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('are there things that can be done instead of using drugs -- strategies, cognitive techniques, behavioural interventions, other psychotherapeutic approaches??')

Question 104: Dear Dr. Duncan, I am a mental health professional. I read your story in the Reader's Digest of July 2004 and immediately went to your website. It is a wonderful website and provides extremely useful information. In am writing from Calcutta, India, and very little information on TS is available here. The reason for my sending this mail to you is the following:

About two months ago, a 29 year old female was referred to me for psychotherapy. She was reportedly suffering from OCD. The symptom was that she has an irresistible urge to insert her finger in her right eye. She has this symptom from age 12 and has been treated by the best psychiatrists both in America and India. Nothing has helped her beyond temporary relief. She also is on drugs for epileptic seizures which are controlled now. The girl has lost sight in her right eye and has also damaged her left eye. The symptoms decrease or increase in intensity from time to time. She does this mostly in bathrooms or places where she cannot be observed. She also has an urge to scream loudly and when she does that her mouth becomes distorted. Somehow I became a bit skeptical about the diagnosis of OCD. Her personality does not have any perfectionist trend, the anxiety-reduction after completion of the compulsive act is also not present. I am aware that it may not be present in all cases.

My questions are:
a. Is it possible that the symptom this girl is suffering from is TS and not OCD?
b. Could it in any way be related to her epileptic seizures?

Even before reading your story, in last week's session, I advised her to be aware of her urge and immediately to do something which will make her hands inactive, like putting her hands in a pair of gloves etc. I would like to help. Any suggestion will be hightly appreciated. With thanks in advance, PM.


Question 99: Just wanted to ask for a little assistance with a young fellow...we're looking for some advice to help him transition into a new school. We want to be as helpful as we can and give them some suggestions....I thought of you and if you might have some good ideas. [He] has a real problem with transitions and new things so the move will have some impact on his behavior but we want to be as pro-active as possible. Anything you can send or direct me toward would be good. Cheers, C.M., NS, Canada.

Question 96: My son was diagnosed with full blown TS and symptoms of ADHD and OCD when he was 6 yrs old (now 7). He also experiences bouts of rage and when he is emotionally "hurt" he will verbalize the desire to do violent things. I don't really believe he would ever do what he comes up with but...he is currently on Luvox and with the more recent light shed on the possible conection with odd behaviors and SSRI's I'm seriously reconsidering giving him the med. His rages have greatly decreased since his diagnosis but I think that has more to do with our acceptance of him and his natural developement than any med (in the last 11 months he has been on Clonidine, Respiradol, Serequel (2 wks), and now Luvox (in that order). We fired the first psychiatrist we were with as we by this point had more knowledge of TS than he did and now find ourselves on at least 3 different waiting list to get our son some help. In the mean time I can no longer tell if the medication he is on is doing anything or if it simply the wax and wanning of the disorder and seriously the more I read about the medications he is/has been on the more confused and frightened I get. The next suggested med (via the pediatrition) is concerta in combination with luvox. But not one physician has ever talked to my son about what he feels/experiences so how do they know what is the disorder and what is his lack of understanding and frustration with the disorder?

Please send me some feedback on the direction I should take now...I feel like I'm drowning in confusion. Meds or no meds? that is the question. Sincerely, D.R.

Question 95: Dear Dr. Dunc, My 10 yr old son....has just been diagnosed with TS +associated disorders. Anyway, have you ever heard of a TS patient who stutters to have improved stuttering by using a speech easy device? This device is similar to a hearing aid and new to Canada. Of course the company thinks it would be worth the $200+ assessment but we would have to also cover expenses to get there etc. I would pay any amount if it actually would help aleviate [our son's] stuttering since this is the "tic" which gives him the most "attention". Have you heard of this? Since TS is caused inside the brain and believed to be chemical, could a device work? Just wondering.... Thank you, M.M, ON, Canada.

Question 93: Hello: My daughter was recently diagnosed with OCD and high anxiety... The problem I have is that there is very little help out there for her or me and how to cope. She has obessive sexual thoughts that have caused her much distress and discomfort. she is receiving therapy but there is little out there on how to approach this. In most cases the therapist told me exposure is used but in this case it is hard to do. Exposure to masturabation is not an option my daughter wants to take. She is taking [medication] but her Doctor wishes to stop this medication in early 2004. I guess what I want to know is there any approaches oout there that could help her. i just feel at times to be at the end of my rope. The medication to me has made her more demanding and outspoken. G.L., NS, Canada.

Question 85: I was one of the fortunate 500 that sat in the audience at Horton High School in Greenwich and witnessed the magic that is you!! I am prof and grief therapist. I have a question regarding one of the techniques I was taught as a graduate student re: behaviors that needed to be performed in access of 30 times a day. The technique involved the paradox of asking the client to increase the behaviors and hence they would be unable to perform, say handwashing, at all. Can you share your understanding of how this works? Or possibly you don't support this approach. It was lovely to be in your presence. Regards, S.S., NS, Canada.

Question 84: I have searched your archives but couldn't fine an answer to my specific question. My grandson has very negative reactions to positive reinforcement. Tell him he's done a good job and he gets all bent out of shape. My daughter, who attended your presentation in Kentville, Nova Scotia mentioned this was because it increased his internal pressure by making him believe he now has to live up to that standard he's just set. I can appreciate that and don't want to cause him any more pain. Would it be reasonable to encourage him by making it incident specific? handled that one really well, for example and let it go at that? Are there other strategies for providing encouragement and positive feedback that would not be as threatening to him? He is 8. By the way, my family came home saying your presentation was great and they will be going to every one within reach. They will be bringing family members and friends to the one you are having in Halifax in October. I believe you are doing a lot of good for a lot of people and I thank you for it. P.D., NS, Canada.

Question 79: I am a 14 year-old boy who lives in north west New Jersey. Ever since I was 7 I've had mild tics. They annoyed me but nothing more. But the last month or so the tics have become increasingly worse. Everybody notices....The thing is, I don't have T.S. I have been tested at least 5 times and all came out negative. I am a freshman in a public high school and am in 4 out of 4 advanced placement classes. My question is, if I don't have TS, what do I have, what's wrong with me, and how can I stop. M.S.S., NY, USA.


Question 77: I have two girls with TS. Both lately have increase their vocabulary with swearing quite frequently. I tell them to stop or find another word but this does not happen. How can they control their rage attacks as well as the swearing. I e-mail your site to various friends or people who are uneducated hoping to enlighten them. Other wise if they chose not to associate with us it's their loss. J.D., USA.


Question 74: I was....wondering something about coprolalia. I understand there is an average age where children develop coprolalia - somewhere around 12-14, is that correct? Do children who develop this learn the swear words from what they hear or is it a natural vocal tic that causes them to swear. I guess what I'm wondering is if children who have tourettes hear swearing and develop coprolalia are they more likely to swear? Should a person be cautious about swearing around someone with TS? JS, MB, Canada


Question 71: I have read Dr. Schwartz books, "The Mind and the Brain" and "Brain Lock". So far, he is the only reference I've read that says that his....method can actually affect the brain physically, and reduce significantly the symptoms of TS Tics. What is your opinion of Dr. Schwartz's work? Do you know or think that his methods work? I think the question comes down to this; How 'physical' is TS as relates to the brain, and how much can the physical abnormalities that define TS actually be changed by non-physical opposed to resorting to drugs or surgery? DHK, FA, USA.


Question 64: This is my first time writing to you. I was diagnosed with Tourette's when I was seven years old. It used to be real bad. I am now 12 and everything is under control. I'm taking nine mg of orap a day. But the problem is that I get tired really easily. Do you have any suggestions? My e-mail address is protege5rulz.............. (As you can see, I'm in love with the Mazda Protege 5.) Thanks, N.W., ON, Canada.


Question 50: I work with Developmentally Disabled Adults between the ages of 18 and 29 as a facilitator assisting them in making the transition from school to adult life. One of the individuals I serve is a young woman age 21 who also has Downs Syndrome. Her tics are in the form of spitting. Her cognitive level of understanding seems to be at about a 5 year old level in most areas. She understands only concrete simply concepts. Those of us who spend time with her are noticing the spitting increases when she is out in public or in situations which are new to her [and] I am not sure if she is capable of understanding what is happening when she is spitting. Right now she is getting all kinds of negative messages from the world at large and I am seeing her self esteem being eroded and her family also feeling discouraged. Do you have any suggestions of how I/we might help her? Blessings, B.H., ON, Canada.


Question 33: I am doing a research paper/project on the suppression of tics through behaviour therapy. I am having a hard time finding resources in this area. Would you be able to point me in some direction? Thanks, C.D. (aspiring Child and Youth Worker), ON, Canada.


Question 30: It is not uncommon for TS children (even adults) to be sexually inappropriate, perhaps intrusive and not complying with the cultural/societal norms. How does one address this in an in-service since the question has popped up? More importantly, how does one handle this behaviour to extinguish it? With some young children it seems to extinguish fairly quickly with talking and substitution training for in public. For others whom are at the age when this can be viewed as deviant, criminal behaviour--Young Offenders 12+ and age of sexual consent 14 years--what suggestions for working with these young people. Some of them are some management issues need to be addressed. K.T., BC, Canada.


Question 18: Both my son J. and I suffer from insomnia--I'm probably worse than him but he may get worse as he enters his teens. The only thing I have found that helps is making sure I'm really calm (no stimulation) before I go to sleep and I also take low dose (10-20 mg.) of Elavil every evening. I recently started a new job and have found my insomnia has intensified greatly. I just can't stop my mind from racing with all the things I need to get done at work and elsewhere. I just tried self-hypnosis with no success. Do you have any jewels of wisdom in regards to insomnia. K.M., ON, Canada.


Question 14: What do you know about the Asthsma/coughing tic? [My son] has had a horrible cough for the last week, was dx with asthsma long before TS but am hearing things about it as a tic now. Matt has no weezing currently (at the moment) but is constantly coughing and the inhaler doesnt work. I know you're busy so I'll understand if you can't respond and won't be upset. R.S., MO, USA


Question 11: Thank-you Duncan for your response to my question concerning our son's sleep disorder. You mentioned quite a few useful things. I had wondered about behavior modification for TS. But the pediatric neurologist that Chase our son sees says that there really is no way to turn the motor off in Chase's brain so easily. I had mentioned to the doctor the idea of getting an aquarium for our son's bedroom in hopes to help relax him at bedtime. He said that we could try but not to hang our hopes on it.

Are the sleep clinics familiar with treating a sleep disorder associated with TS? [Our neurologist] has had to remind me of the physialogical nature of this disorder on more than one occassion. Reminding me of an actual problem with neurotransmitters and the tics not being emotionally induced.....[Our neurologist] is also very conservative with the meds. He doesn't want Chase treated for his tics unless he is hurting himself or unable to be productive. And none of those have occurred so presently he only takes something for bedtime. We too would like to keep him on little meds as possible or none at all.

God Bless you and the ministry that you offer to us folks. You have a gift. Don't give it up. Sincerely, S.H., Texas, USA.


Question 10: Hi. [Our daughter] has been diagnosed with agoraphobia and we are looking for some direction. Her family Dr. is a pill pusher but admits meds would conflict with epileptic meds. I wonder if some type of counselling is successful for this. What would an almost Dr. suggest would be the most effective course of action. She is working with a neurologist for her epilepsy. Jrvb, Ontario, CA.


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