Asperger's and Tourette's

[pinkhair]

Hi all, this is my first post. My 10yo son, who was diagnosed with Aspergers/High Functioning Autism at 31/2 years has now (last week) been diagnosed with Tourette's Syndrome. This is escalating rapidly and his anxiety is increasing very quickly so his behaviours at school and home are a disaster. I can find info so far on each syndrome but not on how they work together. Does anyone have experience of this and if you do can you tell me what therapies or meds seem successful? Is psychotherapy necessary for TS and should that be a different therapist to the AS one? Thanks in advance ( I hope)

[Jason C Bourret, Ph.D., BCBA]

Risperdal has been shown to be successful in treating tic disorders, including Tourette syndrome.  It is good to hear that the medication seems to be having at least some beneficial effect.  As some of the individuals responding have mentioned, it is important to be working with a doctor who has experience treating this disorder and there are also some behavior therapy options that have been shown to work.  The one that I have seen the most empirical support for is called "habit reversal."  This, essentially, entails teaching an individual to be aware of when the tic is occurring and giving them a competing response to engage it (e.g., diaphragmatic breathing.  I highly recommend pursuing seeking out clinicians and therapists who have experience working with children similar to your own and incorporating a “training” component into the treatment for the Tourette syndrome.

[MaryannesMom]

You may want to try neurofeedback.  

[SueNYC]

I have two children with Tourestte's - one with Asperger's.   My dad has Tourette's.  I had Tourette's as a kid - the tics aren't the big deal - the underlying problems behind the tics are.  They see doctors that specialize in Tourette's.  My children's tics did not start until 5 or 6.  My son's tics which involved hand licking and sniffing pretty much disappeared by 9.  My daughter had throat clearing and also a hand lick.  The throat clearing is gone but the hand licking has become a rare event.  It hit its height and is now on the wane.  My non-AS daughter hada real doozy - she had a three month tick of a quick touch to her vagina - you should have seen the school officials lose it over that one.  We were like - "get a hold of yourself, she is 7 you people are 40."  We had to have her psychiatrist explain to these public school "trained professionals" that the OT's have it all wrong and that it isn't a sensory intergration issue.  That misguided finding came out of one badly done study that has been totally repudiated but they forgot to update the OT's textbooks.  And that is why people need to bring their children to reputable Child Study Centers and stop listening to out of date school professionals.  By the way, the tic mysteriously disappeared after legal action was threatened and they laid off of my poor kid and stopped stressing her.  My 7 year old other tics are on the wane right now.  If she would only stop reorganizing and cleaning all the time I would be much happier.

Generally, at this age, you ignore the tics.  You need to think of the tic as a variation of OCD behavior.  The tic is something that needs to be done so that the individual has a feeling of "rightness".  When the child is old enough to get the sensation that the tick is about to happen then habit reversal training can be attempted - that is usually around 11 or 12.   Most tics come and go and my son's has pretty much resolved themselves but still will occasionally re-emerge when he is feeling stressed.

As far as medication goes, Tenex is my drug of choice.  Not only does it help the tic, it helps your little one fall into a restful slumber.  We like Tenex alot.  ALso. really helps as a mood stabilizer.

Buspar is also pretty effective.  It is a pretty good bang for the buck as far as anxiety drugs go.  None of my children were medicated before the age of 6 - so if I were you I would visit someone especially trained in giving prescription psychotropic drugs to children.  My brother used a regular psychiatrist for his children - and let's just say the man triggered off hallucogenic delusions in my brother's six year old.  A child psychiatrist couldn't believe the cocktail that the other doc put into his kid.

We are generally a family of OCD, anxiety ridden people.  Goes back at least 4 generations.  Tics are actually fairly more common than most people believe.  I mean, check out roger Clemens during the hearings.  His tic was in full steam - which I happily pointed out to my kids.  

Good luck,

Sue NYC

[mcdcnk]

My son (7 years old) has what looks to be tics. He clears his throat incessantly, sometimes 20-30 times in a minute. He also shakes his hands and crosses his fingers, which is worse when he is anxious. He also developed a facial tic but only when he eats/drinks Splenda. The pediatrician said he thinks the throat clearing is related to allergies, but so far allergy meds and shots haven't helped. I have put him on Omega-3's and that has helped somewhat, but not totally. Do you think this could be tourettes? He is highly intelligent for his age, obsessed with numbers and math. Could it be a form of OCD?

[TSASmom]

My son was diagnosed with Tourette's when he was four. His tics have changed over the years, waxy and waning in the usual pattern. He currently has a shoulder shrug that leaves him is lots of muscle pain by the end of the day. An eye tic, shifting his vision back and forth constantly, makes it difficult for him to concentrate at school. The eye tic occurs two to three times per day and lasts about 15 minutes. The shoulder, neck rolls seem to be pretty constant. He gets relief for a few minutes at a time. He is 11 years old now.

He's been diagnosed with the typical trio, TS, ADD (he isn't hyperactive, but diffinitly has attention deficits), and OCD.

Two years ago he was also diagnosed with Asperger's. He fits most of the criteria. Social rules sometimes confuse him, and he has difficulty with picking up the nonverbal messages most people clearly understand. His interests are narrow: Star Wars, Transformers, and SpongeBob mostly. I hope the fixations will mature with him.  

Therapy, especially social skills training, over the years has been tremendous help. He actually plays football with the boys at recess now! He's been in speech therapy to help with understanding the pragmatics of language, spoken and written, for several years. He also sees a child psychologist who is working with him to find ways of dealing the the tics, OCD issues, and social concerns.

His MD is not a trained psychiatrist, but someone who has gained expertise working with children with neurological disorders because of special interest in the area. We've not tried Tenex yet, Risperdal has been helpful in increasing our son's social behavior, in combination with all the therapy. He is also taking meds for anxiety and attention.

I would strongly encourage 'pinkhair' to provide her son with lots of social skills training. I agree with SueNYC that the tics can be dealt with through educating others, and your child about the syndrome. People are much less kind to those with Asperger's. The long-term effects of not understanding social rules can be devastating. We are amazed at the social growth of our son, and hope that, eventually, he will be able to have fulfilling, long-term social and career relationships.

By the way, it is really nice to find a site where discussion of the two syndromes is going on. I've searched several times for information about comorbidity of TS and AS, but haven't had any luck until today. Thank you all for sharing your knowledge, and experience.

TSASmom

[pinkhair]

Thanks for all your comments. We are now using Risperdal and this seems to be helping a bit. I really think a social skills course would be a good next step but am having trouble finding something local (in Australia!!) .