Overview of Tourette's Syndrome
Tourette's Syndrome leads to repetitive movements and tics, which are most commonly verbal. They can be sounds, words shouted or screamed, or of offensive content. Physicians divide them in motor and verbal ones, and simple and complex ones. Eye-blinking, shoulders-shrugging, or head jerking are some examples of repetitive movements in children and adults with Tourette's syndrome. Verbal or motor tics can appear at any time of the day and also during the night. They may disturb the quality and quantity of sleep, leading to low quality of life. In this article, we will mention the effect of weighted blankets not only during the night but also in the daytime.
What is Tourette's syndrome?
Tourette's syndrome is a disorder that usually becomes apparent in childhood. It can become evident from as soon as two years old till adolescence. Most commonly, children receive a diagnosis by the age of six. It is a disorder of the nervous system (NS) that doesn't have a cure. However, people may control it with medication and lifestyle interventions or psychotherapy. Individuals with Tourette's syndrome have an urge to perform their tics, and they cannot stop their bodies from doing them. Therefore, they might make unwilling sounds or gestures that they soon get used to, but people find odd or unusual. Most individuals with Tourette's syndrome can control and stop doing a tic for some time. However, as they hold back their tics, it gets harder and harder. They eventually have to do them, even if they hesitate or don't want to.
How common is Tourette's syndrome?
Tourette's syndrome is more prevalent in boys than in girls. Centres for disease control and prevention (CDC) suggest that an estimated 1 in every 162 children live with the disorder. However, these numbers are just estimated and the actual number of children with Tourette's syndrome is unknown. Another study suggested that current statistics represent only about half of the valid cases. Regarding children known to have the disorder, an estimated 37% have moderate or severe forms of Tourette's syndrome. Additionally, girls are three to five times less likely to develop it, when compared with boys. Race and ethnicity might also play a role as non-Hispanic white boys have twice the chance to present with the disorder when compared with black boys of Hispanic or non-Hispanic descent.
Tourette's syndrome and co-occurrence of other conditions
Research suggests that about 86% of well-established Tourette's syndrome cases co-occur with another disorder as well, of mental, behavioural, or developmental nature. An estimated 63%, meaning more than half of children, had also received an ADHD diagnosis. Accordingly, 49% of children suffered from anxiety and 25% from depression. Learning disabilities were present in 47% of them, while 30% had developmental disturbances. Finally, 35% belonged in the spectrum of autism, and 29% were coping with language and speech difficulties.
A mental disorder that appears in more than one-third of children with Tourette's syndrome is the obsessive-compulsive disorder (OCD). However, they both are separate entities, and they belong to distinct categories. OCD is an anxiety disorder, while Tourette's syndrome belongs to Disorders Usually First Diagnosed in Childhood. However, individuals with OCD have different pathophysiology and behavioural phenotype. They experience obsessive thoughts, which lead to compulsive responses. As in Tourette's syndrome, people with OCD cannot fully control their behaviour. If they try to, they succeed for a while, finally giving in their compulsive behaviours.
Causes and risk factors of Tourette's syndrome
Scientists don't know the exact cause of Tourette's syndrome. They hypothesize that the disorder appears as a result of environmental and genetic factors. As a neuropsychiatric syndrome, it might involve chemical imbalances in the brain, including certain hormones and neurotransmitters.
Risk factors are some characteristics, behaviours, or external parameters that increase an individual's likelihood to develop a medical condition. Some of the most well-established risk factors regarding Tourette's syndrome are family history and gender. As mentioned previously, boys have more chances to develop the disorder than girls. The ratio is three to five times higher. Also, a positive family history of Tourette's syndrome or another tic disorder might increase your risk of developing it in the future.
Symptoms and signs of Tourette's syndrome
Tics are the main symptoms that characterize Tourette's. They can be motor and verbal. A child can have both equally, or some predominance to one of the two categories. They range from mild to moderate or severe. The latter may significantly affect a child's daily life and school or social performance. Tics can also be simple or complex. Simple vocal tics are usually grunting, coughing, throat clearing, barking, or whistling. Motor ones are eye blinking, shoulder shrugging, head jerking, eye-rolling, nose twitching, or repetitive movements of the mouth.
Complex tics are usually more severe, and they involve more muscle groups. For example, complex motor ones may be jumping, repeating movements they observe, coming up with unusual gestures, bending, smelling objects, or twisting. Complex vocal tics can be some of the following:
- Repetition of words or phrases they come up with, or they hear from other people
- Using offensive language or swearing
Symptoms may appear in various frequencies and intensities. They usually become worse and more severe under physical or emotional stress, such as anxiety states, various transient illnesses, or just tiredness. Tics are not stable. They may change over time by replacing older tics. They can also occur during sleep and disturb the quality of rest and daytime functioning. Tics usually improve in adulthood.
It is interesting to understand how a tic manifests in the body and how it feels to have one. Before its onset, individuals experience a premonitory urge, which is similar to tingling or itching sensation. This urge gets relieved by performing the motor or verbal tics. Some people draw a parallel between having a hiccup and experiencing a Tourette's tic.
Tourette's and sleep disorders
Tourette's syndrome is an independent risk factor for subsequent sleep disorders in children. A study revealed that "sleep disturbances occurred in 62% of patients with TS, and polysomnography study revealed sleep apnoea, abnormal arousal pattern, and motor and vocal tics during all stages of sleep". The study also suggested that Tourette's is a risk factor for sleep disorders, regardless of the presence or absence of comorbidities, such as ADHD or OCD. Children with the syndrome often report they can't sleep because of their Tourette's. The following are some of the most common sleep disturbances in children and adults with Tourette's:
- Early-onset or late-night insomnia, meaning difficulties falling or staying asleep
- Evening separation anxiety
- Tics while sleeping
Quick facts on sleep issues and Tourette's
- Children or adults with Tourette's syndrome most probably continue experiencing tics during the night and while sleeping
- Sleep- disturbances in children may affect their development, learning ability, and cognitive skills
- Emotional distress might occur in children who can't sleep because of their Tourette's syndrome
- The results of several studies are not consistent, and scientists are not entirely aware of the clinical impact of sleep problems in children with the disorder
How tics disrupt the daily life of those with Tourette's?
Tics in children with Tourette's might significantly disrupt their daily life and school performance, leading to developmental delays and learning difficulties. Children with the disorder might also receive negative feedback from their classmates. They might be socially isolated or bullied by other children who do not understand their condition. On top of that, individuals with Tourette's might experience sleep difficulties. Insufficient rest during the night might affect a child's school performance independently, causing cognitive disturbances, memory problems, and daytime tiredness. The child might not be able to participate in extracurricular activities, such as sports, for example. Living with Tourette's might also make it hard even to watch a movie at the cinema or attending a theatre play. Most of the time, children with Tourette's have comorbidities, such as ADHD and OCD, further disrupting the quality of their life. Occasionally, symptoms are so severe they make it impossible for a child to attend classes at school.
Complications of sleep deprivation in children with Tourette's
Children with or without Tourette's might have severe complications as a result of sleep deprivation. The effects might be short-term or long-term. The following are some of the most well-established ones that come as a result of not getting sufficient sleep during the night:
- Cognitive problems, including memory disturbances
- Low school performance
- Difficulties getting up in the morning
- Short attention span
- Low immunity with frequent infections and colds
- Clumsiness, making children prone to accidents
- Prone to mental health illnesses in the future, such as anxiety and depression
- Aggressive or disruptive behaviour
- Irritability and moodiness
Teens might experience a lack of motivation, impulsivity, addictive behaviours, and overconsumption of stimulants such as coffee or energy drinks. Generally speaking, infants 4 to 12 months need about 12 to 16 hours, including naps. Children 1 to 2 years need11 to 14 hours, of 3 to 5 years they need 10 to 13 hours, and of 6 to 12 years, 9 to 12 hours. Adolescents need 8 to 10 hours on average.
Tics while sleeping
Children and teens with Tourette's might have motor or vocal tics while sleeping too. They might be simple or complex and usually disappear during the deep stages of sleep. The sleep cycle includes the slow-wave and REM phases of sleep, also called REM and NREM. Both are significant regarding a child's well-being and development. However, tics in children with Tourette's are disruptive and affect the quality of life, having long-term complications on a child's health and performance.
Living with a person with Tourette's
The impact of Tourette's on the family is significant. Parents want the best for their children and build-up on them with a usually higher effort. Other families learn to function in guilt and wonder whether it's their fault or their genes'. However, over time, parents accept that each family has its unique challenges. Through education and frequent sessions with professionals, they come to the point where they stop considering the disorder as a problem. Children with Tourette's have the same needs as every other child, including positive reinforcement. However, some might be good and successful in different fields than the ones their parents initially considered. We all have talents that we can work on, evolve, and eventually become successful at something. The development of individual skills is crucial for children with Tourette's to help them complete their personalities and enter the community without difficulties. Families and children with the disorder eventually understand that it is not Tourette's that defines an individual, but what they can do beyond that. If siblings exist, they should find the courage to support their sister or brother with Tourette's, but also receive the support they need themselves.
The scientific community lacks a specific test for the definite diagnosis of Tourette's syndrome. A medical history following a behavioural observation to establish the presence of motor and verbal tics are necessary for confirming a diagnosis. Some children might have comorbidities, such as ADHD or OCD, whose symptoms may overlap with Tourette's. Other children may experience secondary signs of anxiety or depression. Therefore, it is necessary to establish the primary diagnosis and develop a strategic therapeutic plan that fits each individual and their background. The following are the main criteria to diagnose Tourette's syndrome:
- The child has both motor and verbal tics
- Both types of tics don't need to occur at the same time
- Tics are present nearly every day, for most of the day and at least for a year
- Tics appear during childhood or adolescence and may change in type, frequency, severity, or intensity
- Tics are not the result of another medical disease or side effects of medication
Sometimes, diagnosing Tourette's is challenging, as physicians should exclude all other potential causes of tics. To do so, they might need time and some other investigations, such as blood exams or imaging tests. An MRI or a CT scan, for example, could indicate a tumour in the brain or any abnormality in its architecture.
There is no definite cure for `Tourette's syndrome. Current therapeutic approaches focus on minimising and controlling the tics and providing a higher quality of life. Interventions aim to provide children with every-day functionality that will further help them integrate into the school environment and the community. In other words, living the same life and having equal opportunities with any other average child. In cases in which the tics are not severe or complex enough, children might not need treatment at all. Every-day interventions at home and sufficient sleep might be adequate for some children with mild symptoms and signs.
There are many types of treatments that use medication to minimize symptoms of Tourette's. Some children might need a combination of them, others a single drug, and some nothing at all. Sometimes, people might need medication to treat secondary or co-occurring medical conditions, such as ADHD or depression. At the same time, drugs used in ADHD might help a child with Tourette's by increasing their attention span and ability to concentrate. The most commonly used ones are the following.
- Medication that decreases dopamine levels in the brain
- Botulinum (Botox) injections
- ADHD medications
- Central adrenergic inhibitors
- Anti-seizure medications
Another way to treat Tourette's syndrome is therapy. Many different types of approaches could be beneficial for children with the disorder, according to their tics and the degree they disrupt daily life. Cognitive-Behavioural therapy, for example, could make the child familiar with habit-reversal training. This way, he or she will learn how it feels before a specific tic appears or how to monitor symptoms in various situations. Similarly, psychotherapy can improve the signs of Tourette's but also work on other co-occurring disorders, such as ADHD or OCD. Finally, deep brain stimulation (DBS) is an intervention used exceptionally for cases resistant to other types of therapy. DBS is the implantation of a battery-operated medical device in the brain. This implant delivers electrical stimulation to specific parts of the brain that control movement. However, this method needs further research.
Children with Tourette's might have to deal with numerous sleep disorders that disrupt their rest and decrease their quality of life. Weighted blankets provide a calming effect during sleep, that may help children with Tourette's feel comfortable and secure. They may ease their anxiety and help them relax their brains. Weighted blankets will not cure Tourette's, but they will make a child's bed-time productive. They help to reduce the negative effects that the disorder has upon sleeping, by generating a calming effect. Weighted blankets work by providing deep pressure (DPS) stimulation to sensory areas in our bodies. DPS may reduce the heartbeat and blood pressure levels, providing the ideal circumstances for sleeping. People might use buy weighted blanket to help treat or control various conditions such as anxiety, trauma, and generally sleep disorders prevalent in all age groups. Most importantly, weighted blankets could also help reduce the symptoms and signs of Tourette's comorbidities, such as ADHD or OCD.
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