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Thread: Different View points

  1. #1

    Default Different View points

    In addition to tics, children with Tourette syndrome are also likely to have emotional and behavior problems or comorbid conditions, have difficulty in school and poor self esteem and they are more likely to have symptoms of obsessive compulsive disorder, anxiety disorders, attention deficit hyperactivity disorder (some children with Tourette syndrome and ADHD don't have tics until they begin stimulant therapy for their ADHD, although stimulants do not cause the tics), learning disabilities, mood disorders and oppositional defiant disorder.
    Actually, this isn't necessarily true. What has happened is that many children who have BOTH Tourette's and other issues are much more likely to show up in clinics seeking help. SO, it appears that people with Tourette's are more likely to have these other problems.

    But studies which have been done outside the medical realm--just plain random sample studies-- seem to indicate that people with Tourette's are as likely to have other behavioral issues as the general population.
    In addition to tics, children with Tourette syndrome are also likely to have emotional and behavior problems or comorbid conditions, have difficulty in school and poor self esteem and they are more likely to have symptoms of obsessive compulsive disorder, anxiety disorders, attention deficit hyperactivity disorder (some children with Tourette syndrome and ADHD don't have tics until they begin stimulant therapy for their ADHD, although stimulants do not cause the tics), learning disabilities, mood disorders and oppositional defiant disorder.
    Actually, this isn't necessarily true. What has happened is that many children who have BOTH Tourette's and other issues are much more likely to show up in clinics seeking help. SO, it appears that people with Tourette's are more likely to have these other problems.

    But studies which have been done outside the medical realm--just plain random sample studies-- seem to indicate that people with Tourette's are as likely to have other behavioral issues/learning disabilities/etc. as the general population.

    The largest of these studies that was done was on the army recruits in Israel. Since military service is mandatory there, it was a good way to get a VERY random sample. Of course, even with that, we can't know how accurate it is since many of the young adults may not have wanted to admit to having any problems, (I may not have admitted anything at that age if it wasn't anonymous). But I think it's the closest we've seen yet to being a well-done random-sample study.

    (This study, DID, however, find that OCD rates were higher in those individuals with TS than in the general population. ADHD rates were slightly higher, but I don't know if 5% is considered statistically significant???).

    This is a link to the abstract... unfortunately, you have to pay PubMed to read the whole study. http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

    I'm not saying I'm 'married' to the idea that there's no connection between these disorders. However, at this point in time, that seems to be where the studies are point us (with the exception of OCD). However, in terms of treatment (which is what I'm always concerned with), I find it misleading and confusing to attribute problems of ADHD, anxiety, etc. to Tourette's. Some people may just think it's semantics, but I think that it can be a blockage to proper treatment. I think I've already mentioned that I've seen this happen before where problem behavior was attributed to TS and was never treated properly until it was finally figured out to be child-onset bipolar in a few cases and Asperger's in a couple of others. And by then a lot of damage and wasted time/schooling occured. (and on the opposite side of that, I know a woman with Autism who also has Tourette's and feels her life would've been easier if not all her tics had been labeled stims).

    It can also lead to improper stereotyping, such as a teacher thinking any TS student that comes his/her way will automatically have learning issues and treat the child accordingly when this simply doesn't appear to be any more likely than the 'normal' population.

    So, I may tend to harp on this subject, but I really, really, REALLY think it's important and worth the time to seperate the diagnoses in order to find effective treatment.


  2. #2

    Default Different View points

    You state that the information that I wrote was wrong but where are you getting this information? What medical books?

    Studies done outside the "medical realm" leaves open the question of reliability. Studies done in a foreign country such as Israel with radically different cultures, and inadequate medical care can the information gathered be applicable to western society.

    The person Richard wrote a letter stating that his family needed support with his son's symptoms. Regardless of what was causing the symptoms, supportive emails to him and his family is vital right now.

    If I am stating the wrong information then I would like to know. Please state where you are getting your information.

    Steve, could you please give us your view. Thanks Steph

  3. #3

    Default Different View points

    I'm sorry, I think you misunderstood. I didn't say you were wrong, I said that the fact that children with TS are more likely to have that other stuff "isn't necessarily true". And I said that studies seem to INDICATE that people with TS are as likely as non-TSers to have the other behavioral issues.

    And ALL studies have questions of reliability, I understand that. As I mentioned above, MANY studies are done on samples culled from people that show up at clinics. People who ONLY tic are LESS likely to show up at a clinic or doctor's office and therefore don't get counted. Also, I realize that studies done in different cultures are bound to have different results and I stated that there were probably other problems with that study too. But since it's the largest 'random sampling' study, I think it's the best one we've got at this point. :? (If I recall correctly, the other two random studies I'm aware of have pitiful samplings.. like maybe the kids from one elementary school or something. The Israel one is a sampling of like 28,000 individuals!)

    I realize too that Richard is looking for help for his son. And in my opinion, it is important that he determine WHERE the problomatic symptoms are occuring from. If he assumes it's Tourette's, when it's, say, Schitzoaffective disorder or Bipolar that is causing the problems, he's NOT as likely to find a satisfactory outcome. So, in trying to explain that not everything stems from Tourette's, I AM trying to be supportive and helpful.

    As far as where I'm getting the information, I already posted the link to the Israel study abstract. Here's another, if you wish to read it, that states "Children with TS-only did not differ from unaffected controls on the parent ratings of aggression and delinquent behavior or on the teacher ratings of conduct problems. By contrast, children with TS+ADHD were rated significantly above unaffected controls and similar to children with ADHD-only on these indices of disruptive behavior."

    http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

    And this is a good article! http://www.tourette.ca/articles/article4.html

    The tone of your post worries me that I've somehow offended you. I hope not, that was not the intent. I could try to dig up more studies for you later (although, since many of them are on PubMed I can't link to the whole article ), but it's 4 hours past my bedtime now and I REALLY need to try to get to sleep.

  4. #4

    Default Different View points

    Hi, I am a nursing student and before I write about ANY kind of medical information I make sure that what I am stating is correct and leaves no room for interpretation.

    What you said to Richard is "Technically, Tourette's is just tics. Other problems/behavioral problems stem from other diagnoses." This is an incorrect statement. Here is a website devoted to TS and states that tourettes is not just tics and there are many others that state this.

    http://www.tourettes-disorder.com/sy.../symptoms.html

    This is the last email that I will write about this subject. Liability is hammered into our heads so much that you have to be 100% accurate with the information that is given to people. Thanks Steph

  5. #5

    Default Different View points

    It's hard to be 100% accurate about anything when we talk of Tourette's. So much is still unknown. However, when I make my statements about studies indicating that behavioral problems stem from other than the actual Tourette's, I'm referring to peer reviewed studies. That website is something altogether different.

    However, I'm not going to write about this with you anymore either. We're going to have to agree to disagree.

  6. #6
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    Default Different View points

    The interpretation of Tourette Syndrome on the TSFC Forum is guided by the medical advisory board of the Tourette Syndrome Foundation of Canada.

    Tourette Syndrome is described differently in various parts of the world, and our description conforms to the DSM IV, revised.

    Full details of our interpretation are contained HERE

    We do not insist citing literature references for each claim made in Forum discussions, and we can't expect lay volunteers to use medical terminology at the same proficiency level as a practicing health professional.

    Our dedicated Forum volunteers use their experience and knowledge about Tourette Syndrome to provide direction and support for parents or individuals learning to deal with the disorder.

    May I suggest that battling over the terminological exactitude of definitions might only serve to distract from the original question of dealing with a person with, perhaps multiple diagnoses, one of which might be Tourette Syndrome.

    The original question was from a concerned parent who was seeking advice on how to motivate and adult son.

    If one was faced with such a challenge, what would be the resources to seek out?

  7. #7

    Default Different View points

    Quote Originally Posted by StephMomToOne
    Hi, I am a nursing student and before I write about ANY kind of medical information I make sure that what I am stating is correct and leaves no room for interpretation. - Here is a website devoted to TS and states that tourettes is not just tics and there are many others that state this.

    http://www.tourettes-disorder.com/sy.../symptoms.html

    -Liability is hammered into our heads so much that you have to be 100% accurate with the information that is given to people. Thanks Steph
    I understand that accuracy is important to a nursing student, and reliable sources of medical information are important to everyone. I was surprised to see this information from what looked like a reputable source, so I did some checking.

    That website, according to the author's own words, is not written by a Tourette's or practicing professional of any type. He signs his website with "PhD" but a simple google search reveals that the "accrediting organization" is not listed as a valid accrediting organization by government websites, that these "accredited PhDs" can be purchased from Universal Life Church for less than $100, and that the webmaster himself states that he is employed as a handyman.

    I also recognize a lot of the content as coming from other sources, which don't appear to be referenced, so I'm not sure if there are copyright issues. That would not be surprising for someone being so casual about the "PhD" title to a medical website.

    I suggest that the reference provided by Steve is a more reputable and reliable source of information. It is important to know your sources, as there is so much dubious information on the internet. It's alarming that this webmaster has misled even a nursing student. Since another Canadian TS website also carries the "PhD" title associated with this man's name, it's not hard to see how one can be misled.

  8. #8

    Default Different View points

    Hi, My books say the same thing. According to Foundations of Psychiatric Mental Health Nursing, A Clinical Approach, Fourth Edition by Elizabeth M. Varcarolis ADHD is often associated with Tourette's disorder; at least 25% of males with Tourette's disorder have ADHD. Nongenetic Tourette's disorder often coexists with PDD, a seizure disorder, obsessive-compulsiver disorder, or ADHD. Besides I am not telling anyone who to believe.

  9. #9

    Default Different View points

    Quote Originally Posted by StephMomToOne
    ADHD is often associated with Tourette's disorder; at least 25% of males with Tourette's disorder have ADHD. Nongenetic Tourette's disorder often coexists with PDD, a seizure disorder, obsessive-compulsiver disorder, or ADHD. Besides I am not telling anyone who to believe.
    Hi, Steph. ADHD is often associated with Tourette's in clinical, referred populations. In fact, the numbers typically reported are much higher than 25%. ADHD, when it occurs together with TS, is a more impairing condition than TS alone, so these patients are more likely to end up in clinics. This is referred to as ascertainment or referral bias, and we have to be careful not to extend results about referred populations to the entire population.

    Non-genetic Tourette's is usually referred to as tourettism, and is probably a different thing than Tourette's, so that's two somewhat subtle distinctions that the manual doesn't make. That's a very strange way of stating it.

    Seizure disorders are not associated with Tourette's, but they are associated with autism, so those could be cases of misdiagnosis. And so on ... anyway, I wasn't suggesting you were telling anyone what to believe, just to be very aware of how reliable some resources are (or are not, in the case above).

  10. #10

    Default Different View points

    Actually this information was taken word for word from the book. Anyway I came on this forum to try and find information to help my son. He is having a rough time. Steph

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