Review current literature on TS with an emphasis on the diagnostic criteria and symptomology, as well
as identify prevalence and etiology of the disorder. Explore and identify co morbidity conditions
Identify current treatment practices for TS
Identify implications for the future pediatric nurse or school nurse role and practice for children and families affected by TS.
Exhibited chronic motor and vocalization tics
patients with motor & vocal ticsHis major contribution was to clearly define this movement disorder
Multiple motor tics and one or more vocal tics.
American Psychiatric Association (2000) defines tics
“sudden, rapid, recurrent, nonrhythmic, stereotyped
motor movements and vocalizations” (p.108).
Substance abuseAny other underlying medical conditions
Can experience a combination of different tics OR
Frequency of tics does not indicate severity of TS
This is because many of the tics are intermittent
Motor & vocal tics occur several times a day for
TS is based on whether the tics are simple, complex, or a combination of the two
Severity & frequency of tics is different for each child
Onset of phonic tics occurs much later than motor tics
Some tics barely noticeableSome tics occur 30-100 repetitions in a minute
60% of all cases may have a hereditary link
Autosomal dominant trait (Gelmann & Selekman, 2006)
The earlier a child is affected, the more severe the
Males are 4 times as likely to exhibit symptoms than
Pediatric autoimmune neuropsychiatric disorders
associated with streptococcal infections (PANDAS)
Neurotransmitter responsible for transmitting information
Chronic group A beta-hemolytic streptococcal infections
Decreases brain activity in the basal ganglia, which then
Abnormal levels trigger the development of tics
decreases the production & use of dopamine (Cavanna, Servo, Monaco, & Robertson, 2009). Present with an abrupt onset of motor tics that occurs with strep infectionContinued periods of remission & exacerbation
90% of children diagnosed with TS have one or
10-20% of school age children have transient motor
Attention-deficit hyperactivity disorder (ADHD)
Anxiety disordersBehavioral/emotional problems
2-12% of children diagnosed with ADHD have TS
50% of children who develop TS early in life will
outgrow the tics by age 18 (Shapiro, 2002)
These children often experience an increase in tics
Related to brain maturation after pubescence
Alternative expression of the TS gene, which links these
two conditions together (Gaze et al, 2006)
ADHD & OCD will continue with ticsBased on severity of co-morbid conditions
Tics may increase during periods of excitement,
Some children will show an increase in tics due to no
Present for one year with no tic-free periods greater
than 3 monthsTics may decrease during periods of sleepIncreased fidgeting Difficulty concentrating
4 main components of treatment for tics associated
Treatment depends on severity of tics & any
2. Understanding of the disorder and concerns with
3. Collaborating with family members4. Understanding treatment modalities
Block dopamine production, which controls tics
Inhibit dopamine production, which suppresses tics
Many undesirable side effects, such as sedative effect, weight gain, impaired cognitive ability, extra pyramidal
Tics are involuntary, but children can be taught
techniques to suppress or decrease the negative effects of ticsTeaching child & family how to avoid triggers, then provide techniques to lessen the severity and occurrence of ticsFamily supportSchool interventions
Psychological problems can occur due to TS
Due to rejection, isolation, bullying, etc.
Provides clear instructions for school personnel
Educating students and school personnel on TS
Start of medication regimeMonitor every month for 3 monthsMonitor every 6 months while receiving treatment
TS children are more prone to experience violence
Reinforcing socially acceptable behaviors in classroom
Conducive to positive learning environment
Focus on empowerment & conflict resolution
Maintain open communication with families
National Institute of Neurological Disorders and Stroke
National Tourette Syndrome Association, Inc.
TS is a debilitating neurobehavioral disorder that begins in early childhoodDiagnosis is difficultTreatment is essential to well-being of child and family
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders
Golder, T. (2010). Tourette syndrome: Information for School Nurses. Journal of School Nursing, 26(1), 11-17. doi: 10.1177/1059840509343113.
Cavanna, A., Servo, S., Monaco, F., Robertson, M. (2009). The behavioral spectrum of Gilles de
Harvard Health Publications (2009, March). Understanding the risks of antipsychotic treatment
la Tourette syndrome. Journal of Neuropsychiatry and Clinical Neurosciences, 21(1), 13-23.
in young people. Harvard Mental Health Letter, 25(9), 1-4.
Christner, B. & Dieker, L. (2008). Tourette syndrome: A collaborative approach focused on
Himle, M., Woods, D., Piacentini, J., & Walkup, J. (2006). Brief review of habit reversal training
empowering students, families, and teachers. Teaching Exceptional Children, 40(5), 44-51.
for Tourette Syndrome. Journal of child Neurology, 21, 719-725.
Gaze, C., Kepley, H., & Walkup, J. (2006). Co-occurring psychiatric disorders in children and
Jimenez-Shahed, J. (2008). Tourette syndrome explained. Pediatric Academic Society, 24(12),
adolescents with Tourette syndrome. Journal of Child Neurology, 21(8), 657-664.
Gelmann, G., & Selekman, J. (2006). Mental Health Concerns. In Selekman, J. (Ed.) in School nursing: A comprehensive text (pp. 781-809). Philadelphia: F.A. Davis Company.
McDonagh, J. (2009). Growing up in school with a chronic condition. British Journal of School
Gilbert, D. (2006). Treatment of children and adolescents with tics and Tourette syndrome.
Journal of Child Neurology, 21(8), 690-700.
National Institute of Neurological Disorders and Stroke (2008). Tourette Syndrome Fact Sheet.
Ondo, W., Jong, D., & Davis, A. (2008). Comparison of weight gain in treatments for Tourette
syndrome; Tetrabenazine versus neuroleptic drug. Journal of Child Neurology, 23 (4), 435- 437.
Shapiro, N. (2002). “Dude, you don’t have Tourette’s”. Tourette syndrome, beyond the tics.
Pediatric Nursing, 22(3), 243-253.
Whitted, K., & Dupper, D. (2005). Best practices for preventing or reducing bullying in schools.
Children & School, 27(3), 168-175.
NACIONES Convención sobre los Derechos del Niño COMITÉ DE LOS DERECHOS DEL NIÑO 50º período de sesiones EXAMEN DE LOS INFORMES PRESENTADOS POR LOS ESTADOS PARTES EN VIRTUD DEL ARTÍCULO 44 DE LA CONVENCIÓN Observaciones finales El Comité examinó el segundo informe periódico del Chad (CRC/C/TCD/2) en sus sesiones 1374ª y 1375ª (CRC/C/SR.1374 y 1375), celebrad
Please send your compositions as a separate attached file, Times New Roman, size 12. Your paragraphs should have “sangria” of “primera línea” CORRECTION CODE COMPOSITION CORRECTION Capital/small Letter Suffix incorrect Add suffix Spelling Wrong word Change word order Add one word Add two words etc. (?) – The teacher does not understand