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Question 7:

I listened to your presentation today and thought you were excellent- thanks for sharing and informing!! Why does Tourrette's only surface at around 5 years old...what do the younger kids do to indicate that they will be going in that direction and is there any parenting method to help??? K.A.S., Ontario, CA

Hello K.A.S.!

Thank you for taking the time to send such nice feedback: I'm glad that I can help!

It is not known for certain why TS takes a while to manifest itself, although from a genetic perspective it is not unusual for certain traits to be set on a "time-delay" -- the hormonal changes that occur with puberty are not triggered until the second decade of life, for example.

A theory of my own, which is the topic of my doctoral dissertation, is that tics are the product of countless learning episodes. Put very simply, an area of the brain that is involved in inhibiting "incidental associations" made between different motor movements (like, say, walking through a doorway and blinking simultaneously) is not functioning properly in individuals predisposed to TS. Therefore common actions (such as eye-blinking) become "connected" to a great number of regular activities, resulting in what we call tics (in this case, an eye-blinking tic). If this theory is true, one reason you may not see tics until age 5 or older is simply because it takes some time for all of these incidental associations to develop and strengthen to the point where they surface.

If a child is going to develop tics, it is a good bet that (s)he will exhibit other forms of disinhibition even earlier -- impulsivity, hyperactivity, distractibility, irritability, or sensory sensitivities are often evident and diagnosed (in the form of ADHD) first.

As far as parenting methods go, since this is a disorder based in genetics there is nothing to PREVENT the disinhibition but many of the techniques I discussed in my presentation around symptom negotiation, responsibility, and acceptance are crucial at home. As well, I offer another presentation (A Disordered Mindframe II) that goes into the question of family interaction in detail -- unfortunately I didn't have time to cover it at the workshop you attended (since it was predominantly intended for teachers I wanted to focus on important issues for schools). I believe you received some general handouts for it though.

I hope this helped!
Dr. Dunc.

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