Disruptive Behaviors

Overview

Children with Tourette Syndrome often display behavioral challenges. These may be due to deficits caused by common related disorders such as dysinhibition, ADD, obsessive/compulsive difficulties, anxiety, rage, sensory integration deficits, learning challenges, etc. It’s important to understand the reason for the challenging behavior in order to assist the child learn to live successfully with this complex disorder.

Explosive Outbursts and Tourette

An interactive and informative webinar on “Outbursts, Rage, and Tourette” hosted by the Tourette Health and Education Program. Explosive outbursts of anger or “rage attacks”, are a common and major cause of morbidity for children and adults with TS.

This presentation will explore:
• Characteristics of explosive outbursts in TS
• Impulse control issues that occur with TS
• Special attention will be paid towards treatment strategies

Dr. Cathy L. Budman discusses Transitioning Back to School: Explosive Outbursts and TS.

Disinhibition and Tourette

The complexities of Tourette and Tic Disorders can be difficult to understand. Often, individuals with Tourette and Tic Disorders are unable to restrain their behavior and will act in such a way that oversteps boundaries of social conventions or may seem impulsive. It is important to know that these behaviors are not willful. This condition is referred to as disinhibition.

Inconsistent Ability to Inhibit Behaviors

Inconsistent ability to inhibit behaviors, motor and vocal, occurs in people with neurological disorders, resulting in a reduced ability to inhibit behaviors even when the individual intellectually understand they are being inappropriate. In effect, it becomes extremely difficult to use their learned inhibitory skills “in the moment.” To say it a different way, the braking system in their brain fails. This inconsistent system failure may result in involuntary behaviors such as being disrespectful, making inappropriate statements, exhibiting behaviors that are not “socially acceptable,” emotional outbursts, silliness, contextual swearing, rage, oppositional behaviors, etc.

Being “Out of Control”

This can be compared to the difficulty we all experience when we occasionally become overwhelmed by a particular event that causes us to act in a manner that may be seen as being “out of control.” Think about how you would respond if you were hurrying to get to an important appointment and you came out to find that your car had a flat tire. You may say things that under normal circumstances you would not say. At that moment, your mental braking system fails and your inhibitory process is not functioning in a manner that is more typical for you. It’s not that you don’t know how to respond appropriately, it’s that you may not be capable of doing that “in the moment” due to difficulty with inhibiting.

Occurrences in Children

For children with TS, this phenomenon occurs more frequently, AND inconsistently. For instance, a student who is capable of completing simple math may become oppositional if given a sheet of 100 questions at the end of the day. Since this difficulty is inconsistent (as most symptoms are), this feeling of being overwhelmed may come at times that are not immediately obvious to the casual observer.

It may also occur as a result of a suggestion that the behavior is prohibited. Telling someone NOT to do something actually puts the thought in the person’s brain and may result in the reverse effect. Basically it becomes more difficult to inhibit. Consider a child who has repeated eye-blinking tics. Is it helpful to continually remind the person not to blink? Of course not; it would make it more difficult.

Providing Understanding and Support

Some youth with TS will have inappropriate tics or behaviors due to disinhibition, which may result in extreme social isolation because of inappropriate statements or vulgarity. If a student is demonstrating these types of behaviors, this is the time for the adults involved to help him or her with strategies to help modify these socially inappropriate behaviors. However, since symptoms are neurologically based, it must always be remembered that modifying symptoms can fall anywhere on the continuum from being absolutely impossible to modify, to difficult, to possible. Imagine being in a formal restaurant when suddenly you have a compelling urge to scratch the bottom of your foot. Think of your response if someone told you to modify your need to take your shoe and sock off in order to scratch your foot and instead to scratch your knee.

Understanding and support are essential at these difficult times. Choosing our battles is essential if we are to help children with TS. If students are involved in behaviors that will lead to being socially ostracized or resulting in physical self-damage, then it may be helpful to use positive and proactive strategies in an attempt to modify this behavior. However, in most cases the best approach is planned ignoring. Typically, symptoms are reduced in environments in which symptoms are ignored and the person feels accepted.

(Reprinted courtesy of Tourette Association of America)

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Cathy L. Budman, MD

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