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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.

Good evening B.H.!

Given that you feel she is very concrete and may not be able to understand the complexities of social interpretation, cause-and-effect, etc. I would suggest sticking with a purely solution-focused, equally concrete approach. Let her know that spitting openly IS not and WILL not be condoned while at the same time teaching her acceptable "compromises". Spitting into a handkerchief might be one example. Other children with TS I know will "wipe" their mouths on their sleeves and release the saliva then. For still others, making the "noise" of spitting (without actually engaging in the action) satiates the tic urge -- these individuals may learn to make the noise quietly, or into their hand.

The important thing to get across is that scratching an itch ONE way may not be allowed, but scratching it a slightly different way is just fine. When it is clear to her that the options are to either spit in a slightly different way or not spit at all, compromises suddenly look more appealing. While eventually most individuals with TS can learn to problem-solve in this way on their own, given the limitations you say your client has she may always need support in finding and practicing appropriate compromises.

I hope some of the suggestions above, whether they work or not, at least give you a starting point for thinking about ways to resolve this issue in a way that will suit YOUR client best.........take care.

Dr. Dunc.

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