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Life's A Twitch! Celebrating 15 years.
1998 - 2018
Life's A Twitch! Celebrating 15 years.

 

Question 62: My question is this, my son is most often a very sweet and loving child, and as you understand he has his moments that include the rages, however I am wonder(ing) if TS has some effect on the ability to make the choice between right and wrong. Some times the choices my son makes are very poor even though I know he knows he shouldn't have made that choice....I am worried because for the last eight months his choices are for a lack of a better word ridiculously wrong and inappropriate, I will also let you know he is on risperidol 1.5.mg per day and when he goes to his fathers every other weekend he is not always getting this medication, then when he gets home by Sunday evening he is a handful and very very angry and hurtful to his siblings and me. Is it a possibility that the constant interruption of medication causing this inability to make good choices or does it have to due directly with his TS. S.H., ON, Canada.


Strictly speaking this is not an effect of TS itself, however more often than not (some researchers suggest as high as 90%) of individuals with TS also have symptoms (if not a diagnosis) of attention-deficit hyperactivity disorder (ADHD). While most people think of difficulties sustaining one's focus when they hear about ADHD, the other component of this disorder is impulsivity -- acting before you think, or "firing before you aim", much as you describe. As you so aptly put it is not necessarily about not knowing what the correct choice was. It is more about not having the ability to put the brakes on your initial gut reaction long enough to consider and choose between the many other reactions you could respond with. If your child has never been assessed for having ADHD this might be an option you'd want to at least explore.

With regards to risperidol causing impulsivity, that is unlikely as a side effect of this drug. Risperidol is a medication used predominantly for the treatment of tics and rage, whereas medications such as methylphenidate (Ritalin) or clonidine (Catapres) are used for controlling ADHD-type issues. Hence inconsistent use of risperidol would be more likely to result in the anger and lowered frustration tolerance reactions you describe rather than impulsivity.

Having said that, though, ANYONE has a more difficult time making the right choices when they are frustrated, of course -- this is especially true of individuals with rage issues. If you find that your son's poor choices ONLY occur when he is angry, then your assessing doctor may be less likely to see this as an impulsivity problem, more likely to see this as a result of the rage issues, and would want to discuss with you ways of ensuring that his medications for this condition are more consistently adhered to.

I want to close by emphasizing that, not being your doctor or knowing many details about you, your husband, your son, or the situation, you should only consider this response as advice regarding possible directions to explore and questions you should ask. You should consult with your own doctor (medical and/or Psychologist) and solicit their opinions on this matter.

I hope this helps S.H.!
Dr. Dunc.

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Last updated on March 25, 2022

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