Milestone II: Tourette Syndrome

Research and Theoretical Foundations
Tourette syndrome (TS) is a hereditary disorder that is passed from one generation to
another (Mathews et al., 2019). A lot of research has been conducted on Tourette syndrome. Earlier,
it was believed that the condition was associated with anger, and hence it was thought that
psychoanalysis would be used for treatment. However, scientists have recently thought that the
syndrome can lead to malfunctioning of the neurological system. A slight alteration of the
dopaminergic transmission can help minimize the symptoms since it is believed that it is not
a psychological but rather a neurological disorder (Okun, 2013). It is thought that the genetic
makeup of a human being is a factor that influences TS. The likelihood of the disorder to be
found in people who are closely related is very high (Mathews et al., 2019).
Specific scenarios can cause an adaptive response once encountered again, causing
behavioral syndromes. Environmental experiences elicit tics that cause the basal ganglia to
produce movements that are procedural and automatic (Huisman-van Dijk et al., 2016). People
with the disorder are more accurate and quicker in performing specific compared to people that
do not have the syndrome. Also, they have been doing better in several sports and are also great
at playing musical instruments.
However, the chance of emergence of tics is higher when the emotions of the individual
are aroused or when they decide consciously not to suppress their symptoms (Okun, 2013).
Acting, dancing, and singing are some of the activities that reduce the symptoms of the disorder.
It is, therefore, essential to nurture the talents of the individuals with the Tourette syndrome since
those are some of the activities that lead to less noticeable manifestations. Stress is one of the
environmental factors that may lead to the event of the symptoms (Darrow et al., 2017). The

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response of a human brain to stress makes the body to elicit changes in the physical response,
threat awareness, and causes increased vigilance. The extent of stress determines the changes in
physical response. More stress makes the individual react efficiently and quickly, and vice versa.
In Tourette syndrome, stress causes an increase in ticing as well as worsens the symptoms.
The manifestation of the symptoms become more severe in children. According to
Conners (2011), babies who are born prematurely are more likely to contract the syndrome than
those who are not. Premature babies have lower immunity making them more susceptible. As the
children get into the adolescent stage, the severity reduces. More than half see a reduction in the
tics (Darrow et al., 2017). Mostly, adults do not seek medical attention since they experience
mild symptoms. Tourette syndrome, therefore, is more severe in children and mild in adults.
However, in some cases, some adults may experience an advanced manifestation of the
symptoms.
Research on Tourette disease is more advanced for people who experience severe
symptoms than those with mild ones (Leivonen et al., 2017). Individuals with mild symptoms do
not visit hospitals; hence the data that is available on them may not be sufficient. According to
Conners (2011), Tourette syndrome has no cure. However, the disorder is treated through the
management of the symptoms. There exists no single treatment that can manage all symptoms.
Psych behavioral therapy, reassurance, as well as education, are some of the strategies that are
used in the management of the syndrome (Leivonen et al., 2017). Parental support is crucial in
guaranteeing the wellbeing of children. The support of parents helps young children to overcome
the symptoms of the disorder.
The disorder is thought to stem from an abnormality in the brain. While the exact cause
of the abnormality remains unknown, research points to the fact that the abnormality is genetic.

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The syndrome is exhibited mainly by people who stem from the same family. To this end, it falls
on nature in the continuum of nature versus nurture. Continuity is the view that change is
gradual in nature (Leivonen et al., 2017). On the other hand, discontinuity is the belief that
change occurs as an abrupt succession of changes. The symptoms of TS are first noticed in
childhood. While research on the disease is still ongoing, current research points that the disease
falls on continuity in the continuum of continuity versus discontinuity. The symptoms advance in
a gradual and cumulative manner (Leivonen et al., 2017). The changes do not occur abruptly.
Stability is founded on the idea that personality traits that are present when one is an infant
continue to be present through out one’s life. On the other hand, change states that one’s
personality is modified through their interactions with the environment. TS starts to be
manifested during one’s infancy. As a result the condition inclines to stability as opposed to
change (Leivonen et al., 2017).
Program Selection
The Tourette Association of America is the largest non-profit organization that deals with
research and support of individuals with Tourette syndrome. It has come up with a program that
was launched in 2014, known as the Tourette Association of America center of excellence
(Centers of Excellence – Tourette Association of America, 2020). Leading scientific and medical
researchers run and coordinate all its activities. The program aims to conduct thorough research
through clinical as well as scientific research on the syndrome, also identify and recognize the
medical institutions that are specialized and involved in taking care of the individuals with the
disorder. To add, they educate and train the community on the tic disorders, including the
Tourette syndrome.

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Additionally, the program provides accurate and timely information on tic disorders and
Tourette syndrome (Centers of Excellence – Tourette Association of America, 2020). It enables
the patients to receive high-quality services as well as treatment that is based on evidence from a
team of experts whose knowledge is diverse. The program also ensures that health care personals
are highly equipped with relevant training and education. It is achieved through frequent training
so that they are up to date with the recent discoveries and information on tic disorder and the
related syndromes. Through this, the health care personnel become more confident and equipped
in delivering the services hence giving safe treatments.
In collaboration with the national association and support groups, the program ensures
that the patients, as well as their families, are helped, and they improve awareness so that the
general public at the community and the local level clearly understands the disorder (Centers of
Excellence – Tourette Association of America, 2020). The services that are offered at the centre
include botulinum toxin therapy, deep brain stimulation, as well as occupational therapy. These
services help in minimizing the symptoms as well as equips the patients with necessary survival
skills. There are specialists in the center who offer adult and child psychiatry and neurology
specialties and medical treatments. The program advises the patients and their caregivers on the
appropriate control measures to take. A research conducted by Kushner (2009), shows that
diagnosis and evaluation are also provided at the facility. Since stress and some psychological
issues may lead to the disorder, the program offers psychological and counseling services that
ease the situation. Behavioral therapies are given in support of the patients suffering from the
disease (Centers of Excellence – Tourette Association of America, 2020).
In 1990, the American Congress passed the Americans with disability act, which was
signed by President George Bush, senior (Parry & American Bar Association, 2010). The law

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gave all the people with disabilities a right to access any public place and Tourette syndrome
being a disability; the patients are freely allowed to visit the center and enroll for the program.
Also, public or private facilities that provide health care in the United States can apply to be part
of the program. The eligible centers must have a reasonable fee and should offer alternatives to
the patients who may not afford care and those who do not have insurance. Also, they must show
interdisciplinary care. The Tourette Association of America Center of excellence creates public
awareness of the syndrome, which helps in addressing cultural, ethnic, and socioeconomic
sensitivity. Also, it ensures the confidentiality of the patients’ information (Centers of Excellence

• Tourette Association of America, 2020).
  The program sticks to the concepts of the developmental theory in its approach to
  assessment. The program is run by a team of multidisciplinary experts who are well conversant
  with the risk factors that predispose on to the disease. Also, they conduct research that enables
  them to know the developmental stages where the symptoms are more severe than the others.
  The intervention methods do not vary from what the developmental theory would support. One
  of the interventions in managing the condition is counseling in counseling. There is a team of
  experts in the program who provide counseling services to patients who are mostly children. It
  enables the children to be more aware of their bodies as well as the manifestation of the
  symptoms. The stress that would pile up due to worrying is relieved hence better management of
  the disorder. Occupational therapy is another treatment that is employed. It enables the patient to
  lead a healthy life, and it is done per the age of the individual.
  Tourette Association of America’s center of excellence has measures that ensure that it is
  in line with the developmental theory. However, more research needs to be done so that proper
  protective, as well as treatment measures, can be put in place. More awareness ought to be

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created for the society; caregivers and the patients can be equipped with the necessary
knowledge and education (Kushner, 2009).

References

Centers of Excellence – Tourette Association of America. (2020). Retrieved 1 May 2020, from
https://tourette.org/about-tourette/overview/centers-of-excellence/

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Conners, S. (2011). The Tourette syndrome & OCD checklist: A practical reference for parents
and teachers. San Francisco, CA: Jossey-Bass
Darrow, S. M., Hirschtritt, M. E., Davis, L. K., Illmann, C., Osiecki, L., Grados, M., … &
Budman, C. L. (2017). Identification of two heritable cross-disorder endophenotypes for
Tourette syndrome. American Journal of Psychiatry, 174(4), 387-396.
Huisman-van Dijk, H. M., Van de Schoot, R., Rijkeboer, M. M., Mathews, C. A., & Cath, D. C.
(2016). The relationship between tics, OC, ADHD and autism symptoms: A cross-
disorder symptom analysis in Gilles de la Tourette syndrome patients and family-
members. Psychiatry research, 237, 138-146.
Kushner, H. I. (2009). Cursing Brain?: The Histories of Tourette Syndrome. Cambridge:
Harvard University Press
Leivonen, S., Scharf, J. M., Mathews, C. A., Chudal, R., Gyllenberg, D., Sucksdorff, D., … &
Sourander, A. (2017). Parental psychopathology and tourette syndrome/chronic tic
disorder in offspring: a nationwide case-control study. Journal of the American Academy
of Child & Adolescent Psychiatry, 56(4), 297-303.
Mathews, C. A., de Leeuw, C., Goudriaan, A., Smit, A. B., Yu, D., Scharf, J., … & Posthuma, D.
(2019). Involvement of astrocyte metabolic coupling in Tourette syndrome pathogenesis.
Okun, M. S. (2013). Parkinson’s treatment: The 10 secrets to a happier life. Createspace
Independent Pub.
Parry, J., & American Bar Association. (2010). Civil mental disability law, evidence and
testimony. Washington, DC: American Bar Association.