Blog About Tourette Syndrome - Tourette's Disorder

Friday, December 30, 2005

About "Dr. Laura Schlessinger" and Tourette's Syndrome

Does Her
" Never To Be Humble Opinion"
Contribute to
"One of the Saddest Things in Her Life ?"
Viewing the "Dr. Laura" Tourette's incident in perspective
following her interview on Scarborough Country, MSNBC

"There are probably more Internet hate sites about me than Charles Manson. In fact, I don't think there are any hate sites about Charles Manson, but if you call up my name on one of these things, you will find hundreds of thousands of just demeaning, hateful, hostile, ugly things about me, and I walk around sometimes in circles trying to think, gee, I am trying to help people lead better lives. Why does that engender so much hate? So, I have had to come to peace with there are forces that are against goodness, and what I think is basic common sense truth. And you have to be able to stand up against that wind. " (1)

So claimed "Dr. Laura" Schlessinger when she was interviewed on MSNBC's Scarborough Country to promote her upcoming, appropriately-named theatrical event, In My Never To Be Humble Opinion. It is billed as a two-act, one-woman show where she will share her opinions on "everything from childbirth to death." The pre-publicity gives the impression we are to see a more open, personal side of "Dr. Laura." She revealed a bit of this in her interview with Joe Scarborough, when she almost teared up as she admitted that ...

"... it's one of the saddest things in my life that I don't have a relationship with God right now." (1)

Right now?
Or never?

No, hopefully not never -- God doesn't give up that easily, even on someone prideful and arrogant, who apparently vows "never to be humble." Does Laura Schlessinger really want a relationship with God, and is the lack of one really her greatest sadness, or are these interview admissions really about promoting her upcoming show and herself to a large segment of her followers? It's hard to tell.

This is a woman who apparently just doesn't get it. Compounding her history of moral and spiritual confusion (5), she seems to see no connection between her behavior, her lack of a spiritual relationship with the God she professes to embrace, and her image problems. She presents herself as a victim of the internet age, comparing herself to the serial killer Charlie Manson, even while acknowledging her own lack of humility in the title of the show she's promoting! She sees herself, apparently, as a victim in a role in which her own actions play no part. Not surprisingly, she's assumed the victim role before, in discussing the Tourette's incident. (2) "Dr. Laura" seems to have no cognizance of how her own actions and behaviors are connected to her image, and would have us believe that she advocates only "basic common sense truth," while anyone pointing out when she is simply wrong about medical facts must be a "force against goodness." She doesn't seem to understand that she is accountable for her actions, particularly when they are wrong, and/or can harm others. Where was this "common sense goodness" when she made assumptions about a child with Tourette's, making pronouncements and judgments based on inaccurate medical information, and reversing all of her professed family "standards" to insist that the child be excluded from an important family event? She did this without apparently having even a basic, fundamental knowledge or understanding of Tourette syndrome or the circumstances actually experienced by this child in this family.

Perhaps it never occurs to her that some people may find some of her own pronouncements "hateful, hostile, and ugly?" Perhaps her arrogance doesn't leave room for such ideas to enter into her consciousness. Or perhaps she's just playing to a segment of her audience, in order to increase ratings and promote her show.

Further, because she is viewed as being aligned with the religious right (in spite of her professed lack of a relationship with God), she contributes to unfavorable impressions of those with the political and religious orientations she pretends to represent.

Let's review the facts of the Tourette's incident, as it provides an example of how Dr. Laura herself is responsible for "engendering so much hate."

In the infamous Tourette's incident of so many years ago, Laura Schlessinger employed a double standard as soon as she heard the dreaded "T" word. She reversed her previous statements and positions about the importance of family not taking sides, and drew hasty conclusions about the child as soon as she heard the caller was referring to a child with Tourette's syndrome. After a LOT of protest over her inaccurate and judgmental response, she took a second chance to address the issue on a subsequent show, but then aired even more damaging and inaccurate information about Tourette's disorder! The transcripts of those shows, and a record of her attempts to rewrite this history into something different, are now part of her documented history. (3) She never personally apologized on air or on her website, she never personally fully retracted her inaccurate statements, and she never made amends for the harm done to people with Tourette's syndrome. What did occur is that a post allegedly representing her views was made to an internet message board, with no means of verifying that it came from her or represented her views, and containing statements which she personally did not make on air or on her website. So, was the apology from her or from her "handlers?"

Contrast this, for the sake of argument, with how it could have gone, were it not for "Dr. Laura's" own pride, arrogance and apparent inability to repair damage done. In a different, (not uncoincidentally) little known incident, a columnist made an unfortunate reference to Tourette's in one of her articles. She received some published and other private protests and comments on her article, in which she used Tourette's as an analogy to describe a politician's stupid comments. In response to my e-mail to her, I received an immediate reply, which included among other things, two simple sentences:

"I'm sorry for my insensitivity. It was dumb." (4)

How easy was that?

End of story, right there, just that simple. Just as simply, "Dr. Laura" could have apologized and and used her radio format to correct the inaccurate and hurtful information she put out about Tourette's in her first show. Instead, she used her credentials "as a scientist" (she's not a medical doctor, or a psychologist) to air incorrect information about Tourette's syndrome a second time.

So why is a straightforward apology and admission of error so hard for "Dr. Laura?" Is there, per chance, a connection between the things she acknowledged to Joe Scarborough, and her inability to make amends when her wrongful, inaccurate information brings harm to others? Isn't there is a reason that pride is considered a great downfall? Is there a connection between her arrogance and spiritual yearning? These aren't questions for a rocket scientist, but the connection seems to have escaped Laura Schlessinger.

Let's look at some more of what she said in her interview with Joe Scarborough.

"I really immersed myself in Judaism to the point that I had a Orthodox conversion, and let me tell you, when I do anything, you know me well enough to know, it's 120 percent. I had great hats, I mean. I wore—I did Shabbos. I did everything, and I was never—it's very sad for me to say this, it upsets me to this day, but as hard as I worked and as hard as I tried and as hard as I prayed and as hard as I immersed myself, I didn't get there, and it's a great sadness to me ... " (1)

Well, wearing the hat doesn't get one a relationship with God, nor does pursuing a relationship with Him through our own self-directed hard work and goals. Humility and submission to the will of a greater power doesn't seem to have entered "Dr Laura's" conscious awareness of Desirable Ways to Approach God. How can one expect to find a relationship with God in the presence of pride and arrogance?

If a relationship with God is truly what Dr. Laura seeks (and not just more publicity), the way out of her greatest regret and sadness is not that hard to find. It's there for the asking and for the taking. But a first step is putting aside "never to be humbled" pride and arrogance. Dr. Laura might even consider a starting place for practicing humility: setting the record straight for one small child with Tourette's, who wanted to attend his aunt's wedding. Humbling one's self is a good start towards learning to submit to God's will.

But ... What does "Dr. Laura" want more -- the ratings or the relationship? Or, stated another way: can she ever allow herself to be wrong?

Dr. Laura Schlessinger, this is to you: the child was young, impressionable, easily scarred and damaged, with his whole life ahead of him. The acceptance of his family could be his first step towards a healthy outcome, and family rejection could be the first step towards a life of despair. You were misinformed, hasty, judgmental and wrong in your medical facts and assumptions about the child. When given the chance to become informed, and do the right thing, you didn't take advantage of that opportunity. Some might even say you were "demeaning, hateful, hostile, and ugly" to people with Tourette's syndrome. You had the chance to make a difference. You consciously chose not to do the right thing. You are accountable -- to the families with Tourette's, to your audience, and, yes, even to God. Taking you to task for medical misinformation is not "hateful" ... it is holding a public person, who enjoys a wide audience, accountable for disseminating misinformation in ways that can bring further harm to persons already living with a stigmatizing condition. You have turned your failure, and your mean-spirited response to that sister-of-the-bride, into a situation where you have convinced yourself that you are the victim of the internet, and that it is others who are just "bound to hate." Another name for this narcissistic behavior is denial.

It's really not that hard to Go and Do the Right Thing. Or is it? As Dr. Laura might say:

Don't forgive those who wronged you unless they evince Remorse, Responsibility, and Repair (her "three R's"). (6)

Another example of Dr. Laura not following her own advice? She accuses those of who hold her accountable of being "forces against goodness," yet she demonstrated no remorse, reponsibility, or repair in her response to the Tourette's debacle.

I'm not sure how her forgiveness policy fits in with most religious doctrine, but that is between her and God.

(1) Transcript of MSNBC's "Scarborough Country," December 29, 2005.
(2) Dr. Laura claims the "victim role" in Tourette's incident.
(3) Dr. Laura on Tourette's, transcripts and incident of May, 2001.
(4) Kathleen Parker Tourette's Response
(5) Dr. Laura Loses Her Religion
(6) Wikipedia: Laura Schlessinger


TSNW - TSNowWhat - Tourettenowwhat - Tourette Syndrome Now What

Monday, December 19, 2005

Tourette's "Genetic Breakthrough" - The SLITRK1 Gene

"Genetic Breakthrough Yields Clue to Tourette Syndrome"
Putting the new findings about the SLITRK1 Tourette's Gene Into Perspective

There was a big splash in the media about a "genetic breakthrough" with respect to Tourette's syndrome. Some of the media reports went so far as to leave the impression that *the gene* for Tourette's had been found, and that, consequently, a "cure" might be forthcoming.

In order to put this Tourette's gene finding into perspective, it may be instructive to look at some of the more serious, official press releases and articles about the SLITRK1 genetic finding.

"Pursuing genetic analysis of one boy with TS with a known chromosomal abnormality, the group was able to pinpoint a gene (SLITRK1) on Chromosome 13 that is associated with some forms of TS." (1)

"A bad break that apparently gave a young boy Tourette syndrome ... a boy who had an inversion in chromosome 13: A portion of his chromosome had an orientation opposite that of normal chromosomes. The boy was the only member of his family with Tourette syndrome and the only one with the inversion." (2)

" ... the researchers focused on identifying an individual with both TS and a chromosomal abnormality." (4)

"They compared the gene to a wider TS population of 174 people. The team found an abnormal DNA sequence in one family and the identical, very rare change in the DNA sequence in two unrelated people." (3)

"Searching for the same gene in the genome of 174 other individuals with TS revealed three individuals with the same mutation. " (4)

"Taken together, these converging results suggest that this gene is associated with some forms of TS in some families." (1)

"The researchers stressed that the discovery only explains one in 100 people who have Tourette's Syndrome." (8)

" ... the gene is responsible for at most a small fraction of Tourette cases. Other researchers warn that the findings, although interesting, remain tentative. 'Each piece of the evidence is intriguing but not on its own conclusive,' says UCLA geneticistNelson Freimer. 'To what degree can the pieces be combined to make a persuasive case? Opinions will differ on that.' " (2)

"Scientists remain uncertain of the ultimate impact of the research. 'In terms of how characteristic it is of the Tourette's population as a whole, the jury is still out,' King said." (4)

Summarizing this information from "official" sources:

A. The identified boy had a chromosomal abnormality.

B. No one else in his family had Tourette's syndrome.

C. Of 174 people studied, the chromosomal mutation was found in a total of 3 people (1 percent to 2 percent).

D. Tourette's syndrome researchers and experts ackowledge that the findings pertain to some individuals, some families, and a small fraction of Tourette's syndrome cases (about 1 in a hundred).

E. Opinions among Tourette's experts and researchers vary as to the relevance and significance of this finding.

A more confusing aspect of the way this finding has been presented has to do with what is known as "tourettism," which refers to secondary causes of tics, that may mimic Tourette's syndrome. We find indications throughout the medical literature that chromosomal mutations are a known cause of tourettism, which mimics Tourette's, but may be different from primary, inherited, genetic Tourette syndrome.

Here is some information about tourettism:

"Motor and phonic tics are most frequently due to Tourette syndrome, but there are many other causes of tics ... Genetic and chromosomal disorders, such as Down's syndrome, neuroacanthocytosis, and Huntington's disease were associated with tics ... To understand the physiopathology of tics and Tourette syndrome, it is important to recognize that these may be caused or associated with other disorders." (7)

"Pathologic tics (secondary [tourettism]) * Infections - Encephalitis, Creutzfeldt-Jakob disease * Sydenham chorea * Drugs - Stimulants, levodopa, carbamazepine, phenytoin, phenobarbital, antipsychotics (tardive tics) * Toxins - Carbon monoxide * Developmental - Static encephalopathy, mental retardation syndromes, chromosomal abnormalities * Other - Head trauma, stroke, neurocutaneous syndromes, chromosomal abnormalities, schizophrenia, neuroacanthocytosis degenerative disorders." (5)

"Several conditions, termed tourettism, may mimic Tourette's syndrome. Drugs, including stimulants, levodopa (Dopar, Larodopa), and antiepileptic medications (eg, phenytoin [Dilantin], carbamazepine [Atretol, Epitol, Tegretol], lamotrigine [Lamictal]), may cause tourettism. ... Neuroleptic medications with potent dopamine2 (D2) antagonist activity (eg, haloperidol [Haldol]) may cause tardive tourettism, which presents with delayed and often permanent tics identical to Tourette's syndrome. Other causes of tourettism include infections (eg, Creutzfeld-Jakob disease, encephalitis), toxins (eg, carbon monoxide), Huntington's disease, head trauma, stroke, neuroacanthocytosis, chromosomal abnormalities, cerebral palsy, neurocutaneous syndromes, and schizophrenia. " (6)

This information may help put this Tourette's genetic finding into perspective. It is likely that the boy's chromosomal mutation is unrelated to the Tourette's gene(s) that most people with tics have inherited, particularly since no one else in his family has Tourette's, and the SLITRK1 gene was not found in 98% of the study sample of people with tics. Whether or not this finding is related to tourettism and will ultimately be helpful in identifying the gene(s) associated with Tourette's syndrome remains to be discovered.

(1) TSA: Genetic Breakthrough Yields Clue to Tourette Syndrome
(2) TSA: Teenager’s Odd Chromosome Points To Possible Tourette Syndrome Gene
(3) Researchers at Yale Identify a Genetic Link to Tourette's Syndrome
(4) Yale Daily News: Genetic mutation is linked to Tourette's
(5) e-medicine article on Tourette Syndrome
(6) PostGraduate Medicine: Is It a Tic or Tourette's?
(7) Secondary tics and tourettism
(8) Science Daily

Tourette Syndrome - Now What?
TSNW - TSNowWhat - TouretteNowWhat - Tourette's Syndrome Now What?

Sunday, December 18, 2005

Tourette Syndrome Plus

Tourette Syndrome “Plus”

The Pros and Cons of the Terminology
"Splitters" versus "Lumpers"

The term “Tourette Syndrome Plus,” or TS+, was coined by Leslie Packer, PhD, to remind people to sort out symptoms that may be coming from conditions other than Tourette’s. The “plus” refers to comorbid conditions, beyond the diagnostic criterion for Tourette’s, which an individual may have. For example, one might have TS plus AD/HD or TS plus bipolar or TS plus learning disabilities. The idea was to remind people of the importance of “splitting” rather than “lumping” of diagnoses, in order to more appropriately target treatment towards problematic symptoms. For example, if a child has anxiety in addition to tics, the anxiety may warrant treatment priority. If a child has attention-deficit, hyperactivity disorder along with tics, treating the AD/HD most often takes priority over treating the tics. If a child has angry, explosive outbursts and inflexible behaviors (colloquially referred to as “rage,” although there is no such diagnostic entity or medical term), then the comorbid conditions beyond Tourette’s, which are leading to those behaviors, should be identified and treated (“rage” has been found not to be associated with Tourette’s, yet we still hear the term “Tourette’s rage”).

Tourette Syndrome "Plus"
“When I first began talking to people about TS, I realized that when some people would say ‘That's a symptom of my son's TS,’ they weren't talking about tics but about features or symptoms of disorders such as Attention Deficit Hyperactivity Disorder or obsessive-compulsive symptoms. So to decrease confusion in our communication, in 1991, I introduced the term ‘TS+’ to refer to individuals who have TS plus features of one or more other disorders such as Attention Deficit Hyperactivity Disorder (ADHD), Obsessive-Compulsive Disorder (OCD), anxiety, self-injurious behaviors, anger or rage outbursts, or depression, to name but some of the conditions that may be associated with or frequently comorbid with TS. The goal was to help people remember that not everything may be a tic of TS, and that the child may have other conditions that may be responsible for any impairment they are experiencing.

‘TS+’ is not a technical or diagnostic term, but rather a convenient way to remind ourselves that there is (sic) often other things affecting a child who has been diagnosed with TS. This is particularly evident when we examine school functioning. In the vast majority of cases I've dealt with over the years, it is seldom the tics that are the child's or teen's biggest problem.

Unfortunately, and despite my best efforts to remind people not to attribute everything to TS when it may be due to something else, all too many people continue to describe people with TS as having a variety of problems that may not be due to TS at all, but rather to some other condition. For example, one publication from the National Tourette Syndrome Association suggested that TS was linked with Central Auditory Processing Disorder (CAPD), and yet there is not one study that shows any direct association between TS and CAPD. Such imprecise writing does not further our understanding of TS. It is one thing to say that children with TS and Attention Deficit Hyperactivity Disorder may be more likely to have CAPD, but it is quite another thing to say that children with TS are more likely to have CAPD.”

So, in spite of Dr. Packer’s best intent when coining the term, and her efforts to clarify the correct usage of the term she coined, the horse is out of the barn, and is not going to be corralled. A tour of internet websites and message boards shows that the term is still most often used incorrectly, by people who believe that the symptoms of their comorbid conditions can be rolled in under the Tourette’s umbrella. Many laypersons and professionals alike have come to use the term to broadly refer to Tourette’s symptoms in general, and confusion of diagnostic boundaries results. When conditions comorbid with tics aren’t correctly identified, the risk is that the appropriate and most effective treatment can’t be targeted. For example, if a child has tics plus bipolar disorder, you can’t treat the bipolar correctly by thinking the manic behaviors are coming from Tourette’s and trying to treat the tics. Bipolar responds to mood stabilizers, rather than the typical medications which treat tics.

Although the term TS+ does make it more convenient for those who need to describe a child who has diagnoses beyond tics, in my opinion, the current mis-usage of the term by most people who employ it does more harm than good, and the term should be eliminated from Tourette’s terminology. Here is a summary of some of the issues:

1. “TS-only” versus “TS-plus:” but ... Tourette’s is TS-only. The diagnostic criterion for Tourette’s define a tic disorder, which may occur along a spectrum from mild to severe. It doesn’t define a tic disorder plus AD/HD or a tic disorder plus bipolar or whatever. The widespread usage of the term “TS-plus” had led to the need for another term, “TS-only,” to counteract the common usage of the term “TS-plus.” And it goes beyond that: one finds all kinds of awkward terminology used to desribed diagnostic Tourette's syndrome, such as, pure TS, plain TS, and so on. This may lead some to forget that the people who have “TS-only” are the people who have ... well ... Tourette’s according to DSM criterion. There should be no need for additional names to describe those who do have the basic condition as defined in the DSM. They should not be the “exception” that needs clarification, because another term has necessitated that clarification. The true nature of Tourette’s is obscured when one thinks of “TS-only” as the exception, and fails to dig deeper and realize that most cases of Tourette’s (i.e.; TS-only) probably go under-detected and misdiagnosed, while ascertainment and referral bias brings clinical attention to more cases of Tourette’s plus comorbidities (TS-plus). People who don’t have comorbid conditions along with their tics are less likely to come to diagnostic attention, and less likely to come to tertiary, clinical attention where they will end up in a published study.

Persons with TS+ are more likely than TS-Only to have problematic behaviours. … Co-occurring or "comorbid" problems or disorders often determine the impact of the TS, as well as whether medical treatment is needed. One should be very careful to not attribute everything to the TS diagnosis; if you do, you may overlook important possibilities.”

And, also from Roger Freeman, MD
An international perspective on Tourette syndrome: selected findings from 3,500 individuals in 22 countries. Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P. Dev Med Child Neurol. 2000 Jul;42(7):436-47. "The small proportion of individuals with TS only reflects a clinical and epidemiological dilemma: most individuals with TS seen and followed in clinics are comorbid and therefore contribute to the idea that TS is necessarily associated with other disorders and behavioral problems ... However, the prevalence of behavioral problems in the TS only group may not differ from the general population.”

2. One can find endless examples of persons who erroneously employ the term “TS plus,” to the point that generates confusion about what Tourette’s is, and may lead to inappropriate treatment. This can lead people with perhaps undiagnosed comorbid conditions to truly believe that their symptoms are typical of or common to people with Tourette’s, while missing other diagnoses which would benefit from accurate identification and treatment. One finds this very frequently with respect to bipolar disorder, learning disabilities, “rage,” and AD/HD. It also increases the myth, misinformation, and stigmatization attached unnecessarily to a diagnosis of Tourette’s.

3. “Lumping” comorbid conditions under the “TS-plus” umbrella is misleading. Since the tics rarely are the first treatment priority, and comorbid conditions are most frequently what leads to academic, social or behavioral difficulties, why are we calling attention to the Tourette’s as the source of the problems, by employing the label “TS-plus?” If we need to use shorthand, why aren’t we saying “AD/HD+” for a child with AD/HD plus tics, or “bipolar plus” for a child with bipolar plus tics? That would make it clearer what symptoms should be targeted for treatment.

4. The Tourette Syndrome Study Group seems to agree on the importance of the benefits of reductionism, and “calling a diagnostic spade a spade.”

Challenging Phenomenology in Tourette Syndrome and Obsessive–Compulsive Disorder:
The Benefits of Reductionism

“In the clinical setting, a reductionistic approach makes most sense. Describe the action as accurately as possible, calling complex behaviours “intentional repetitive behaviours” (12) if they are not definite pure forms. Describe all epiphenomena including sensory phenomena, cognitions, affective state, changes with the completion of the action, how endpoint is judged, senselessness and so on. Treatment, therefore, focuses on the most disabling symptoms, with the aim to improve overall quality of life rather than to eliminate all symptoms. Medication choice is based on knowledge of how parsed phenomena best respond to specific current therapies. For the purpose of diagnosis, certain labels may be applied (“OCD” or “Tourette”), but the therapeutic path will more closely relate to the pattern of phenomena than will the broad labels which, by nature, will lose resolution when it comes to understanding the individual’s unique situation.

Faced with related phenomenology dilemmas, the TS Classification Study Group (13) used a reductionistic approach when it said of its numerous tic syndromes, “Although some of these separate entities may ultimately be shown to be caused by the same etiology (or even the same gene), until that is established it is considered best to divide the condition into distinct entities.” “(This classification) can both expand and consolidate, as (etiological factors) are identified (13).” One promise of reductionism is that accurate description of the variations of phenotype will lead to the best chance of correlating such variation with neurobiological underpinnings, as the latter become elucidated. We may find that phonic tics are simply motor tics of noise-making musculature; however, we may find that they are somehow neurobiologically distinct from other tics. We do not yet know, and until we do, we should continue to subdivide them. An approach such as this one has already led to the description of two likely biologically distinct types of OCD (10).”

Tourette Syndrome - Now What?

TSNW - TSNowWhat - TouretteNowWhat - Tourette Syndrome Now What?
are the names I post under, but you should be aware that other webmasters have used my name in an attempt to drive traffic to their own sites ... I guess imitation is the sincerest form of flattery !!

Tics, stims and stereotypies: Tourette's versus autism

Tics, stims and stereotypies:
Differentiating Tourette's, Autism spectrum disorders, and Stereotypic Movement Disorder

"Not all that tics is Tourette's"

There are many secondary causes of tics, which is also referred to as "tourettism." These include such diverse conditions as autism, mental retardation, head trauma, stroke, Asperger's, carbon monoxide poisoning, Sydenham's Chorea, and many other conditions.

Further, there are numerous conditions besides those on the spectrum of tic disorders (transient tics, chronic tics, and Tourette's disorder) which include tics as a feature of the condition. When attempting to sort out the etiology of stereotyped movements or tics in childhood, it is helpful to be aware that "not all that tics is Tourette syndrome."

Two common conditions of childhood which are often confused with Tourette Syndrome, because of the stereotyped movements, are Stereotypic Movement Disorder, and conditions on the autism spectrum. Sorting out the similarities and differences between tics, stims and stereotypies if hard even for trained professionals, and the confusion results in a number of misdiagnoses.

The information contained here is to help parents become informed and work with their medical professionals to help sort out and differentiate between the diagnoses of tic disorders, autism spectrum disorders, and Stereotypic Movement Disorder, and to understand the similarities and differences between tics, stims, and stereotypies.

The diagnostic criterion for Tourette's disorder rule out other medical causes of tics in order to confer a TS diagnosis.
There are numerous causes of secondary tics (also referred to as "tourettism"), other than primary, inherited Tourette Syndrome.
Stereotypic Movement Disorder is another condition which may easily be confused with Tourette's. Roger Freeman, M.D. of the Neuropsychiatry Clinic at British Columbia Children's Hospital, Vancouver discusses Stereotypic Movement Disorder here:

"Stereotypic Movement Disorder can be confused with tics and TS. SMD is an official DSM-IV diagnosis, but it's rarely made. ... Repetitive movements usually start before age 2, and consist of intense patterns (like hand-flapping, pacing, running, bouncing, with or without vocalizations and facial grimacing) in longer runs than tics (can be 10-30 minutes). This can be stimulated by excitement or rarely boredom. When older, they often say they like it, it's fun, they have to do it before they do something else, and that it stimulates their fantasies, yet they can usually be easily called out of it. It often looks very odd. They typically shape their patterns later so that the movements are done in private or within the family. The main problem is that if you're not familiar with it, you're likely to think it's an autistic spectrum disorder or Tourette's. The pattern itself can look indistinguishable from autistic stereotypies, but is much more prolonged than tics."

The similarities and differences between tics, stims and stereotypies are summarized here, as excerpts from several Tourette's textbooks and medical journal reports, including:

Tourette Syndrome, Advances in Neurology, Vol. 85. Editors, Donald J. Cohen, MD, Joseph Jankovic, MD, Christopher G. Goetz, MD. Lippincott, Williams & Wilkins, November, 2000. ISBN: 0-7817-2405-8 Chapter 7: Autism Spectrum Disorders: Relevance to Tourette Syndrome, Isabelle Rapin.

Recognition and Management of Tourette's Syndrome and Tic Disorders MOHAMMED M. BAGHERI, M.D., JACOB KERBESHIAN, M.D., and LARRY BURD, PH.D. University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota.

Other FAQ (Frequently Asked Questions) about Tourette's syndrome may help sort out additional factors which should be considered when pursuing a Tourette's diagnosis:

Tourette's FAQ

Tourette Syndrome - Now What?
TSNW - TSNowWhat - TouretteNowWhat - Tourette's Syndrome Now What?

HBO Documentary - I Have Tourette's but Tourette's Doesn't Have Me

Video clips and audio from the HBO Tourette's documentary

News 10 Report
CBS News

To order the DVD, I Have Tourette's but Tourette's Doesn't Have Me, from the TSA

Classroom lesson plan to be used in conjunction with the DVD, I Have Tourette's but Tourette's Doesn't Have Me

TSA Newsletter, That Darn Tic, featuring the "child stars" of the DVD, I Have Tourette's but Tourette's Doesn't Have Me

Feedback on the HBO Documentary, I Have Tourette's but Tourette's Doesn't Have Me

Tourette Syndrome - Now What?

TSNW - TSNowWhat - TouretteNowWhat - Tourette's Syndrome Now What?
are the names I post under, but you should be aware that other webmasters have used my name in an attempt to drive traffic to their own sites ... I guess imitation is the sincerest form of flattery !!

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