I posted a while ago about my 4 year old son and Tourette Syndrome...

Thank you for pointing me in the right direction.  I have another question....

His Tourette Syndrome is SEVERE, he has OCD (obsessive Compulsive disorder) categorized as moderate, and ADHD that is just mild (hyper and impulsive, not distractible).  He is on a medication now called Tenex and this has improved the hyperactivity and some of the motor tics, but, the vocal tics are very bad still.  His echoing is at an all time high level (it is annoying his K-4 teacher to no end), his grunting and snorting are almost constant (these are not annoy though), his barking is pretty bad, NOW he has a new vocal tic... he screams out "Stupid idiot!" at no one... it is never directed at anyone, he just yells it for no apparent reason.  He knows that that is not acceptable language in our home, he says that he needs to yell it and always puts his hand over his mouth after he yells it and says "sorry."  Now to my question...  are there methods that I can use to help him to not do the echoing and the "bad" word yelling?  His psychiatrist said that I need to "change" his tics that are unacceptable, but, gave me no ideas on how to do this.    Also, are there medications other than the Tenex that may be more effective in treating the vocal tics?

Thank you for your time...

Beverly

[Kevin Kennedy, Ph.D.]

Dear Beverly,

Re: behavioral management of the vocal tics, this is certainly easier said than done. It's not as if your son is planning his behavior and displaying control over it. The nature of such tics is that they are involuntary in nature.

Having said that, sometimes incentive plans can bring about some change. What you might try is rewarding your son from period to period during the time he is at home (e.g., one hour at a time). He would receive his reward whenever he goes through a period without displaying a certain tic (focus on only one tic behavior at a time). Do not punish him for displaying the tic. Remember, if the behavior is truly a tic, it is not deliberate and voluntary.

Re: medication, pharacologic treatment of TS is not a simple and straightforward proposition. Several different classes of medications are often employed, usually in some combination. Antihypertensives and selective serotonin reuptake inhibitors are frequently prescribed. But it's usually sensible to allow sufficient time to see the results of any particular medication, and try not to expect immediate, dramatic results. Also, the nature of tics (both motor and vocal) is that they wax and wane, even without medication. Aggressive treatment of TS with medication makes perfect sense, as long as it's accompanied by patience and deliberation.

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