There have been some articles on the news recently about the singer Lewis Capaldi and his recent diagnosis. He is not the first celebrity to have this condition; others include Billie Eilish, Dan Aykroyd, David Beckham, and Howard Hughes.
What are the symptoms of Tourette syndrome?
Tourette syndrome or TA or Tourette's syndrome are common neuro-developing conditions that occur at birth and adolescence. It is a condition that causes a person to make involuntary sounds and movements called tics.
There can be several movements or motor tics and possibly also vocal tics. Typical tic symptoms include blinking, coughing, throat clearing, snorting, and face moves. These usually precede a recurrent or unresolved urge to activate the affected muscle, known as a predictive urge. It may be possible to suppress tics temporarily and characteristically, they can change their location strength and frequency. These incidents are usually not noticed by a casual observer.
Complex motor tics might include facial grimacing, a head twist, and a shoulder shrug. Other complex motor tics may appear purposeful, including sniffing or touching objects, hopping, jumping, bending, or twisting. Examples of vocal (phonic) tics in Tourette syndrome include throat clearing, grunting, barking, repeating the words of others, shouting and swearing, obscene or forbidden gestures or inappropriate touching, and imitating others' actions.
Whilst unacceptable behavior is the most publicized symptom of Tourette's, only around 10% of people with Tourette's exhibit this.
Do Tourette's vocal tics and motor tics go away?
There is no known predictive cure for Tourette Syndrome. there are treatments to help manage the tics caused, and many have tics that do not get in the way of them living their life and do not need any treatment.
Treatments such as hypnotherapy and interventions using NLP are very effective in reducing tic incidents, so much so that tic severity diminishes and becomes handleable for the client.
Those with milder tics find a way to accept them and continue life as normal, finding coping mechanisms to deal with motor and vocal tic, and facial tic symptoms.
Those with severe tics may find that repetitive movements significantly interfere with their daily lives and affect their quality of life; for those people, finding a means to control tics is more important than seeking a cure.
Can you get Tourettes at any age?
Tourette's disorder consists mainly of persistent tic problems. Whilst the tic occurs in almost every age group, the tics typically get less serious after age 18. And for many children, they do "grow out of them."
A patient's medical history often shows a pattern of early stress-related disorders that affect the nervous system. If untreated, they can spill over into early adulthood, and severe symptoms can affect motor or vocal abilities and lead to learning difficulties.
Obsessive Compulsive Disorder (OCD)
People with Tourette syndrome may also demonstrate OCD behaviours, where they feel that something must be done over and over. An example of this includes touching an object with one hand after touching it with the other hand to "even things out." Children sometimes repeat a sentence over and over again.
The anxiety felt due to the tics motivates them to develop obsessive-compulsive symptoms, using repetitive behaviors, as a way of dealing with the anxious feelings. Adding these to their common tics.
Common co occurring conditions are often recognised as stress related responses in their own right.
Attention Deficit Hyperactivity Disorder
Doctors aren't sure why, but about half of people with Tourette's also have symptoms of attention deficit hyperactivity disorder ( ADHD ). They may have trouble paying attention, sitting still, and finishing tasks. Tourette's can also cause problems with anxiety and learning disabilities such as dyslexia.
Sufferers of this problem have a lot to deal with; it is no wonder that they sometimes respond the way that they do. Environmental factors directly affect the stress levels of people with ts and other ts symptoms.
Helping Patients with Tourette Syndrome
In my career, I have worked with quite a few patients with Tourette syndrome, some with simple motor tics and some with complex vocal tics, including socially inappropriate behaviors that have made it very difficult for them to be accepted in ‘normal’ society. Their behavioral or conduct issues have exasperated those around them.
Some of their behavioral or conduct issues have amused those around them. Those who seem to have no inhibitions about uttering unspeakable things can cause great offense.
Whilst others have had some odd preoccupations, possibly connected to their obsessive-compulsive symptoms.
Early Days
In the early days, those who behaved this way were said to have “behavior problems,”, especially in relation to children. These days it would be more easily recognised as Tourette's Syndrome, a diagnosis that used to be rare and obscure. When I first trained only a few clinicians knew about it.
George Gilles de la Tourette
The first cases were described by the French neurologist, George Gilles de la Tourette, in the late nineteenth century. The syndrome was firmly embedded in the area of neurology, not Psychiatry, until at least 1980 when it became an official diagnosis in the DSM III.
It took a neurologist, Oliver Sacks, to bring TS to the attention of the public, with his very colourful case histories of adults who had the extreme forms of complex tics. Even today with the exception of a very few speciality clinics TS especially in childhood may be hard for many clinicians to identify, let alone parents or teachers who have never come across it before.
Most folk still know TS by its stereotypical behaviours like swearing (coprolalia), grunting or wild gestures, and these features do occur in often very disabling ways for certain individuals, but this is only in the minority of cases. TS is neither as rare nor as stigmatising as we might have previously thought. According to current statistics, the prevalence could be as high as one person in every 162, many with a “softer” presentation of the disorder. This can make it harder to recognise, it s really difficult to properly gauge what the true stats might be.
Neurological Disorder Characterized
TS is a neurobiological disorder characterised by a minimum of two waxing and waning motor tics, accompanied by at least one vocal tic. These can be sounds as basic as throat clearing or language-based, like syllables, words, a combination of words, or even swearing.
The operative term is “vocal.” These symptoms occur in bouts, which must last for more than one year for a diagnosis to be made.
Those are surprisingly simple criteria. Motor tics, like blinking, can be common and go almost unnoticed, possibly occurring mildly and transiently. They only become a marker of TS if they co-occur with vocal tics, though this does not necessarily need to be simultaneous.
Even today I come across children who are misunderstood and misdiagnosed since so many behaviours seem voluntary, mischievous and wilful to those with no first hand knowledge of TS.
Is it Genetic?
TS runs in families, though no specific genes have yet been identified, though there are psychosocial factors, and possible abnormalities in brain functioning as well as a dysfunction in some neurotransmitters like dopamine for instance.
TS commonly emerges with other conditions such as OCD and ADD. For the majority of children diagnosed with TS, tics wax and wane over time and often diminish or fade away by adulthood. Why some cases don’t improve, and some do, and why many don’t suffer any noticeable impairment in school or relationships, while some do, remain unanswered questions.
With the recent growth in interest around neurodiversity, you might wonder if the physical and linguistic disinhibitions we are talking about could enhance certain skills if channelled productively. I'm thinking about the recent discussions about the noises some athletes make for instance. There is some evidence, be it only anecdotal that Mozart might have had symptoms of Tourette’s, Dr Samuel Johnson, the great English lexicographer, almost certainly had TS.
Since tics wax, wane and change over time, and children’s brains are more plastic than those of adults, the provision of alternate Channels to redirect the energy of tics before they become fixed might well alter the patterns or outcomes of TS. Tourette’s might even be harnessed to advantage if a child found suitable outlets or channels for peremptory vocal and physical urges. Going back to Oliver Sacks, he said he observed a “ticcy” energy that he saw as real strength. Just imagine being able to assist those, especially the younger patients who present with TS to harness this dynamic energy to enhance their lives.
At the ICCH, we have developed several Clinical hypnosis techniques aimed at reducing Tourette’s symptoms and increasing tic control, which can be taught and installed in every age group of patients and is on the curriculum of the Diploma. It also forms the focus of a workshop that other professionals can join.