"Dude, You Don't Have Tourette's:" Tourette's Syndrome, Beyond the Tics

Naomi A. Schapiro

Disclosures

Pediatr Nurs. 2002;22(3) 

In This Article

Abstract and Introduction

Abstract

While coprolalia is the most well-known symptom of Tourette's syndrome (TS), it affects only a minority of persons with the condition. TS is a chronic neurobiological condition consisting of vocal and motor tics. Many children with TS have associated obsessive-compulsive disorder (OCD) and/or attention deficit hyperactivity disorder (ADHD), both of which can interfere with school, peer, and family functioning more than the tics themselves. The article distinguishes TS from other tic disorders and reviews literature on epidemiology, etiology, clinical course, and diagnostic and treatment issues. The article discusses the role of primary care pediatric and advanced practice nurses in the diagnosis and management of TS and details helpful interventions in the arenas of personal, family, and educational support, as well as symptom management and indications for medications. The author also suggests areas for future nursing research.

Introduction

Eleven-year-old Erica is on the medication line at summer camp. While waiting for her turn with the nurse, she joins a discussion among campers on the merits of Prozac [TM] for depression. She points out that she takes the same medication for her "OCD," connected to Tourette's syndrome (TS). Another camper refuses to believe she has TS, partly because he doesn't see her making any strange movements, but primarily because she isn't blurting out obscenities.

This anecdote illustrates several of the conundrums connected to living with a diagnosis of TS. The involuntary interjection of obscenities into daily conversation, or coprolalia, is the most famous TS symptom, but affects only a minority of persons with TS (Singer, 1997). The vocal and motor tics that are characteristic of TS wax and wane and may not be present at any given moment (Packer, 1997). Since TS can be an invisible condition while the symptoms are quiescent, children with TS are faced with the dilemma of "passing for normal" or being "out" about their condition (Joachim & Acorn, 2000; Wilensky, 1999). Finally, many children with TS also have attention deficit/hyperactivity disorder (ADHD) and/or obsessive-compulsive disorder (OCD), and these associated conditions may interfere with daily life more than the tics themselves (Carter et al. 2000; Packer, 1997).

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