Blog About Tourette Syndrome - Tourette's Disorder

Monday, October 08, 2007

Strengths and advantages associated with Tourette's syndrome

Strengths and advantages associated with Tourette's syndrome

Tourette syndrome occurs along a spectrum—that is, its severity ranges from mild to severe. The majority of cases are mild and require no treatment; the impact may be so mild that casual observers might not realize the person has Tourette's. Most people with Tourette syndrome lead productive lives with no barriers to personal or professional achievement. Intelligence and lifespan are normal and the overall prognosis is positive, although a minority of people with Tourette's have severe symptoms that persist into adulthood (1).

Tics peak in severity at around age 10; there is typically a steady decline in tic severity throughout adolescence, when one half to two-thirds of children with TS experience a reduction or complete resolution of tic symptoms. These results were found in a cohort of patients with TS encompassing all levels of highest-ever tic severity and including comorbid diagnoses; several of the subjects had very high initial severity and comorbid diagnoses of OCD and ADHD. A study of 46 19-year-olds with TS found that the symptoms of 80% had only minimum to mild impact on their overall functioning. A follow-up look at 31 adults with Tourette's found that all had completed high school, 71% were employed full-time or pursuing higher education, and 52% finished at least two years of college.

Severe Tourette syndrome persisting into adulthood is a rarity. Although Tourette's can be difficult for this group, discussions with adults in the Tourette syndrome community reveal that not everyone wants treatment or a "cure", particularly unless they know what else they may "lose" in the process. Some believe that there may even be latent advantages associated with the genetic vulnerability and that Tourette's is associated with heightened creativity. Adults are also concerned that the process of "curing" TS could result in cognitive losses (2).

Research supports advantages associated with Tourette syndrome.

A study of 11 adults with TS found that they could visually bisect a line more accurately than control subjects (have a ticcer hang all your pictures quickly without a tape measure).

A study of eight children with Tourette syndrome found they were much quicker at certain mental grammar skills than children without TS. The underlying brain differences that lead to tics may also lead to "other rapid behaviors, including the cognitive processing of rule-governed forms in language and other types of procedural knowledge". Michael Ullman, PhD, said, "These children were particularly fast, as well as largely accurate, in certain language tasks. This tells us that their cognitive processing may be altered in ways we have only begun to explore, and moreover in a manner that may provide them with performance that is actually enhanced compared [to] that of typically-developing children". Six of the eight children studied had "TS-only"; two of the eight had ADHD, one of whom also had OCD.

Martha Denckla, MD, of Johns Hopkins University School of Medicine reports that there is evidence supporting the clinical folklore that children with "TS-only" (40% of children with TS, according to Denckla) have unusual gifts; neuropsychological studies reveal advantages in children with TS-only. A study of full-scale IQ showed that children with TS-only had higher IQ scores than predicted by statistical models, relative to their parents' intelligence. She says, "there is reason to give some credence to common clinical lore, namely, that these children are unusually intellectually gifted youngsters who show no cognitive deficits." She also reported that none of the children with pure Tourette syndrome (TS without co-occurring conditions) had learning disabilities.

Another study of motor function found that 76% of children with TS-only were faster than average on timed motor coordination; similar results were not found among children with TS with co-occurring attention deficit hyperactivity disorder.

A controlled study of 13 people with TS found that cognitive control was enhanced in people with Tourette's (without ADHD) because a lifetime of suppressing tics results in more efficient control of inhibitions. A follow-up study confirmed the result that individuals with Tourette's exhibit greater cognitive control than age-matched subjects. The enhanced cognitive control in the TS group was found in spite of there being a statistically-significant slight advantage in the average IQ of the age-matched controls. Subjects with ADHD were excluded from the sample and controls were also screened to eliminate ADHD.

When ADHD co-occurs with TS, social, behavioral and academic difficulties may be present. Many studies have shown that behavioral disturbances seen in TS are actually caused by co-occurring ADHD and not the TS itself, and that learning disabilities may be secondary to ADHD as well. Denckla argues that there is a case for categorizing "pure TS" separately from "TS plus ADHD" and that "it is important to inform the parents of [children with pure Tourette syndrome], who comprise 40% of all children with Tourette syndrome, that their future is not burdened with the same issues as those of the remaining 60% of children who have comorbid ADHD with Tourette syndrome." She also says that treatment for TS plus ADHD need not differ from treatment for ADHD alone.

1. Walkup JT, Mink JW, Hollenback PJ, (eds). ''Advances in Neurology, Vol. 99, Tourette Syndrome.'' Lippincott, Williams & Wilkins, Philadelphia, PA, 2006, p. xv.

2. Leckman JF, Cohen DJ. ''Tourette's Syndrome—Tics, Obsessions, Compulsions: Developmental Psychopathology and Clinical Care.'' John Wiley & Sons, Inc., New York, 1999, pp. 408–409.

Strengths and advantages associated with Tourette syndrome

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