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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.

Source: http://www.pediatricnursing.net/conf/handouts/2010/session_134_golder.pdf