This paper examines Tourette syndrome (TS) as a neurobiological tic disorder, tracing its growing recognition and prevalence from fewer than fifty recorded cases in 1972 to affecting roughly one in two hundred children today. Drawing on clinical literature and the illustrative case of Kenny, the paper describes motor and vocal tic presentations, the common mischaracterization of coprolalia, and the high rates of comorbid conditions including obsessive-compulsive disorder (OCD), attention deficit disorder (ADD), and learning disabilities. It also addresses the emotional and social consequences faced by sufferers, available pharmacological interventions and their limitations, and the current scientific understanding of TS as a genetically transmitted condition linked to dopamine metabolism.
Tourette syndrome is a form of disability that has only recently come into the forefront of public discussion. However, as its symptoms and manifestations have become more widely recognized, more and more cases are being reported every year. According to Wilson (2003), "Until 1972, the condition was considered to be quite rare, with only fifty known recorded cases at that time. Today, the syndrome is identified in as many as one out of 200 children" (p. 105).
While most people think of Tourette syndrome as the spontaneous blurting out of curse words, the disorder is far more complicated than that. In fact, only about "one-third of all children with Tourette syndrome also have coprolalia, the involuntary use of vulgar or obscene language and/or gestures" (Wilson, 2005, p. 105). Essentially, Tourette syndrome is what is known as a tic disorder, which can involve all sorts of involuntary movements — from snapping one's fingers to grunting or barking to blinking one's eyes. For most patients, these irregular movements and vocalizations usually begin occurring around the age of five, though they can occur earlier or later as well. The frequency of the tics can vary from occasional occurrences to up to one hundred times per minute. There are also periods of remission in some sufferers, though these are relatively rare (Wilson, 2003).
A Tourette syndrome sufferer does not have to exhibit all possible symptoms. However, according to Hendren (2002), "to be diagnosed with TS, a person must present with both motor tics and vocal (phonic) tics. The motor and vocal tics do not necessarily occur concurrently" (p. 23). In Kenny's case, Tourette syndrome has manifested as general facial movements, and he also has vocal tics, usually in the form of grunting or snorting. In addition, Kenny displays strong compulsive tendencies, particularly involving touching things (including himself), wringing his hands, and spinning.
Not surprisingly, Tourette syndrome is commonly associated with other disorders such as obsessive-compulsive disorder (OCD), learning disabilities, and attention deficit disorder (ADD). According to Wilson (2003), "Approximately 50 per cent of children with Tourette syndrome also have learning disabilities, and many experience some form of attention deficit. Obsessive compulsive behavior is also observed in 55 to 74 per cent of cases of Tourette syndrome and tends to take the form of needing to complete tasks to perfection or perform certain rituals" (p. 105). Kenny appears to have OCD, although he is able to control his hand wringing at times. He also has trouble sitting still, which may be evidence of ADD.
The association with OCD is to be expected because, as Carr (1999) explains, "the tics that characterize Tourette's syndrome are similar to those which occur in isolation. And the movements which typify chronic movement disorder are probably subserved by the same structures within the basal ganglia as those which underpin compulsive behaviors and complex tics" (p. 470).
"Stigma, low self-esteem, aggression, and stress effects"
"Medications tried, side effects, and role of education"
"Genetic transmission, dopamine, and unresolved causation"
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