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Thread: Tic Suppression - better to suppress or not?

  1. #1

    Default Tic Suppression - better to suppress or not?

    My son is 7 and we have been living with tics now for about 5 months. He started having a "screaming" tic about a week ago where there would be a high pitch scream and then a lower pitch one. When I ask him if he has had to do that tic at school he says he "reallllllly" feels the need but doesn't want to be embarrassed so he holds them back even though he says it is very difficult. He is also afraid to release it even at recess as he doesn't want anyone to think he's "screaming like a girl" I also have seen him wait until he is turned from a group of people before he releases some of the more complex motor tics all the while the eye blinking is almost a constant as many of the other simple ones.

    When he first told me that he was holding them back at school I thought - This is a good sign that maybe he will grow out of this.

    After talking with him tonight, however, I am wondering if I should suggest not holding them back. The idea behind this is that when I asked him how long he suppresses them before he thinks about something else he said "like 28 minutes". Granted he is only 7 and does not have a complete grasp on time but I am worried about that time that he is trying to suppress them and what all he is missing. He is also diagnosed with ADHD and I'm really wondering if sometimes the school work doesn't get done not only because of that but maybe because he is putting so much energy into suppressing the tics?

    If anyone has any input it would be greatly appreciated!

    Thanks!

  2. #2
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    Default Re: Tic Suppression - better to suppress or not?

    I am worried about that time that he is trying to suppress them and what all he is missing
    My personal view, based on my own lifelong experience with Tourette is that suppression, if it can be accomplished without causing greater difficulty or overwhelming stress is beneficial.

    Essentially, learning to suppress is the basis of the recent trend to teaching young children CBT to learn to identify the premonitory urge to tic and to redirect or suppress the tic. It's a way to control tics with no medication, as it were.

    I feel that if your son can learn this skill at a young agem it might help him in adult life in situations where, due to social or workplace limitations, his ability to temporarily suppress his tics could help him when necessary.

    I know that my ability to suppress served me well throughout my life in business as well as social situations.

  3. #3
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    Default Re: Tic Suppression - better to suppress or not?

    At the same time, if your son expends so much energy in suppressing the tics that he can't keep up in class, then isn't the answer either. Especially if he is also diagnosed with ADHD.

    The following is from the TSFC's Understanding Tourette Syndrome: A Handbook for Families:

    Although some people, including children, may be able to suppress tics temporarily, the tics do not disappear when they are suppressed. A common analogy is that a tic is like a sneeze. When you need to sneeze, the sensation builds up in your body until you finally sneeze. If you try to stifle or hold back the sneeze, the sensation is still there and can increase. Eventually the sneeze will make its way out. Sometimes a sneeze that has been held back comes out with even greater force than if you had sneezed when you first felt the sensation.

    Families with a child with TS will often say their child's tics are not noticable at school - because their child is holding them in all day. Then they are surprised when their child comes home and explodes. The last sentence of the quote refers to what we call the "rebound" effect: if you hold in tics, they come back later at a greater intensity. This, I suspect, is where the "screaming tic" is coming from. Holding a tic of this intensity back, all day, will take a lot of energy on your son's part.

    When Steve wrote:
    Essentially, learning to suppress is the basis of the recent trend to teaching young children CBT to learn to identify the premonitory urge to tic and to redirect or suppress the tic.
    CBT (Cognitive Behaviour Therapy) and CBIT (Comprehensive Behavioral Intervention for Tics) are both strategies that can help your son control his tics. From Dr. B. Duncan McKinlay's website Life's a Twitch:

    CBIT combines habit reversal training with psychoeducation, relaxation techniques, social support, and functional interventions to provide an alternative treatment for tics that has been found to be as effective as pharmacotherapy.These strategies are not about suppression as much as they are about redirection.

    I would suggest you follow your intuition. Don't ask your son to suppress his tics, but instead find ways to help him redirect the ones that are embarrassing. Dr. McKinlay has a book called Nix Your Tics available on his web-site. We have the handbook for Families mentioned above, but also a Handbook and Resource Kit (with a video) for Educators. All of these books are filled with strategies to help make it easier for your son.

    We even have a video, Tourette is Powerful, which is perfect for your son's age group. In it, other children describe Tourette Syndrome in their own words and it is the perfect tool for explaining TS to your son's class. a short preview of the film is available on the video's info page.

    Finally, take a look at our Kids Korner. There are lots of resources including a Kids Activity Sheet and a PowerPoint presentation created by children.

    I hope this helps!
    Tina
    Tina, Forum Moderator, TSFC Staff Liaison

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  4. #4

    Default Re: Tic Suppression - better to suppress or not?

    my son is eight and also surpresses in school. because he does not want to be embaressed. he has been screaming now for almost two months. he spends a lot of time surpresing in school , and i know that he is suffering with his work, the school teacher said that he has not learned anthing yet this year. im at a loss and am not sure what to do for him.

  5. #5
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    Default Re: Tic Suppression - better to suppress or not?

    Hi Brendamasn and Davispenn,

    A strategy we often recommend is to talk to your child's teacher about "tic breaks."
    Right now your son is suppressing his tics, and all that energy is being taken away from his energy to learn.
    He needs an escape valve so he can focus.

    Tics are often preceded by sensory sensations. Work with your son to figure out what it feels like before he has to tic.
    Going back to the sneeze analogy, you can feel a sneeze coming - it can be a tingle or tickle in your nose.
    It could be a discomfort at the back of your thoat. Figure out what sensations your son feels before he tics.
    He may already know them. And when he feels these sensory urges, already begins the work of suppression.
    The more he suppresses the urge, the more he is going to feel anxiety and tension, and the more that urge to tic will intensify. Try and work out a scale with him for these feelings of tension.

    Start with the low level urges. With the support of his teacher, he should be able to express some of the small tics in class. If he can let some of his energy out in small tics, it will reduce some of his anxiety and help him focus.
    Creativity on the part of you and the teacher can really help here. For example if he has a tic that makes him tap a pencil, add a ball of playdough to the corner of his desk. He can tap away on that and not disturb the class.
    Or if he has a foot-tapping tic, place a piece of carpet under his desk.

    Stress balls can also be a great way of letting him burn off energy in a way that increases his focus.
    But be sure to set clear rules - the ball should not leave his desk area. He is not allowed to throw it or bounce it.
    Depending on the desk structure in the class, he might be able to keep it under the desk.
    Or you could donate stress balls for the whole class. There might be a Valentine themed item you could give in the coming weeks instead of Valentine cards. See what the teacher thinks about this first.

    For the higher level urges, you're going to need the help of the school office.
    He is going to need a strategy put in place where he can leave the class, let his tics out and come back.
    The key here is to provide a strategy that is not obvious to the rest of the class,
    does not feel like punishment and does not embarrass him more.
    What we often suggest is a signal between him and his teacher that indicates a high level urge.
    The teacher then asks him if he would take an envelope to the office for her.
    There's nothing in the envelope, but it's a signal to the office that your son needs a tic break.
    Your son takes the envelope to the office, lets out tics as he walks down the hallway.
    If he needs more time, or a safe room where he can let out loud, potentially offensive, tics,
    then the office provides that for him until he's ready to back to class.

    In addition, if his tics are building up over the course of the day, signing him up for a sport right after school,
    will help him get some of that energy out before he comes home.

    There are many strategies like these outlined in the books I referenced below.

    Hope this helps.
    Tina, Forum Moderator, TSFC Staff Liaison

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  6. #6

    Default Re: Tic Suppression - better to suppress or not?

    i am attending a meeting at the school on thrusday i will bring up the stradies you have sugested and see what can be done for him. as for a sport activite i would love to enroll him in anything, the problem is that he also has high levels of anxiety and although i know he would have fun , he wont particapate in any sport without me litteraly draging him to the practice or game myself getting him use to the coatch and teammates first two or three times, and even then i have to stay with him and not leave. we have had him in soccor every year since he was three, with the same start to every season. he crys and trys to run away when brought to field. last year was a terrible year for him. the boys are getting older and more competive and with all the other things becides ts my son has , he has a unique way of trying to fit in the other boys were not accepting of him and made fun, his ticking was extream during any practice or game. he does not want to go back into scoccer this year and i wont make him. im going to try horseback riding this summer and have already booked off time form work to take him. i am trying to convice him that karate may be a good fit for him. he enjoys pretending he is a karate kid . i have not been sucessful yet . and have even brought him to a class to watch hoping he would like to try but he just cryed and would not even watch the class. lol as for horseback riding this summer im already being met with extreame anxiety attecks at the mention of enrolling him.

  7. #7
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    Default Re: Tic Suppression - better to suppress or not?

    Hi Brendamasn,

    Some youth with Tourette Syndrome just don't do well with team sports. Your son may be one of these. It can be a combination of anxiety of performing to the level of the other kids, but it can also be a sensory issue based on not wanting to be touched by others.

    How about a hip-hop dance class where his tics could give him some really cool moves? Or less competitive sports like taichi or yoga that reduce stress, but also train him to have more control of his body and still let him practice "karate-like" moves?

    And then there's always swimming, instead of a team, your family could venture out the open swim time at the local pool, and everyone could get some exercise. Or sign him up for lessons ...

    Tina
    Tina, Forum Moderator, TSFC Staff Liaison

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  8. #8

    Default Re: Tic Suppression - better to suppress or not?

    have tryed swimming, which he likes, not lessons. he does not like lessons. he thinks the instructors yell at him. which is not the case. but even getting him out to the pool is a struggle. i have offered dance lessons also he which i know he would enjoy if i could get him out the door to go. but i cant get him out any more with out him fighting me. when he was younger it was easy to pick him up and make him go. but now that he is older hes to strong to make him go if he does not want to .and i cant get him out the door.

  9. #9
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    Default Re: Tic Suppression - better to suppress or not?

    Hi Brendamasn,
    If you can't get him out of the house, bring the exercise home. There's lots of videos out there.
    (However, the social aspect of a non-contact class would be a good thing for his development.)
    Or do what we do, go on a family walk ... that usually ends up at the gelato place in the summer.

    You're fighting a number of things here. First he doesn't want to be embarrassed or yelled at by instructors.
    Then, there is the disinterest in exercise by most young people at this time.

    Maybe introduce him to some of our @Random Videos.
    In particular, Shane Fistel: A Portrait of Tourette Syndrome.
    Shane teaches martial arts in Toronto, but also channels the energy of his tics into his art.
    You can access specific films on the @Random site by waiting until the opening introduction ends,
    and then selecting "Credits" from the menu in the top left.
    This film just won Award of Merit at the Best Shorts competition.
    Tina, Forum Moderator, TSFC Staff Liaison

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  10. #10

    Default Re: Tic Suppression - better to suppress or not?

    i have recentlely purchaced a tread mill he has enjoyed running on from time to time. excercise is not the problem with him he loves to work out he just has so much anxiety about leaving the house . he has a friend that he plays with but wont walk up the street to call on him he will phone him to come over to our house and play. but is resistent to play outside or at his house. we use to walk all the time take hikes both in winter and summer its just been this past year that he crys and fights us about leaving the house for any reason. he will go to school with some resistance but the mention of leaving the house for any other reason is tramatic to him. it takes me months of preparing him about a hair cut before i can get him to go get one without a fit.

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