Tim Howard’s ‘The Keeper’ Tells That Athlete’s Story

Tim Howard

CreditEverton Football Club

If you want to know what one of his spectacular crashes feels like, Evel Knievel once told a reporter, strap on a helmet and sit on the hood of a car. Have someone get that car up to 90 miles per hour. “Then you hold your nose and fall off,” he said.Continue reading the main storyShare This Page

If you want to know what it’s like to be a professional goalkeeper, I’ve long suspected, arrange for a line of cannons to fire twisting soccer balls at your head and private bits at speeds approaching 100 m.p.h. A miss can be disastrous.

This is a reality Tim Howard confirms in his new memoir, “The Keeper.” He describes watching his onetime teammate Landon Donovan kick a ball so hard that, had the opposing team’s keeper not ducked at the last second, “his head might have gone into the goal along with the ball.”

You’ve got to be cool and quick to be a high-level goalkeeper, and few are cooler or quicker than Mr. Howard. You remember him. He was the bearded keeper on the United States men’s national team during last summer’s World Cup in Brazil, a man who made so many dramatic saves (and set a tournament record during a game against Belgium) with such a nonchalant affect that he became a hero to millions, this writer included.

Mr. Howard writes about that surreal time: “My assistant, Amber, showed me the ‘Things Tim Howard Could Save’ memes that had been popping up all over the Internet. There I was, saving the Titanic. Saving a swimmer from the shark in ‘Jaws.’ Saving Janet Jackson from her Super Bowl wardrobe malfunction.” On the Wikipedia page for secretary of defense, someone briefly substituted Mr. Howard’s name for Chuck Hagel’s.

There were many reasons to root for Mr. Howard. He was raised by a single mother in an apartment complex in North Brunswick, N.J. His father, a long-haul trucker, had moved out before his son could form any memories of him.

Mr. Howard grew up with obsessive-compulsive disorder and Tourette’s syndrome. His disorders have manifested themselves, throughout his life, in facial and speech tics, in compulsive behavior and in extreme sensitivity to noise, touch and light.

You root for his book, too. While soccer memoirs are a staple on international best-seller lists, we don’t see many of them in this country. Soccer is a second- or third-tier sport in the United States, and books about it are mostly aimed at the coaches of children’s leagues.

I don’t want to oversell “The Keeper.” It’s a quickie, composed in a few months with the help of a co-writer, Ali Benjamin. To read the book, you will require a certain tolerance for sports clichés. But a good story gets told. My 13-year-old self would have read it straight through three times. My 49-year-old self was happy enough to polish it off in an afternoon, with lumps forming only two or three times in his throat.

Don’t come to “The Keeper” for the gritty and libidinous details about what it’s like to play professional soccer in the English Premier League, where Mr. Howard was a goalkeeper for Manchester United before moving to Everton, his current team.

This isn’t a soccer-world update of “Ball Four.” There are no nightclubs, no drugs and — despite the fact that Mr. Howard gets married and divorced in the course of the book — no WAGs, the British term for the often eye-popping “wives and girlfriends” of players. Mr. Howard’s book is mostly about hard men on a difficult mission, and as such it can be nearly as single-minded as Ernest Shackleton’s diary.

Mr. Howard was 10, and doing poorly in school, when symptoms of obsessive-compulsive disorder and Tourette’s began to appear. He was compelled to clear his throat constantly, to roll his eyes and to jerk. At one stage he had to touch people before he could speak to them.

“With each of them, it was the same pattern: that awful sensation welling up, the one that could only be relieved, inexplicably, by some action,” he writes. “As soon as I did it, I felt normal again. Seconds later, the cycle would repeat itself.”

A doctor tells his mother that there is often “a flip side” to Tourette’s, an unexpected benefit. In Mr. Howard’s case, it was a kind of Zen calm and an ability to see things on the soccer field that others seemingly could not. “I could see the flicker of a striker’s eyes before he pivoted,” he writes. “Sometimes I even saw it in time to warn my defender.”

He was a big, strong kid on the field, and he caught the eye of coaches. His mom drove him everywhere to play, often staying in third-rate hotels and eating peanut butter and jelly sandwiches made with store brands because she couldn’t afford anything more.

Mr. Howard played for America’s Youth National Team and skipped college (he was still a poor student) to sign with a low-level professional team, the New Jersey Imperials. He earned $13,000 a year and felt rich.

After a few years, he caught the eye of Manchester United, where his salary leapt to more than $1 million a year. The British news media greeted his arrival with tittering headlines like this one, from The Guardian: “United Want American With Brain Disorder.” He won over Manchester fans, however. In the stands, they began to sing a ditty about him, to the tune of “Chim Chim Cher-ee” from “Mary Poppins”:

“Tim Timminy, Tim Timminy, Tim Tim-eroo We’ve got Tim Howard and ... ”

Well, the rest is unprintable here.

Mr. Howard eventually lost his starting position in Manchester, and he never felt truly at home until he went to play at Everton, a smaller, scrappier Premier League team in Liverpool. He’s gone on to be an importantadvocate for children with Tourette’s syndrome.

He’ll be 39 by the time the next World Cup rolls around, ancient for a soccer player, yet he hopes to be on the field. He remembers a phone call from President Obama after the last one. “I don’t know how you are going to survive the mobs when you come back home, man,” he recalls Mr. Obama saying to him. “You’ll have to shave your beard so they don’t know who you are.” We’d know Tim Howard, either way.

Source:NyTimes

New approach for those with Tourette Syndrome being tested in clinical trials

Medical researchers are hopeful that a new investigational drug being tested in clinical trials will prove to be an effective treatment for Tourette Syndrome – an inherited, misdiagnosed, misunderstood neurological disorder that presents in childhood and causes involuntary motor and vocal tics.

The new drug, AZD5213, targets the human histamine H3 receptor.  In the brain, this receptor regulates neurotransmitters associated with Tourette Syndrome – including dopamine and histamine.A mutation that affects histamine synthesis was recently confirmed to be the cause of TS in a father and all eight of his children, a finding supported by research in mice.

If approved for treatment of Tourette, AZD5213 might represent an alternative to antipsychotics, which don’t work well in all patients and can cause serious negative side effects.  Discovered by AstraZeneca, AZD5213 has been shown to have a favorable safety profile, with no serious drug-related side effects reported in Phase 1 and Phase 2 clinical trials completed at the time of this report.

“AZD5213 represents an exciting new approach to the treatment of Tourette Syndrome, and we are currently recruiting teenagers suffering from the disorder to participate in the clinical trial,” says Dr. Roger Kurlan, Director of the Movement Disorders Program at Overlook Medical Center’s Atlantic Neuroscience Institute in Summit, N.J.

Dr. Kurlan, who frequently collaborates with the NJ Center for Tourette Syndrome & Associated Disorders (NJCTS) in Somerville, N.J., is a leading expert in the treatment of Tourette and is one of approximately six medical researchers involved in the clinical trial.

AZD5213 already has been studied in other clinical trials, including those for Alzheimer’s disease. With Tourette Syndrome, which is associated with changes in brain chemistry that appear to cause the characteristic symptoms of the disorder, AZD5213 might be able to counteract these changes – with the potential to provide symptomatic relief with less of the negative side effects associated with existing treatments.  More than 200 human subjects have already received single or multiple doses of AZD5213, with no serious drug-related adverse side effects.

The clinical trial is a 6-month, multicenter, randomized, safety, tolerability, pharmacokinetic, and preliminary efficacy study of AZD5213 in adolescents 12 to 17 years of age with Tourette Syndrome. The trial includes an up to 21-day screening period, 6 months of once-daily treatment with placebo or AZD5213, and a 3-week follow-up period.

Because of the crossover design of the trial, all enrolled patients will receive AZD5213 for at least part of the trial. Approximately 24 subjects will be treated in this study.  Safety will be carefully ensured by a battery of safety tests administered at visits throughout the study, and efficacy will be determined by means of questionnaires designed to assess the severity of symptoms associated with Tourette Syndrome.

According to the Centers for Disease Control and Prevention (CDC), 1 in 100 children show signs of Tourette Syndrome. The disorder is three times as likely in boys as in girls, and most patients experience their worst symptoms in their early teen years. There is no cure, and symptoms can persist throughout life – although most patients see improvement as they approach and enter adulthood.

Exaggerated portrayals of Tourette Syndrome have been used for comic relief in films and TV shows, usually featuring characters who shout obscenities involuntarily. In reality, this type of verbal tic – known as coprolalia – is present in only 10 to 15 percent of those with TS.

“In real life, Tourette’s is no laughing matter,” Dr. Kurlan says. “These patients often struggle with self-esteem and socialization issues, which generally arise at a crucial time in their social development. Sadly, many are victims of bullying and the ridicule of their peers.”

Tourette’s is most often present in combination with other neurological disorders, such as attention deficit-hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD), and Tourette’s patients are commonly troubled by depression, anxiety and developmental delays.

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P.A.N.D.A.S.

“PANDAS” is an acronym for “Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.” Although the relationship between infection and movement disorders was noted hundreds of years ago, scientists began studying it in the early 1990′s. The findings have been contentious, with some researchers arguing that PANDAS is not really a unique disorder, while others arguing that it is. PANDAS is not listed in the current or proposed diagnostic manual for mental health disorders. The term PANDAS is generally used to describe a subgroup of children who have either a tic disorder (such as Tourette’s Syndrome) or Obsessive-Compulsive Disorder and whose tics, obsessions, and/or compulsions typically worsen dramatically following streptococcal infections or children who have no prior history or tics, obsessions, and compulsions but who suddenly “explode” in symptoms following a Group A ß-hemolytic streptococcal infection. It is important to keep in mind that the symptoms of Tourette’s Syndrome and OCD do tend to go through periods of exacerbation (“waxing cycles”) and that most waxing cycles are not due to infection. PANDAS is thought to affect perhaps 10-15% of children with Tourette’s and/or OCD. What parents refer to as “strep throat” is one form of streptococcal infection. In some cases, parents may be aware that their child had a strep throat in the recent past, but in other cases, the child may have (or have had) a strep infection without it being detected. While research has focused on bacterial infections, there are clinical reports of viral infections also being associated with acute onset or dramatic exacerbation of OCD or Tourette’s Syndrome. There are also clinical reports that suggest that it may not just be tics and obsessive-compulsive symptoms that are acutely worsened. Some reports also suggest that children or teens who have this PANDAS problem may also experience acute-onset or worsening of separation anxiety and mood problems, and that PANDAS may also be linked to ADHD. PANDAS is thought to represent a type of auto-immune problem: instead of the body’s antibodies fighting an infection, they attack the healthy cells in the basal ganglia of the brain, causing the acute worsening of symptoms. There is not much for educators to know other than on a practical level, if the student does have PANDAS, expect that their symptoms will be significantly worse following an infection and that more accommodations may need to be provided. Source

Research Update: The Genetics of TS and OCD

The genetic architecture of TS is largely unknown. Geneticists agree that TS is indeed a hereditary or genetic condition, meaning it is passed down from parent to child. Beyond that, little is understood about the topic. Researchers have long sought to understand which genes specifically cause TS.

Scientists continue to make strides in answering this question with the latest breakthrough coming from a team researchers from Massachusetts General Hospital and the University of Chicago. These scientists published a report in the October issue of PLOS Genetics, which contained the first direct confirmation that both OCD and TS are highly heritable (or very inheritable). The report also discusses some major differences in the genetic makeup of the two conditions as well with OCD heritability being concentrated in specific chromosomes and TS heritability being spread among many different chromosomes.

According to one of the co-authors of the report, finding the exact genes responsible for TS is similar to trying to locate the proverbial needle in a haystack. This research attempted to narrow down where in this genetic haystack there might be needles. In doing so, this work demonstrated that the majority of genetic susceptibility to both TS and OCD can be discovered using what is called the GWAS or genome wide association study method. The study confirmed that 20% of the genetic susceptibility of TS come from rare variants. In contrast, OCD derives all its susceptibility from common variants. That said, both TS and OCD have “shared genetic liability.”

Additional investigations of these findings could help scientists to identify the affected genes and better understand how the expression changes contributes to someone having TS and OCD. Further down the road, a greater understanding of the genetic origins of these conditions could contribute to the development of new therapeutic approaches.

To read the full article click the link below

here:http://www.plosgenetics.org/article/info%3Adoi%2F10.1371%2Fjournal.pgen.1003864

Source

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Where tics and compulsions meet: TS plus OCD

Tourette Syndrome and Obsessive Compulsive Disorder often occur together.  In fact, the Centers of Disease Control and Prevention states that more than one-third of persons with Tourette Syndrome also have Obsessive Compulsive Disorder.

Often, tics and compulsions can look similar and be difficult to distinguish. Actually, to an observer it may be impossible to determine whether a behavior is a compulsion or a tic without asking the person performing the behavior and even then it may remain a mystery. The key to distinguishing a tic from a compulsion is the motivation behind the act.

As an example, lets break down a simple motor tic which could very well be a simple compulsive behaviour .  The behavior is blowing on the back of the right hand. If the behavior is a tic the person may feel a premonitory urge to perform the tic.

The premonitory urge could be a tickle on the hand, a sensation in the elbow joint prompting the movement, a sensation in the lips to purse, a feeling in the chest prompting a need to exhale a breath.  Premonitory sensations may be any feeling or urge that prompts the tic, creating the itch that needs to be scratched. The person scratches that itch and the tic is performed.

If the behavior is a compulsion, the person is prompted by a different mechanism to perform the exact same behavior.  The person may have an obsession that there may be dust on the back of the hand, a thought that they may need to blow on the back of the hand to prevent something bad from happening, a feeling of anxiety or emotional unease unless they blow on the back of their right hand. The person then performs the behavior, (not a tic), and temporarily relieves the uneasiness or anxiety.

As you see from this scenario, the behavior from the outside observer is identical.

To the person, the behavior may be triggered from and performed for very different reasons.  It could also be that the person themselves may be unaware of the difference as well.

Distinguishing the “why” the behaviour occurs requires some cognitive awareness, maturity and insight.  A child, for example, may not be able to determine the “why” and just know that they have to do the act.  A person with many tics and compulsions may have a low reserve of mental energy to distinguish the “why” of the behavior.

A person who has little understanding or insight about their differences may also be unable articulate whether they are compelled due to anxiety to perform the act or if the act is a sudden, intermittent, unpredictable, repetitive, nonrhythmic movement that is classified as a tic.

Now lets throw more uncertainty into the simple blowing on the back of the right hand. Perhaps this tic or compulsion is linked with another behavior.

For example, the person has established that the blowing on the back of the right hand is a tic but immediately after performing the tic they are compelled to do it over until it feels just right.  Now the behavior may be motivated by anxiety and the following act is a compulsion.  So the person blows on the back of the hand twice, once performing a tic, the second time because of a compulsion but both times in the exact same way. Alternatively, it may be the opposite, where the initial act is a compulsion which then triggers the tic.

And to make it more confusing, it may not be the exact same behavior, it may be any other tic or compulsion. For example, the person may be compelled to jiggle the door handle to make sure it is locked and then perform a tic by knocking on the door. The combinations may be endless and the compulsions and tics may interact in very intricate ways.

So why may it important to distinguish a tic from a compulsion? Sometimes it may not be. If the tic or compulsion is not intrusive, disruptive or bothersome to the person performing it, knowing the motivation for the behaviour may not be important to them.  If the person is bothered by the act, motivation is important in terms of modifying or extinguishing the behaviour.

Obsessive compulsive disorder may be treated using Exposure and Response Prevention, (ERP) and Cognitive Behavioral Therapy, (CBT). Tics may be treated or modified using Cognitive Behavioural Intervention for Tics, (CBIT).

Both of these therapies require gaining insight about the motivation that drives the behavior and thus determining whether it is a tic or a compulsion. The insight lays the groundwork for the appropriate behavioral intervention. But, not only is knowledge and understanding important for therapy, it helps us to better understand who we are, how our brains work and why we do what we do which will contribute to our overall self-awareness and emotional well-being.

Source

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The ‘extra’ factor

Sam Findlay and his mother, Claire, who is the co-ordinator of the North Yorkshire Tourette’s Action support group

TOURETTE'S Syndrome can often be misunderstood but people must think before they react, Claire Findlay tells health reporter Kate Liptrot.

When told her eight-year-old son, Sam, had Tourette's Syndrome, Claire Findlay and her family struggled to cope with the diagnosis.

“It’s difficult coming to terms with it in the first place,” she said. “The process of coming to terms with and researching Sam’s condition has been a long one. We are still learning new things all the time and it’s been eight years.”

The difficulty in knowing what to do next is an experience faced by many families dealing with the sometimes socially challenging neurological condition thought to affect one schoolchild in every 100.

Tourette’s Syndrome is characterised by a combination of involuntary noises and movements called tics, but the condition can be different for each person and can often be linked to other conditions such as OCD and ADHD. For Sam, Tourette’s Syndrome means he often repeats actions or phrases, and can involuntarily swear.

Now 16, he is doing very well – studying to be a chef at York College, with ambitions to run his own restaurant, and working part-time in the kitchens of the Melbourne Arms near Pocklington.

But it has been a long journey for Sam, who was told to stop coming into a previous job because the manager said he was making “annoying noises” and was sometimes deliberately goaded by other children at school, triggering his tics to the extent it would hurt him. The problem became so bad he had to wear boxing training gloves to school at one stage to avoid harming himself.

“Sam would come through the door having been so wound up on the bus he was hitting things, hitting the walls, not through temper but through the tic,” Claire said.

“School life for Sam was not easy. It was very difficult in the beginning to make school understand that what Sam was doing was not his fault.

“While we were coming to terms with it, we had school constantly telling him off and on one occasion telling us to take him home. They just didn’t know how to deal with it.

“Sam experienced a quiet period with his tics until he was 11 when they exploded.

“Needless to say, the school didn’t cope very well at first and it’s been a bumpy ride ever since, although through it all we had a close relationship with his head of year and she has been brilliant along with some other key members of staff.

“Awareness in education is so important. It took years to find the strength to fight for Sam, to make sure he got the education he deserved.”

When she looks back at home videos, Claire can see the signs of Sam’s Tourette’s Syndrome as young as three or four-years-old through his blinking, nose rubbing and sniffing.

Diagnosed with ADHD at six, his tics seemed to be triggered by his medication for the condition, and he was diagnosed with Tourette’s Syndrome two years later.

His family has found many people working with young people – from teachers to doctors – often have little understanding of his condition.

But it was about two years ago, after years of the family coping on their own, Claire said they started meeting other people with the condition through the charity Tourette’s Action.

“I have met so many fantastic people who have either been through, are going through, or are just about to start the journey we are on,” Claire said. “I can’t explain how it feels to be in the company of this new family. Everyone just gets it. There are no explanations, no judgement and no stress.”

Claire, her husband, Adam, and Sam now coordinate The North Yorkshire Tourette’s Action support group and Sam has featured in last year’s series of The Food Hospital, which worked on his diet to make a difference to his condition.

To the families of other children diagnosed with Tourette’s Syndrome, Claire said: “Remember they are still the same child. They have not changed. It just happens there’s a little bit something extra there that is never going to be the same as it changes all the time. Take it as it comes.”

Tourette’s Syndrome The facts

• Someone with TS may be able to suppress their tics for a period but eventually they have to let them out

• Tics usually start in childhood at about the age of seven, and are usually worst between ten to 12 years. In approximately half cases, most symptoms disappear by the age of 18

• More than 85 per cent of people with TS have more than just tics. Additional conditions include obsessive compulsive disorder (OCD) as well as attention deficit hyperactivity disorder (ADHD). Children and adults may also suffer from “rages”

• Affects include copropraxia, the making of obscene or otherwise unacceptable movements or gestures; coprolalia, using obscene or unacceptable language; coprophenomena, the involuntary expression of socially unacceptable words or gestures and echophenomena - repeating other people’s words and other people’s gestures (echopraxia)

• It is commonly assumed that everybody with TS swears. However, only ten per cent of people with TS have a swearing tic.

Source

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Tourette’s Syndrome: Comorbid Disorders

Tourette Syndrome (TS) often occurs with other related conditions (also called co-occurring conditions). These conditions can include:

 attention-deficit/hyperactivity disorder (ADHD) obsessive-compulsive disorder (OCD)
, Mood disorders such as depression and Bipolar Disorder and other behavioral or conduct problems,
  and non-OCD anxiety disorders

People with TS and related conditions can be at higher risk for learning, behavioral, and social problems.

The symptoms of other disorders can complicate the diagnosis and treatment of TS and create extra challenges for people with TS and their families, educators, and health professionals.

Findings from a national Centers for Disease Control and Prevention (CDC) study1 indicated that 79% of children who had been diagnosed with TS also had been diagnosed with at least one additional mental health, behavioral, or developmental condition based on parent report.

Among children with TS:

64% had ADHD.

43% had behavioral problems, such as oppositional defiant disorder (ODD) or conduct disorder (CD).

40% had anxiety problems.

36% had depression.

28% had a developmental delay

Because co-occurring conditions are so common among people with TS, it is important for doctors to assess every child with TS for other conditions and problems.

Source:http://www.cdc.gov/ncbddd/tourette/otherconcerns.html

http://www.schoolbehavior.com/disorders/tourettes-syndrome/tourettes-syndrome-comorbid-or-associated-disorders/