Stuttering and Tourette's Syndromealt text

This material was compiled by Luc De Nil, Ph.D., Chair of the?ÿ
Graduate Department of Speech-Language Pathology, University of?ÿ
Toronto, and by Paul Sandor, M.D., Director of the Touretteƒ??s?ÿ
Syndrome Clinic, University Health Network.

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What is Touretteƒ??s Syndrome?
Touretteƒ??s Syndrome (TS) was first described in 1885 as a separate?ÿdisease by the French physician, Dr. Georges Gilles de la Tourette. One of the main characteristics is the presence of multiple motor and?ÿvocal tics. Tics are involuntary, sudden, rapid, brief repetitive?ÿstereotyped movements or vocalizations. Tics can be ƒ??simpleƒ??, involving individual muscle groups (e.g., eye blinks, head twitches),?ÿor ƒ??complexƒ?? consisting of coordinated patterns of movements (e.g., jumping, complex facial movements.) Vocal tics can consist of simple?ÿsounds such as throat clearing, sniffing, and more complex sounds?ÿsuch as words, phrases or even complete sentences. One particular?ÿvocal tic often associated with TS is coprolalia (socially?ÿunacceptable utterances). Actually, coprolalia only occurs in a?ÿminority of cases and is often only temporarily present. No two?ÿ
persons with TS display precisely the same tic characteristics.

Diagnostic criteria include: onset before age 18, the presence of?ÿtics for more than one year, a variable frequency and anatomical?ÿdistribution of tics, a gradual replacement of old symptoms with?ÿnewer ones, and the absence of other medical explanations for the?ÿpresence of the tics. Tics tend to increase during periods of?ÿemotional arousal and decrease during intense concentration on a?ÿgiven task.

Touretteƒ??s Syndrome affects approximately .5 to 3 people in 1000. Just as in stuttering, TS is more common in males than females (4:1). The mean age of onset is 6 years old with very few onsets beyond the?ÿage of 13. In up to 70 percent of children with TS the tics will?ÿsignificantly diminish or disappear by late adolescence.

What Causes Touretteƒ??s Syndrome?
Results from twin and family studies have shown convincingly that TS?ÿhas a strong genetic component. For twins who share the same genetic?ÿmaterial, the likelihood of TS occurring in both twins is between 53?ÿand 77 percent. Family studies have demonstrated that the rate among?ÿrelatives ranges from 9.8 to 15 percent. It is thought that TS is?ÿassociated with the mutation in one major gene modified by several?ÿminor genes.

Additionally, most scientists believe that TS is associated with a?ÿdeficit in a circuitry in the brain that links regions in the cortex?ÿwith areas deep in the brain. These connections play an important?ÿrole in the control and coordination of motor behavior. It is thought?ÿthat dopamine, an important neuro-transmitter, is excessively active?ÿin patients with TS, because medications blocking Dopamine receptors?ÿtend to reduce the severity of tics.

Speech and Language Characteristics of People with Touretteƒ??s Syndrome
Research generally has indicated that children or adults with TS do?ÿnot have a general language problem, but that they experience?ÿdisruptions of speech production. These difficulties also have not?ÿbeen found to be related to the severity of vocal tics and as such do?ÿnot appear to have a common cause.

Stuttering and Touretteƒ??s Syndrome
A number of people have suggested that children with Touretteƒ??s?ÿSyndrome may have a higher frequency of stuttering than seen in the?ÿgeneral population. This has raised the possibility of a causal link?ÿbetween the two disorders, especially because there have been some?ÿsuggestions that children and adults who stutter may have atypical?ÿfunctioning of a deep part of the brain, called the basal ganglia,?ÿwhich is an important control center for movements.

The literature reports incidence of stuttering in Touretteƒ??s Syndrome?ÿranging from 7 percent to as high as 33 percent. Much of this?ÿresearch, however, was not based on systematic observations on larger?ÿgroups of children or adults. Recent systematic analysis of speech?ÿdisfluencies has indicated that children with TS indeed are much more?ÿdisfluent than non-affected children, but that these disfluencies are?ÿmore similar to so-called normal disfluencies. Unlike children with?ÿdevelopmental stuttering, disfluencies such as part-word repetitions,?ÿprolongations and blocks do not appear to be a common characteristic?ÿof the speech of children with Touretteƒ??s Syndrome.

What To Do?
While there may not be a direct link between Touretteƒ??s Syndrome and?ÿ
stuttering, the two problems often occur together.

When you think your child has TS
Often the first symptoms of TS are facial tics, such as rapid eye?ÿblinks or twitching movements around the mouth. Frequent throat?ÿclearing or sniffing sounds also often appear early. If you think?ÿyour child has such symptoms, you should make an appointment with?ÿyour family physician or a neurologist for a thorough assessment. Keep in mind that there are no laboratory tests that can determine if?ÿsomeone has TS, hence the opinion of a clinician experienced in?ÿmanaging patients with TS is the only way to confirm the diagnosis.?ÿIf necessary, TS can be treated effectively with medication, behavioral management and proper counseling.

When you think your child is stuttering
Many children with TS have frequent disfluencies in their speech.Sometimes their vocal tics may resemble speech behaviors often seen?ÿin stuttering. If you have questions about whether or not your child?ÿstutters, you should make an appointment with a speech-language?ÿpathologist who has experience in working with children who stutter. The speech-language pathologist will talk to you as a parent or?ÿcaregiver to obtain the necessary background information and will conduct a?ÿthorough evaluation of your childƒ??s speech to determine whether?ÿdevelopmental stuttering is present.

Where Can I Find More Information?
On Touretteƒ??s Syndrome
- A Mind of Its Own. Touretteƒ??s Syndrome: A story and guide by Ruth?ÿ
Bruun and?ÿ Berel Bruun. Published by Oxford University Press (1994).?ÿ
This is a wonderfully written book on Touretteƒ??s Syndrome and how it?ÿ
affects people and their environment.

- Children with Tourette Syndrome: A Parentƒ??s Guide by Tracy Haesle.?ÿ Published by Woodbine House (1992). This is a practical manual?ÿwritten specifically for parents.

- Understanding Tourette Syndrome: A Handbook for Educators?ÿpublished by The Tourette Syndrome Foundation of Canada?ÿ(www.tourette.ca). This book provides lots of information and many?ÿpractical tips useful for educators, speech-language pathologists and?ÿother service providers.

-?ÿThe Tourette Syndrome Association (www.tsa-usa.org) is an?ÿinternational organization which supports and organizes educational?ÿinitiatives and symposia and provides financial support?ÿ for research?ÿinto this disorder. The association provides information to help?ÿincrease public awareness and support to people with TS.

-?ÿThe National Institute of Neurological Disorders and Stroke Web?ÿ
site has information, research and links (www.ninds.nih.gov/index.htm).

On Stuttering
- The Stuttering Foundation of America publishes brochures, books and?ÿvideotapes on stuttering for families and professionals. The complete?ÿcatalog may be found at the?ÿonline store: Click here.

- If You Think Your Child Is Stuttering is an excellent brochure with basic information for parents and 7 simple tips for talking to your child. It can be ordered by calling 800-992-9392. Or download here:?ÿEnglish?ÿand Spanish.