by Emily Kelman-Bravo, LCSW, BCD

This article is intended to assist mental health and related professionals who encounter people with Tourette Syndrome (TS) in their practice. It will provide an overview of Tourette Syndrome and the biopsychosocial issues faced by individuals with TS and their families. Implications for mental health practitioners will be presented.

It is important to keep in mind that the impact of Tourette Syndrome on an individual with the disorder varies greatly and is influenced by many factors. Some of these variables include: the severity of the disorder; how others around them have reacted; the ego strength of the individual; when they were diagnosed; and the familial, peer, educational, and medical supports that have been available to them.

Tourette Syndrome is a neurological disorder characterized by tics-involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way. There is a history of both multiple motor and one or more vocal tics, although not necessarily simultaneously. The tics occur many times a day nearly every day or intermittently throughout a span of more than one year. The tics change over time in number, frequency, type and location, and wax and wane in severity. The onset is before age 18.

There are medications available to treat Tourette Syndrome for those individuals who find that their symptoms significantly interfere with their functioning. Some may choose medication if their tics cause physical discomfort, interfere with activities, or if they experience ridicule and rejection from others. They may seek guidance from medical or mental health professionals in deciding whether or not to take medication.

Many people with TS have additional problems such as: obsessions; compulsions and ritualistic behaviors; Attention Deficit Disorder with or without Hyperactivity; learning disabilities; difficulties with impulse control and sleep disorders. Mental health professionals treating an individual with TS should assess whether referrals are needed for an evaluation for diagnosis and treatment for any of the above conditions.

Sometimes individuals with TS have special educational needs which may necessitate an Individual Education Plan (IEP). If the public school cannot adequately meet the child's educational needs even with an IEP in place, then parents may need to pursue other approaches, consult with an advocate, or consider a special school. Mental health professionals can play an important role in helping the family obtain the most appropriate education for their child. In so doing they have an opportunity to educate school personnel and others about TS.

Individuals with TS and their families often seek help without a good understanding and acceptance of the disorder. Often they view the disorder as a psychological rather than a neurological condition. Because of this, guilt and blame has often developed over time, rather than understanding and compassion. This often is reinforced by schools, employers, other organizations, as well as individuals the person with TS and their families encounter.

It is therefore crucial for mental health professionals working with this population to educate the individual with TS, their family and often the organizations that play a significant part in their lives.

Emily Kelman-Bravo is the Director of TSA’s New York City Counseling Program.

continue: Behavior and Self-Esteem of Children and Adolescents With Tourette Syndrome

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Reviewed: 03/2006