A brief overview of common co-occurring conditions associated with Tourette Syndrome.

Tourette Syndrome is a disorder in it's own entity however in a very high proportion of Tourette's individuals they will also suffer with at least one co-morbid condition.

Attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and Anxiety are the most common but not limited to comorbidities that go with Tourette syndrome (TS).

ADHD

ADHD is the most commonly co-occurring condition with Tourette Syndrome (TS) with around 20 – 30% of children with ADHD also having a tic disorder.

ADHD is when you have difficulty with paying attention, is much more energetic than others, and is unable to control certain impulses.

​ADHD is also diagnosed around the same age as TS, and also has a higher prevalence in boys.

ADHD is caused by the movement and ‘braking’ systems in the individuals brain maturing more slowly.

As with TS, not every child with ADHD will carry their symptoms through to adulthood.

​Symptoms mostly start in childhood. The key thing to remember is that someone with ADHD is not behaving badly on purpose. The area in their brain which is responsible for self-control takes longer to mature than in children who don’t have ADHD.

​Symptoms can range from mild to challenging. Symptoms can be specific to certain environments like home or school.

​ADHD may include, difficulty sitting still, Constant fidgeting, moving, talking, making noises, Low patience threshold for example, they may find it hard to wait in a queue or listen, this can also result in them interrupting others. They may also say and do things without thinking through the consequences due to their immature impulse regulations.

Types of ADHD & some examples of their characteristics:

Hyperactivity: noisy in play, fidgety, struggle to stay seated, always on the go, excessive talking.

Impulsivity: difficulty waiting turns, interrupts conversations, blurts out answers before question is completed.

Inattention: forgetful, poor organisation, distracted, loses things, appears to not listen, avoids tasks that require lots of attention, fails to complete tasks, makes careless mistakes.

OCD

OCD is where someone experiences recurrent obsessions and/or compulsions that are severe enough to effect everyday life. These obsessions are usually anxiety driven.

The symptoms of OCD are obsessions and compulsions.

Obsessions are uncontrollable thoughts, images, impulses, worries, fears or doubts. They are often intrusive (cause disruption and annoyance), unwanted and can be frightening for the person experiencing them.

OCD sufferers will often know that these thoughts are irrational, but this doesn’t mean they can control them. The most common obsessional thoughts are worrying about the safety of others or worrying that everything needs to be arranged symmetrically so that it is ‘just right’.

Compulsions are purposeful behaviours and actions that are performed in an attempt to relieve the anxiety caused by obsessional thoughts. Often the behaviour is carried out according to certain rules, or will be performed as a ritual.

Relief provided by compulsions are only temporary and often reinforce the original obsession. Common compulsions include checking, counting and touching.

The condition affects both children and adults and it is estimated that as many as 12 in every 1,000 people are affected by OCD in the UK.

​OCD and Tourette Syndrome (TS)

It is thought that approximately one-third of individuals with TS experience recurrent obsessive-compulsive symptoms. (Khalifa and von Knorring 2005; Leckman et al. 1997)

It can be difficult to tell the difference between a compulsion and a compulsive tic. A compulsion is typically a behaviour that is carried out in an attempt to relieve anxiety that is caused by an intrusive or obsessional thought.

A compulsive tic is more associated with a physical sensation and needs to be performed to relieve the urge sensation.

Anxiety

Anxiety is common in most children at some part of their childhood. Anxiety is an emotion that gives us an un pleasant feeling with in our body.

Anxiety is often temporary in children and can vary at different parts of their childhood.

Types of Anxiety & some examples of their characteristics

Generalised anxiety disorder: Excessively worrying about a range of different things.

i.e. future, family, friends or themselves, they may have difficulty in relaxing, they may also engage in challenging behaviour if expressing their feelings isn’t possible

Separation anxiety disorder: Children often go through this as a typical milestone, this anxiety appears when their parent leaves the room, but this usually stops around 30months old. If it’s still present at school age it becomes a disorder.

Phobias: An irrational fear of something specific, these emotions are to the extreme and very intense. Individuals may avoid certain situations that enhance this fear. Children may engage in challenging behaviour if they cannot communicate their fear to people.

Anxiety is a normal, and is a part of our survival skills, however the level of these fears and anxieties are predetermined by our genes. Anxiety can also be learned by children watching parents who are anxious in certain situations. Lastly anxiety can also be brought on by trauma.

​Anxiety and Tourette syndrome are closely interlinked, they form a cycle. Anxiety of people seeing tics results in an increase of tics, increased tics results in an increase of anxiety and so on.


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