awakening, walking, or talking in one’s sleep.

The majority of people with TS are not significantly disabled by their tics, or behavioural symptoms, and therefore do not require medication. However, there are medications available to help control the symptoms when they interfere with functioning.

While students with TS as a group have the same IQ range as the population at large, many have special educational needs. It is estimated that many have some kind of learning problem. The condition itself, combined with Attention Deficits and the problems inherent in dealing with the frequent tics, often call for special educational assistance.

Be prepared to make arrangements appropriate for examinations. These may include the use of an amanuensis, a computer, extra time, rest breaks, or a separate room. Also, be aware that necessary arrangements need to be made with the relevant validating body at some point prior to any examinations. If you need to apply for these concessions for an exam, please contact us.