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Question 76: One type of tic that isn't recognized is variations in my speech. My voice gets louder without me knowing it. I get "Quit yelling at me!" when I don't mean to. I get asked if I am being sacastic because of the tone I cann't hear. I over enuciate and people think I am talking down to them, this one I can catch sometimes. Most complaints are that I am yelling and that I am confrontational when I ask questions or am having a discussion subject matter seems irrelevant. I try to get opinions from others but they seem to think I am being bitchy when I do this....I have thought of video taping everyday activities and conversations around the house. Have you had any experiene with this type of disorder? Ideas? Medication? Thanks for listening to me. K.T., BC, CANADA

Hi K.T:

Are you familiar with a diagnosis known as nonverbal learning disorder (NLD)? It is not uncommon for people with TS+ to experience problems with this as well. I have a fairly cursory handout at www.lifesatwitch.com /datafiles/moduleI_nld.pdf, but I would suggest reading up on NLD -- it might help cast some light on what you are experiencing. In a nutshell, I think that people with TS+ are so overstimulated, and fighting so many internal battles, that subtleties in noticing the body language of others, or their own body language, are sometimes missed because there isn't enough room on the mental workbench. Medications aren't really directly indicated for a problem like this, but social skills training is very helpful (discussing, modeling, and practicing each skill, with explicit feedback as you go).

Also, anything that will help to make you more aware of how you sound and/or look will help. Taping yourself is a good idea (video might be cumbersome: I would suggest audiotaping); so is watching yourself in a mirror as you make different faces or adopt certain tones -- learn to recognize how your face and/or voice feels different when you switch from one style to another. Another strategy is to recruit trusted friends or family to cue you when they notice aspects about your approach you wish to curb. It is important to ask people to help you with this at 'calm' times when there is no immediate instance on the table; if you don't trust your non-verbals even then you might want to write the request in an email or letter that you can look over a few times before sending it (this is a good strategy to use in general when face-to-face interaction isn't even necessary). Also, the more room you have in your beaker, the more resources you have available to become aware of how you present to others. Having strategies, medications or other treatments in place for your other symptoms can help with this.

I hope some of this helps K.T.! Take care,

Dr. Dunc.

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