Disinhibition

Medical term: Disinhibited behaviours are actions which seem tactless, rude, or even offensive. They occur when people do not follow the usual social rules about what or where to say or do something. Disinhibition is the inconsistent ability to inhibit behaviours despite knowing they are inappropriate. Individuals experience movements, swearing, emotional outbursts, rage, infantile behaviours, noises, laughter and so on. These can all be either contextual or not. Essentially, disinhibition is when it becomes extremely difficult to use learned inhibitory skills “in the moment”. It is important to know that these behaviours are part of Tourette Syndrome and they are not deliberate. Individuals with Tourette Syndrome are often unable to control their behaviour and can often appear to be overstepping the mark and impulsive. Disinhibition can impact all co-occurring conditions. OCD symptoms, sensory issues, Tics urges, emotional regulation, and inappropriate language to name a few. Even though many individuals will know that what they are doing/ saying is inappropriate at the time, they are not able to put on the brakes to these behaviours. Understanding Disinhibition is essential in understanding Tourette’s! Due to the inconsistency of these behaviours the child may appear as being disrespectful, inappropriate, not “socially acceptable,” having emotional outbursts, showing silliness, have contextual swearing, or even rage. The disinhibition element of Tourette's can be a big problem within school, I bet all of your children can tell you a time they have been "pulled" up on a behaviour that wasn't necessarily a tic but they couldn’t help it. Disinhibited behaviour can place enormous strain on families and educators. It is also important to know, that just like Tourette’s, Disinhibition can also be suggestible. So, reminders of behaviours are more likely to cause the undesired behaviours. Managing Disinhibition Home and School: Respond calmly when recognising behaviour as a symptom and not a purposeful misbehaviour. Discipling for symptoms is counter productive often resulting in fight or flight and an escalation in symptoms, anger and/ or rage. Try and keep anxiety levels low. When anxiety is high it is even harder to use learned inhibited skills. Focus your child’s focus and energy into activities they are interested and good at. Always try not to assume behaviours are purposeful or not. Instead be curious, ask yourself and the child what is happening when these behaviours occur. Have a proactive approach to prevent these behaviours from occurring, however, react situationally when responding to behaviours that do happen. Proactive – Change the environment

  • increase opportunities to access a variety of activities, ensure to have a balance between demanding activities and down time. 

  • Provide a predictable environment to reduce level of demands. 

  • Teach new skills to reduce anxiety and work on emotional regulation.

Reactive - Redirection

  • Distract by offering different activities or change topic of conversation

  • Give choices of what to do next

  • Talk to your child, ask them what is going on

  • Workout together what the behaviours are trying to communicate - these will usually be anxiety fuelled behaviours.

School Specific: Every staff member should be as much aware of disinhibition as they are Tourette Syndrome. As symptoms are often assumed to be deliberate and are punished accordingly. By educating schools on disinhibition there would likely be a reduction in detentions, suspensions, bullying and damaged self-esteems. In turn, an increase in support, academia, and social achievements. Remember, Disinhibition can be suggestible, so rule reminders can increase these behaviours.

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