Category Archives: Resources

Ask Dr. Ticcy Resources

Ask Dr. Ticcy: How do I support the caregiver of a person with TS?


Dear Dr. Ticcy,

HELP! My grandson has been diagnosed with TS complete with the Jekyll and Hyde rages which are overwhelming for my daughter to say the least. He is 6 and tells her that he hates her and wishes she was dead. He would like to stick nails in her eyes and so on. So, tics are one thing but these rages are frightening to say the least.

I am feeling helpless to help! 

He is on medication including one for his ADHD.

I don’t even know why I’m writing this other than as a mother and grandmother I’m feeling absolutely powerless so I can only imagine how my daughter is feeling. How can I help her?

Thanks for listening,
Concerned Mom/Grandmother

Dear Concern Grandmother & Mom,

I am very sorry to hear that you and your family are going through such a challenging time.

You mentioned that a physician diagnosed your grandson with “TS complete with ‘Jekyll and Hyde rages.’” I assume, though I am not certain, that you are talking about the neurological storms or rage episodes. The TSFC’s recent three-part blog series on the subject is well worth reading.

Your concern for your daughter, a mom whose son says he “hates her” and “wishes she was dead,” raises an important question: Who cares for the caregivers?

This question may seem straightforward, unfortunately, the answer is not. I cannot say “there is one organization that your daughter, and other caregivers like her, can go to sign up for ‘caregiver support.’”

Supports and services for caregivers are many and understanding what they are and whether you qualify for them can be time-consuming.

The Government of Canada has various forms of assistance that a caregiver may qualify for and each province has a different landscape of programs and supports as well.

As a result, the TSFC Blog will soon publish a series on caregiver support that will highlight some of the programs and supports for caregivers in each province as well as federally. Each entry in the series will provide links to the programs it discusses and a description of eligibility requirements.

Thank you for writing your message and for bringing attention to the issue of “care for caregivers.”

Sincerely,
Dr. Ticcy

Dr. Ticcy is a pseudonym for the TSFC National Office, which draws on information from experts across Canada and beyond to answer questions from the TS community. Please send your questions to tsfc@tourette.ca with the salutation “Dear Dr. Ticcy.”

Children/Youth Resources

Getting the Jump on Kid’s Summer Camps


Often staff at a typical summer camp are unable to accommodate children or youth with TS Plus, whose challenges may include OCD, ADHD, mood disorders, neurological storms/rage episodes and so on. In response, last summer we published a list of specialized, TS Plus-friendly summer camps in Canada. One member requested that we publish this list sooner next year, since many camps require early registration, and some even have waiting lists, such as Camp Winston in Ontario. So if you’ve thought of planning a summer camp experience for your young one(s) this summer, it’s best to start acting soon.

If you know of a summer camp that specializes in neurological or cognitive disorders that is not on this list, please let us know by emailing ken@tourette.ca and we will update it.

Camps in Alberta

TSFC Edmonton Chapter Day Camp for kids ages 8-10
TSFC Edmonton Chapter Day Camp for kids ages 11-13
Overnight TS Adventure Camp (TSFC Edmonton Chapter partnership with Centre for Outdoor Education)
Camp Amicus
Camp Bonaventure
Camp Health, Hope & Happiness
Camp Tamarack

Camps in BC

Eureka Outdoor Camp
Venture Academy

Camps in New Brunswick

Camp Rotary

Camps in Nova Scotia

Camp Reachability

Camps in Ontario

Camp Concord
Camp Kennebec
Camp Kirk
Camp Kodiak
Camp Prospect
Camp Tamarack
Camp Winston
Camp Zodiac
Kinark Outdoor Centre
New Stride Day Camp
Ontario Pioneer Camp (Christian)

Camps in Saskatchewan

Camp Tamarack

 

Ask Dr. Ticcy Resources

Ask Dr. Ticcy: My Daughter Just Got Diagnosed, And I Don’t Know What To Do!


scared momDear Dr. Ticcy,

My daughter was just diagnosed with TS. I don’t know what to do. I am a teacher but I don’t have experience with TS. Please help!

From,
Newly Diagnosed

Hearing that your son or daughter has TS can be confusing, and downright scary, for anyone, even those of us with a medical or education background!

What should you do?

First, take a close look at the Tourette Syndrome Foundation of Canada (TSFC)’s website www.tourette.ca

Since you are just beginning to learn about the complex condition that is Tourette Syndrome, you can be easily fall victim to information overload. This is why the TSFC website is helpful. The “Learn” section, accessible from the main menu, has many short and to the point information summaries.

Second, purchase or obtain a copy of the TSFC’s Handbook for Families. This is a comprehensive guide to all things Tourette Syndrome and it is written for moms and dads by experts and parents. You can purchase a copy online here.

Next, connect with your local chapter or resource unit. You can email them directly by getting their email at www.tourette.ca or you can ask the National Office to connect you by sending a request to tsfc@tourette.ca. No chapter in your area? No problem, let the National Office know, and they will try to connect you with the closest available volunteer.

If you would like “virtual” support, visit the TSFC’s online forum by clicking the “Forum” option at www.tourette.ca. Signing onto the forum enables you to post questions, participate in discussions, and read about what other parents of kids with TS are thinking and feeling.

In terms of medical treatment, there are a few things to keep in mind…

You may want your son or daughter to see a specialist on an ongoing basis. If you do not yet have specialist appointment but would like to know of a specialist in your area, email tsfc@tourette.ca.

To learn more about possible treatments, take a look at the Canadian Guidelines for the Evidence-based Treatment of Tourette Syndrome, available as a free PDF download here or as a softcover book here.

A few points to remember as you start your journey of learning about TS:

  1. TS is not fatal! You cannot die from it!
  2. While tics may be severe now, many adults (though not everyone) experience less tics as they age.
  3. TS does not have to “hold” a person back—many people with TS are lawyers, surgeons, singers, dancers, computer scientists, teachers and so on. Individuals who do find that their disorder or combination of disorders affect their employment decisions still have many options. For example, a person with TS and OCD may opt for a work-from-home job to accommodate their conditions.
  4. You not alone: many other parents are in the same situation or have been in the same situation.

The TSFC is here to help you through this challenging time.

Let them know if you need help by calling or emailing. A staff member or volunteer will provide you with assistance directly and/or refer you to another organization that can help.

Best wishes to you and your daughter (or son for those of you with sons in the same situation as Newly Diagnosed),

Dr. Ticcy

Dr. Ticcy is a pseudonym for the TSFC National Office, which draws on information from experts across Canada and beyond to answer questions from the TS community. Please send your questions to tsfc@tourette.ca with the salutation “Dear Dr. Ticcy.”

 

Ask Dr. Ticcy Children/Youth Resources

Ask Dr. Ticcy: How do I deal with my child’s coprolalia?


Dear Dr. Ticcy,

How do I deal with my child’s coprolalia?

Thanks,
Perplexed Parent

 

Dear Perplexed,

First, let’s ensure that you and all of our readers fully understand coprolalia.

It is a type of vocal tic that involves involuntary utterances of socially inappropriate language, be it swearing or something politically incorrect or hurtful. It is not just a “swearing tic.” It may include but is not limited to commenting negatively on someone’s physical appearance and racial slurs.

This is not intentional. If I were to touch a hot stove element, I might say a bad swear word involuntarily. The same thing happens to a child with coprolalia. They say it without meaning to and often feel guilty for doing so.

Because the element of intentionality is absent, the meaning of the swearing or socially inappropriate language is not the same. That said, it is still appropriate to encourage a child to apologize for hurt feelings with the understanding that though they did nothing wrong, they are still responsible for the outcomes of their action(s).

Many parents are confused about when a child is performing a tic and when they are acting out. It is hard to tell in certain situations, and unfortunately, there is no definitive way to know for sure.

Here are some steps to assess the situation, which will help you to respond appropriately:

1. Talk to your child: ask whether this was a tic.

2. Consider the context: what happened right before the tic? Did you just tell the child they couldn’t go to the movies because their room was dirty? If so, it may not be coprolalia. Not every situation is that clear cut, however, so it is still important to consider lead-up events as this may help you to learn your child’s triggers.

3. Err on the side of compassion: it is better to believe that it is coprolalia and be wrong than the reverse. The reverse may mean punishing the child for something they had no control over.

Once you assess it to be an instance of coprolalia, consider the advice of author Ross Greene. Greene advises us to think about the why.

Why did the child swear?

Answer: They have a medical condition.

The answer to the why informs your response: the child has a problem—a medical condition—but they are not the problem themselves.

What should you do?

Work together on changing the words to something else. For example, instead of f—, the child could say Ferrari or fudge.

Allow the child to move to a quiet space where they can let their tics out without disrupting others.

Consider ignoring the words and move on quickly once the child has a chance to give a brief apology.

Teach the rest of the class or family members about the tics and learn to re-direct the situation as much as possible. For example, if you say pass the potatoes and the response is a socially inappropriate vocal tic, simply move on without drawing attention to the matter. Someone else can pass the potatoes if the child is still symptomatic or the child can pass the potatoes themselves.

Thank you for your great question, keep ‘em coming!

Sincerely,
Dr. Ticcy

Dr. Ticcy is a pseudonym for the TSFC National Office, which draws on information from experts across Canada and beyond to answer questions from the TS community. Please send your questions to tsfc@tourette.ca with the salutation “Dear Dr. Ticcy.”

Ask Dr. Ticcy Resources Tic Treatments

Ask Dr. Ticcy: Can magnets help treat TS?


Dear Dr. Ticcy,

I heard that doctors are now using magnets to treat TS. Is this true? Is the treatment available in Canada?

Sincerely,
Curious

 

Dear Curious,

Low frequency repetitive transcranial magnetic stimulation (rTMS) is a relatively new procedure. It uses magnetic fields to simulate nerve cells in the brain. Doctors place an electromagnet on the scalp over the supplementary motor area. Next, they activate the magnet for short periods sending pulses of magnetic waves into the brain. The goal is to help to reduce tics through altering the rhythms in the brain. While the treatment is non-invasive, there is a risk of seizures particularly if someone has had seizures in the past.

This treatment was recently tested on individuals with TS in a clinical trial sponsored by the New York State Psychiatric Institute. It is also undergoing testing at several other facilities throughout the world including China and Germany.

Because this is a new treatment, the TSFC cannot endorse it at this time. The choice to undergo treatment is ultimately your own.

Your second question about whether rTMS is available in Canada does not have an easy answer. The TSFC has not been in contact with anyone who performs this treatment, however, this is one of the topics we are looking into for the upcoming National Conference on TS+ on September 26-28, 2013.

A search of the Internet indicates there are some medical centres offering this treatment in Canada, however, according their website, they offer the treatment for depression, OCD and other conditions, but not TS. To learn more, visit www.mindcarecentres.com.

A note about cost: rTMS is not covered by provincial health plans. A course of treatment is estimated to cost $5,000-$7,500 dollars. Extended insurance providers may cover the treatment on a case-by-case basis.

Sincerely,
Dr. Ticcy

Dr. Ticcy is a pseudonym for the TSFC National Office, which draws on information from experts across Canada and beyond to answer questions from the TS community. Please send your questions to tsfc@tourette.ca with the salutation “Dear Dr. Ticcy.”

Children/Youth Resources Tic Treatments

Strategies for Coping with Tics & Compulsions in the Winter


This blog article, by RuthieP, was originally posted on New Jersey Center for Tourette Syndrome’s Teens4TS Blog and is republished here with kind permission.

So I was hoping to put off having to implement my usual winter strategies for a little bit longer, but it’s really getting cold outside where I live, and my usual compulsion/tic combo that gets bad in the winter is on a rampage. Every year in the winter since I was 4 or 5 years old, I’ve have a lot of issues with my lips and with picking.

Every winter is when my tics with my lips get really bad. Some of the things I do with my lips edge more toward the compulsion side of the spectrum, and some edge more toward the tic side of the spectrum. In the winter time, I bite skin off my lips, I lick my lips, I rub my hands against my lips, I rub my shirt sleeve against my lips, and I pick skin off my lips. I also pick on my skin on my ears more in the winter as well.

I’m not exactly sure why this particular combo of tics and compulsions gets so bad in the winter time, but its probably a combination of the fact that it’s cold outside and I’m more stressed in the winter time because I have more homework and tests. So in the winter, I usually have to implement two important strategies to try keep my lips from constantly chapping and bleeding and to try keep the skin on my ears healthy.

The first strategy is that I try to keep the Bert’s Bees chapstick with peppermint on my lips almost 24/7. Bert’s Bees chapstick with peppermint is actually the only chapstick that I am able to use, because all other chapsticks really bother my Sensory Processing Disorder and are just intolerable. The Bert’s Bees helps keep my lips moist, helps me keep my hands off my lips, and helps me keep from biting and licking my lips.

Sometimes though the tic/compulsion is too strong for the Bert’s Bees to keep me from doing my lip tics/compulsions so that’s where strategy No. 2 comes in. Strategy No. 2 is to keep at least two rubber bands on my wrist at all times. When the urge to pick, bite, lick, or rub my lips is too strong, and I notice myself starting to do these things, I pull the rubber band on my wrist back and snap it against my skin.

It doesn’t hurt too much, but over time it helps me associate the tic/compulsion with negative pain. Also the rubber bands on my wrist can help keep my hands busy if I fidget with the rubber bands. While this doesn’t completely stop the tics/compulsions associated with my lips and with picking my skin, it does help reduce them.

In the past, though, these strategies haven’t been completely effective and many times during the winter i’ve given up with them and just stopped using them because of frustration that they don’t help as much as I’d hoped.

So today is the first day this year that I’ve started to implement these strategies. Hopefully they will be more effective this year than they have been in the past. Wish me luck! And maybe if you have similar tics/compulsions to these that I just mentioned, you can try out these strategies and see if they help for you.

Ask Dr. Ticcy Resources Tic Treatments

Ask Dr. Ticcy: Beta Blockers for TS?


Dear Dr. Ticcy,

Is there any evidence for the use of beta blockers to treat tics?
Thanks!
Christina

 

Dear Christina,

Beta blockers are very effective for—and are the first-line treatment for—a movement disorder known as Essential Tremor, or ET. While ET and TS are both common neurological conditions, they have distinct characteristics and treatment also varies greatly.

ET typically affects older Canadians, while TS initially affects young Canadians in most cases, and the movements associated with tremors are vastly different from the premonitory tics that define Tourette Syndrome. So while beta blockers have been demonstrated to significantly improve symptoms of ET, no such evidence has emerged suggesting that they reduce tic frequency or severity. Instead, the newest Canadian Clinical Guidelines recommends a number of other medications, such as haloperidol, an antipsychotic, for children, and tetrabenazine for adults. It should be noted that the guidelines strongly recommend non-pharmacological treatments for TS, including Habit Reversal Therapy (HRT) and Exposure and Response Prevention (ERP).

The new guidelines will be made available to the public later this year through the TSFC.

Sincerely,
Dr. Ticcy

Dr. Ticcy is a pseudonym for the TSFC National Office, which draws on information from experts across Canada and beyond to answer questions from the TS community. Please send your questions to tsfc@tourette.ca with the salutation “Dear Dr. Ticcy.”

Children/Youth Resources

Conquering Back-To-School Anxiety — Part 3


Strategies & Interventions

There are a number of intervention strategies for combating school avoidance, many more than can be discussed here. The following provides a brief overview. If you suspect that your child or a child you work with is struggling with school avoidance, speak to a professional counsellor, doctor or psychologist to obtain more information.

For students whose avoidance behaviour is driven by depression, effective interventions may include cognitive behavioural therapy, prescription medication, gradual re-entry to school and rewards for school attendance.

A different approach might be take for separation anxiety-driven school avoidance behaviour. Teachers can encourage students to bring a “transitional object” from home (e.g. a favourite stuffed animal) and to take a special object home from school, such a drawing or a book, during the first couple of weeks of school to help the student feel more comfortable. Parents can pre-arrange a particular time when their son or daughter gets to call home. For example, the student might get to phone home once they finish their work in a particular class.  Allowing students to phone home to report success tends to be more effective than a cold turkey approach or permitting the student to call whenever they feel the need to do so. If possible, parents can also try to systematically increase the amount of time their son or daughter is separated from them while in the home or outside of school. Morning drop-off can be particularly challenging for children with separation anxiety, so if possible, parents should consider having someone else drop off their child to make it easier for the child to separate and enter the school.

There are several strategies that teachers can employ in the classroom to help children with social/performance anxiety-driven school avoidance. Children with this particular difficulty may require additional adult support during interactions with peers, lunch hour and during transitions. During new or novel situations, teachers can help students with social anxiety disorder by providing them with specific instructions. For example, a teacher could tell the student, “When we get to on our field trip tomorrow, you can help by checking off each student’s name as they get on and off the bus.” Because presentations are a source of panic and anxiety, it is a good idea for the teacher to allow anxious students to watch others do their presentations before asking them to get up in front of the class. Together with the student, teaching staff should plan what the student should do when they feel panicky. This plan may include breathing techniques (e.g. diaphragmatic breathing for 10 breaths), thinking about how a good friend might handle the same situation, exiting the classroom for a brief walk, standing out in the hall for a few moments, and/or going to the office or special education resource room.

This is the final part of a three-part daily series on back-to-school anxiety. If you have a topic that you would like us to cover in the future, please let us know.

We wish all of our young ones the very best at school this year. Be aware of your needs, be ready to speak up, and most of all, believe in yourself!

Children/Youth Resources

Conquering Back-To-School Anxiety — Part 2


Causes

As always, in order to understand how to combat the problem, we first need to understand its causes. “Understanding the reasons that students avoid school is the first step in getting them to return,” writes school psychologist Mary Wimmer. In her 2008 article entitled “Why Kids Refuse to Go to School,” Wimmer stresses that school refusal or school avoidance can’t be attributed to a single cause, it results from a complex mix of factors including mental health problems, family issues and the school environment.

Mental health challenges, whether anxiety, depression, Oppositional Defiance Disorder (ODD), Obsessive Compulsive Disorder, Panic Disorder or some combination of these, account for 90% of the cases of school refusal. According to authors Packer & Pruitt (2010), anxiety, more specifically Separation Anxiety, Generalized Anxiety Disorder, and Social/Performance Anxiety, is the leading cause of school avoidance behaviour, affecting 22% of school refusers.

Children with Separation Anxiety are usually very young, tend to be preoccupied with the possibility of harm befalling loved ones, and are overly dependent on their parents or caregivers. Social or Performance Anxiety, which accounts for 3.5% of school avoidances cases, is slightly different. Rather than worrying about loved ones, this type of anxiety disorder manifests itself as intense fear of judgement from others. As a result, children with this condition typically experience extreme nervousness prior to test taking, making presentations and participating in sports. Generalized Anxiety Disorder (GAD), a diagnosis received by 10.5 % of children affected by school phobia, refers to excessive anxiety and worry about any number of different events and situations. Just like individuals with Performance Anxiety, students who struggle with GAD are usually very unsure of themselves. Unlike cases of performance anxiety, individuals with GAD are perfectionists about their schoolwork; they may also consider the world to be a threatening place. This type of anxiety is associated with secondary health problems including fatigue, restlessness, irritability, sleep problems and muscle tension.

In about 4.9% of case of school avoidance, depression is a primary casual factor. The presence of depression in school refusers is very serious as it is associated with very severe symptoms: self-mutilation, suicidal ideation, suicide attempts and uncontrolled worry.

In addition to mental health problems, scholars also point to school-based factors as drivers of school avoidance behaviour. Large class sizes, an authoritarian style of school management, a high level of discipline problems in school, large groups of low-achieving older students and school violence all can contribute to a student’s anxiety and worry about attending school.

These variables may be compounded by family factors as well. Unfortunately, identifying these factors in a specific case can be extremely difficult. “Parents of students who refuse to go to school for emotional reasons are a diverse group,” writes Wimmer. Some parents of school avoiders are healthy and high functioning, while others struggle with dependency, anxiety, depression, substance abuse, high levels of conflict, and/or emotional detachment. Specific events in the family can trigger school refusal behaviour including prolonged illness, a death of a parent, a vacation or even a weekend.

This is part two of a three-part daily series on back-to-school anxiety. Part three will be published on Friday.

Children/Youth Resources

Conquering Back-To-School Anxiety — Part 1


Fall is fast approaching, and in a few short days, it will be that time again—time to pick up the books, pack the school bag and head back to school!

For many school-aged children, it’s an exciting time—a chance to catch up with friends, swap stories about the summer, sport new outfits and show off new school supplies. It is important to remember, however, that not every child feels this way. For some kids, the prospect of returning to school is unsettling, even dreadful. Rather than feeling excitement, they feel intense fear and anxiety leading them to declare, “I hate school” or “I really, really don’t want to go to school.”

The layperson’s term for this phenomenon is “back-to-school anxiety.” Scholars of the subject call it school phobia, school avoidance or school refusal. Simply defined, these terms refer to any anxiety and fear associated with going to school that can result in a pattern of avoidance of, or refusal to attend, school. This is not to be confused with a dislike of or desire to avoid schoolwork. Quite the opposite; according to one scholar, “Those with true school refusal…are usually willing to complete school work as long as it’s done at home.”

School phobia/avoidance is no small problem. Studies suggest that it affects between 2-5% of all school-age children, with the highest incidence occurring among children between the ages of 5 and 6 (age 6 also happens to be the average age when someone with TS first starts experiencing symptoms).

Left unaddressed, school phobia can have serious consequences. In the short-term, it can lead to poor academic performance, parental conflict, and diminishing peer relationships. In the long-term, it can result in academic failure, school dropout and employment difficulties.

So, what can be done about it? Can it be curbed? Eliminated? Prevented? If so, how?

This is part one of a three-part daily series on back-to-school anxiety. Parts two and three will be published tomorrow and Friday, respectively.