Understanding negative responses in individuals with Tourette Syndrome

TS is More than Tics!

Tourettes Syndrome and its co-existing conditions can often present to many as “behaviour issues”. The English dictionary defines behaviour as a way in which a person acts or conducts themselves towards others. For individuals living with complex neurological conditions such as Tourettes Syndrome, the way in which they respond to certain situations is more often than not, out of their control! Therefore, the word “behaviour “does not apply.

1. DYSINHIBITION

Difficulty consistently inhibiting thoughts and/or actions. Often inappropriate statements or actions can result from the individual’s inability to consistently apply “mental brakes” – they are unable to stop themselves consistently from expressing thoughts or displaying actions that someone else might be able to control. These actions may seem to be excessive silliness, cheeky, no filter comments, emotional outbursts, contextual swearing, blurting out, inappropriate comments, explosive anger, and oppositional defiance.

2. OPPOSITIONAL

Many individuals with Tourettes Syndrome have a secondary diagnosis of Oppositional Defiant Disorder (ODD). This can present as being chronically inflexible and will typically display ODD actions. Underlying difficulties such as OCD, ADHD, tics, processing difficulties, written language deficits, and sensory issues may prevent the individual from expressing their needs or responding appropriately. For example, an individual who becomes oppositional only during a task requiring writing, may be communicating through their actions that they are not capable of writing.

3. IMMATURITY

Frequently individuals with Tourettes syndrome may act in an immature fashion and come across to others as someone much younger, even though they may have more advanced academic abilities. Dealing with ongoing frustration or anxiety may have caused delays in developing skills necessary to keep up with their peers. Their actions may not be age appropriate, which are often perceived by others as being purposeful. It’s also not unusual for friendships to develop with others much younger, Immature responses are frequently seen individuals with Tourettes Syndrome, and should be perceived as a component of the disability, and not manipulative and purposeful.

4. OBSESSIVE COMPULSIVE ACTIONSONS

Characterised by recurrent, unwanted thoughts and images (obsessions), and/or repetitive actions (compulsions) which the person hopes will prevent the obsessive thoughts or make them stop. Performing the “rituals” provides only temporary relief and not performing them significantly increases anxiety. OCD has been shown to be a common related disorder for people with TS. It can be difficult to tell the difference between complex tics and obsessive-compulsive actions.

5. RAGE’

for some individuals with Tourettes Syndrome outbursts of uncontrollable anger can occur, this is often referred to in the TS community as “rage attacks”. Generally, but not always, this is displayed in the home setting more frequently than at school, work or in public. Usually, the individual might yell, throw things, perhaps call names, all in a manner that seems unprecipitated. This symptom is neither the fault of the individual or down to the way they have been raised. Sometimes a change in routine or expectation of an event for an individual who is inflexible may set off an episode. In fact, experience shows that typical interventions (including negative consequences) only serve to increase these rage episodes. It is critically important that those in the life of the individual with Tourettes Syndrome become aware of what reduces or increases the explosive responses.

6. FIGHT OR FLIGHT

In general, individuals with Tourettes syndrome have a heightened response to their environment. A volatile manner or perceived judgment may cause the individual to become overwhelmed – which may escalate into a ‘flight or fight’ response by the individual. It’s important that those around them can remain calm.

7. DIFFICULTIES WITH TRANSITIONS

Very often individuals with Tourettes Syndrome have problems with transitions – they are internally driven to complete the current task or stay in the current environment and not move on. For the individual with Tourettes Syndrome and additional anxiety caused by obsessive-compulsive- disorder, transition difficulties can be exacerbated.

8. USE OF INAPPROPRIATE LANGUAGE (Coprolalia)

Coprolalia is a symptom of Tourette Syndrome characterised by unwelcome, unwanted, and uncontrollable utterances of words or phrases that are not appropriate. Commonly, people come to know coprolalia as the “swearing tic”. This symptom is mocked in movies and other media, but can cause much distress to the individual, especially when feeling judged.

Further reading can be found https://www.tourettes-action.org.uk/ and https://tourette.org/