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

Tim Howard

CreditEverton Football Club

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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

Teaching young patients how to quiet their tics

Tics are very common. We see tics in one in four, one in five children at some point in the first decade of life. Most of these kids don't have Tourette's syndrome," said Dr. Sam Zinner with Seattle Children's.

But Tyler most definitely did have Tourette's. His symptoms had persisted for more than a year.

But as worried as they were about Tyler's disorder, his parents were also concerned about treatment.

"We wanted to do it without medication," said Tyler's mother. "And so when we found Dr. Wiegand, it was life changing for our family."

"Comprehensive behavioral therapy for tics involves teaching kids competing responses to do something different with their muscles when the have the urge," said Dr. Jeffrey Wiegand with Seattle Children's.

"Originally I had head shakes back and forth, so what I do is I keep my neck stiff and I just keep my neck stiff until it's gone," said Tyler.

It took lots of practice. Tyler has lots of different tics.

"We're not looking for a cure. We're looking for finding a way to live with Tourette's syndrome," said Dr. Zinner.

"It's empowering to know that I am doing it all myself without taking drugs and I'm learning how to control it where I can use it later on in life," said Tyler.

He even gave a speech about it in class. Tyler still has Tourette's, but Tourette's no longer has him.

"We're really proud of Tyler. He has worked so hard his fears and his tics. He's just done an amazing job. He's an amazing kid," said Tyler's mom.

Seattle Children's is now training other health providers how to do this therapy.

Source: king5.com

"But Miss, I’ve got Tourette’s!”

"But Miss, I’ve got Tourette’s!”

Ruth Wadman and Georgina Jackson discuss the problems pupils with Tourette’s face in the classroom, and what schools can do to help

Tourette’s syndrome (TS) is an inherited neurological condition involving involuntary movements and vocalisations, “tics”, which persist for a year or more. As many as one school child in every hundred will have TS and boys are three to four times more likely to have TS than girls. Many will have only mild symptoms and may not have received a diagnosis. You may not think you have met a young person with TS, but you probably have.

The popular portrayal of adults with TS uttering obscene or socially inappropriate words and phrases (known as coprolalia) is unhelpful and misleading. Many children with TS find their tics lessen or disappear by the time they are 18 and only ten per cent of people with TS have coprolalia.   

Some individuals with TS do have symptoms that are disabling and that affect their education, social lives and economic prospects. However, milder symptoms often go unnoticed but still can have a detrimental impact on learning and relationships in school.

Our research, in partnership with the national charity Tourettes Action and funded by the Big Lottery Fund, has examined the personal, social and educational impact of TS. Students with TS, parents and school staff shared their experiences and insights by taking part in detailed interviews. We present some key findings from the research in this article. Crucially, our research has shown that TS is a complex condition that can be difficult to understand, and that schools can play a key role in helping students with this condition.

“A few of my teachers don’t really understand it. They don’t really know what tics I have, and some of them are like ‘stop it’ and I’m like ‘it’s a tic and I can’t help it’”. 11-year-old

Tics

Tics are sudden, rapid and uncontrollable sounds and movements. Tics can be simple, such as blinking, head jerking or coughing. Even simple tics are tiring and can cause damage to joints or self-injury. More complex tics, such as jumping and twirling, can seem purposeful but they are not. Complex vocal tics can involve uttering whole phrases that appear to be directed at others. These can be hugely embarrassing for the individual and it is important to remember that these utterances are not intentional.

“One of his tics was a racially offensive word. He didn’t even know he was saying it, and he certainly didn’t want to be saying it”. Mother

People with TS can feel an irresistible urge to tic, like the urge to scratch an itch.

“The feeling before the tic, it’s like a sneeze ‘cause you can’t really hold it back”. 16-year-old

However children, especially younger children, may not be aware of having these feelings. Some young people can hold back their tics for a period of time, but this is very effortful and feels uncomfortable.

Tics wax and wane; they can change in type, frequency and severity. They can get worse for a few weeks and then get better. Different tics can come and go for no reason.

“He tries to control his tics, but he can just get up one day and have a whole new different tic – so he has to start all over again”. Mother

Tics can be affected by periods of stress or stressful events. Many individuals report that their tics are different in different settings or at different times of day. Some students will have more tics at home than they have at school. Young people also report a reduction in tics when they take part in exercise or a pastime they enjoy such as playing music.

The changeable nature of tics can be confusing. It is important to understand exactly how TS affects the individual student.

Associated features

Most people with TS will have, or may develop, other conditions. Some students with TS will have one or two other diagnosed conditions, most commonly attention deficit hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD), but also autistic spectrum disorder (ASD). Other problems associated with TS include anxiety, self-injury, sleep disturbances and outbursts of anger. Therefore, a young person with TS may have a cocktail of symptoms.

“Teachers don’t understand the link between Tourette’s and all these other things – obsessive-compulsive stuff, attention issues and anger issues. They don’t grasp the connection and it’s a big connection”. 16-year-old

Tourette’s does not affect IQ and is not a learning disability.Tourette’s in school

TS does not affect IQ and is not a learning disability, but it can present barriers to learning. Tics tend to become most severe between the ages of ten and 12, so the transition into secondary education is a potentially difficult time. Our research focused on the experiences of students with TS in secondary school. The majority of young people we interviewed reported having difficulties concentrating in school.

“When the tics are really bad I can’t really concentrate on the work; I have to concentrate on keeping the tics in”.13-year-old.

Negative experiences with a small number of staff were, unfortunately, also a common experience. Students with forceful vocal tics can be seen as disruptive and may be told off or asked to stop tics. Young people do not find this helpful.

“He’s a clever boy and sometimes he is not able to produce very much at all but then other times he can do very well. Unfortunately we’ve had a few incidents with teachers telling him to stop ticcing or to ‘shut up’”.SENCO

TS can affect students in many different ways. Classwork, homework and examinations can all be adversely affected by tics. For example, hand or eye tics can interfere with writing, making it hard to complete work on time.

“She just couldn’t control the tics to do the homework… so we’d sit for three hours just to do a thirty minute piece of homework”. Mother

Some young people with TS will need support for learning. However, simply improving awareness and understanding of the condition in school can really help a student with TS to cope.     

Friends and peers

Most young people will have a good group of friends who understand TS and this group can help buffer against other social difficulties such as teasing. 

“He has some good friends, but when it comes to his peer group, they see him as a bit of a target because he stands out”. Father

Student with TS are vulnerable to ridicule, bullying and social exclusion but our research indicates that often this goes on unnoticed in schools.
Young people with TS also report having to deal with feelings of anxiety or feelings of anger in school, and these can also affect their relationships with others. Some students with TS may need social and/or emotional support in school.    

“He does get comments from other students and I know that they do mimic his noises, his tics – and that is something that we try to work with a lot now.”  Head of Year

Future prospects

Young people with TS worry about what will happen in the future, particularly about their employment prospects.

“I don’t want to be grown-up and still have Tourette’s ‘cause I’m scared that’ll stop me from getting a job or something”. 14-year-old

Positive work-related experiences in school can be very beneficial to young people with TS and their families.

“He had work experience and it went really, really well. I think that him and his parents were thinking is he ever going to be able to work, so work experience gave them a bit of hope”. SENCO   

How to help

TS is a complex condition and can affect young people in many different ways. Often, TS can affect students in ways that are not particularly noticeable in school.

“On the surface you wouldn’t think there was anything different about him; he’s good at hiding it. But I’ve learnt that it’s more than just tics and there is a lot of stuff going on in his head. So he may not always be fully engaged”. Teacher

Schools can find it difficult to understand which behaviours are involuntary tics and what may be more purposeful behaviours. 

“He sometimes makes animal sounds in lessons and then he gets in trouble. I need to explain that his noises are involuntary – he can’t help what he is doing”. Mother

Establishing good communication with the young person and the family can help schools to better support the student with TS:

• ask the student and the family about how TS affects him/her and how you can help
• find out what helped the student in his/her last school. Looking at how tics have been managed in the past can provide useful ideas about supporting the student
• it may be helpful to observe the student during the school day as tics can worsen in certain settings
• tics get worse when students are anxious, so good communication is crucial to explore concerns and create a sense of safety.

In the classroom:

• refrain from commenting on or responding visibly to tics whenever practical
• do not ask a student with TS not to tic
• consider appropriate behaviour management in light of the extent to which certain behaviours are not in the student’s control
• allow the student time out of lessons and a safe place to release tics, if needed
• be alert to potential mimicking, teasing and bullying
• be aware of any behavioural treatments or medication the student receives so that you can take account of any side effects and support the management strategies they have been taught.

Further information

Professor Georgina Jackson, lead investigator on the study discussed above, is Professor of Cognitive Neuropsychology, Division of Psychiatry and Applied Psychology, University of Nottingham. Dr Ruth Wadman, a Research Fellow in the department, carried out the research in schools and with families and young people:
www.nottingham.ac.uk

Advice and information on Tourette’s syndrome for teachers and parents is available from the charity Tourettes Action:
www.tourettes-action.org.uk

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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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Role for 6th Grader is his Life

When Jacob Johnson was six months old, he began constantly clearing his throat and coughing. Although he wouldn’t be diagnosed until he was five years old, those were the first signs of Tourette Syndrome.
Patricia and Christopher Johnson were concerned the enlarged lymph node on baby Jacob’s neck was causing problems with swallowing. They were referred to an ENT doctor who told them the lump would eventually disappear and was not causing any problems.
“Jacob’s doctor told us it was just a childhood habit and not to be concerned,” said Patricia.
Still, the couple continued to look for answers other than ‘childhood habit’ when Jacob continued clearing his throat and coughing every day all day. When Jacob was about four years old, he started to roll his eyes to the back of his head very severely. The Johnsons took their son back to the doctor, who thought Jacob had had a seizure or a brain tumor.
“We were then referred to Children’s Hospital in Milwaukee to a pediatric neurologist,” said Patricia. “The neurologist told us on our very first visit that she thought Jacob had Tourette Syndrome.”
The diagnosis isn’t that easy though. Tourette Syndrome is diagnosed by ruling out other issues such as seizures and tumors. Three criteria must be met. The first is experiencing motor and vocal tics, the second is that the tics must wax and wane, and the third is that the person must have the tics for at least one full year.
“Jacob went through numerous tests to rule out other issues,” said Patricia. “He has had psych-necrological testing, EEG, EKG, MRI, and a CAT scan.”
Jacob was officially diagnosed at the age of five. However, symptoms of Tourettes change and Jacob’s are always changing. Jacob either has had or now has neck tics, shoulder rolls, the need to tap on objects or people, tearing, toe and finger curling, facial flaring, arm flaring, and numerous other motor tics. Some of the motor tics cause a great deal of pain.
Vocal tics for Jacob have gone from the cough and clearing of his throat to a loud screech. He is experiencing Echolalia, which is repeating words he hears or things he reads.
Jacob tried numerous medications, but all but one of them had bad side effects for the youngster. One medication caused Jacob severe dystonic movements in his toes and fingers, meaning they curled and twisted them locked in that position. Christopher would leave work to go home and help Patricia take turns watching Jacob.
“It was so overwhelming, said Patricia. “We ended up finally recording him and took it to his neurologist to let her watch and see if she could suggest to help him through these horrible tics.”
Jacob was taken off the medication immediately, but a week was needed for the medication to work out of his system. Jacob is now considered allergic to all medications that can cause distonia. The only medication Jacob takes is a very low dose to help with his anxiety.

Jacob Johnson, center, was diagnosed with Tourette Syndrome at the age of five. He and his parents, Christopher and Patricia, are excited that this year’s Creative Dramatics play will focus on disabilities. Jacob helped write the play and will act the role of a student with Tourette Syndrome, who will be ridiculed for his disability but finds a circle of friends who also suffer from a disability, whether it’s a speech impediment, dyslexia, or something physical, such as needing a wheelchair. 

The family has lived in Horicon for approximately five years, moving to the City on the Marsh from Beaver Dam. The move has been great for Jacob and his family.
“The Beaver Dam school he was attending didn’t understand what Jacob was going through,” said Christopher. “It got so bad that, even though Jacob didn’t want to leave school, I was researching what we had to do to start home schooling him.”
Other students at Van Brunt Elementary School have been very understanding of Jacob’s Tourette Syndrome tics. Patricia said Youth Ambassador Paige Bani visited the Van Brunt second, third, and fourth graders and gave a presentation of Tourettes, with the help of Jacob.
“Paige got involved because her younger brother has it and her mother runs a support group,” said Patricia.
Jacob is comfortable talking about Tourettes, so much so that he has helped write the script for this year’s Creative Dramatics play. The students in the Horicon district write and act a play each year and it has to focus on problem-solving. Students this year chose children dealing with disabilities as the topic. Deb McGilvra is in charge of the program.
“She approached us to ask our thoughts because we have a child with multiple disabilities,” said Patricia. “She was a little worried that she may offend or hurt someone and wanted to do the play being very real but also being very sensitive to others and their feelings.”
McGilvra didn’t need to worry. Jacob, who will be involved in his third play, was receptive to the idea.
“It was something we discussed when we found out the play was going to be about kids with disabilities and I knew right away I wanted to take part and play, really, myself in the play,” said Jacob. “My family thought it was a great idea and encouraged me to do it.”
Jacob wanted to show what he’d been through in dealing with bullies and people who do not understand the noises he makes or things he says or does.
“We are always pushing him to advocate for himself, and what better way than to tell his story through a play,” said Patricia. “We were also so grateful to Mrs. McGilvra for bringing attention to what kids with disabilities go through during a normal school day.”
Jacob had fun helping to write the script. He said McGilvra was constantly checking with him to make sure he was okay with everything being mentioned. Patricia said McGilvra made it clear that anything Jacob was uncomfortable with would be changed or removed.
McGilvra isn’t the only supporter Jacob has. The 11-year-old said the others involved in Creative Dramatics have always supported him.
“Sage and Destiny and Casey and the others helped calm me down last summer when I was an actor for the first time,” said Jacob. “We are like a big family and everyone is so supportive of me and each other. When the others found out that I was playing a kid with Tourettes, they all clapped. It made me feel confident and excited.”
Outside of school, Jacob is involved in the Tourette Syndrome’s 5K walk, for which he received a ribbon. This year’s walk will take place May 31 at Voyageur Park in De Pere. Jacob met Dave Pittman from American Idol, who has Tourettes. Jacob will attend Camp Duncan this year, which will take place June 22 through 28. He was on hand at a health and safety fair in Oshkosh.
Jacob was surprised to receive a letter from Carolos Guevara, a contestant on X Factor who has Tourettes, thanking Jacob for his support. Jacob continues to correspond with some of Guevara’s family members through Facebook.
Patricia and Christopher hope the Creative Dramatics play will help others understand that although people have disabilities, all have something to contribute.
“I want to show them what Tourettes really is and also, if they meet someone who has Tourettes, they might understand and not judge or laugh at them,” said Jacob.
For more information on Tourette Syndrome, visit www.tsa-wisconsin.org.

Preprinted courtesy of Dodge County Pionier

Jacob Johnson poses with Deb McGilvra, who is the leader of Creative Dramatics. The students write a play, create the background, and act the roles. McGilvra made sure throughout the writing of the play that Jacob was comfortable with all aspects. She also wants to make sure the students have fun. 

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Researchers Uncover Mechanism Controlling Tourette Syndrome Tics

A mechanism in the brain which controls tics in children with Tourette Syndrome (TS) has been discovered by scientists at The University of Nottingham.

The study, which has been published in the British Psychological Society’s Journal of Neuropsychology, could herald new non-drug therapies to help young people with TS overcome the repetitive physical movements and vocal sounds which characterise their condition.

The work was funded with a £150,000 grant from the James Tudor Foundation and was carried out by PhD student Amelia Draper.

Professor Stephen Jackson, in the University’s School of Psychology, said: “This new study is very important as it indicates that motor and vocal tics in children may be controlled by brain changes that alter the excitability of brain cells ahead of voluntary movements. You can think of this as a bit like turning the volume down on an over-loud motor system. This is important as it suggests a mechanism that might lead to an effective non-pharmacological therapy for Tourette Syndrome.”

Brain re-structuring

The neurological condition TS affects around one child in every 100 and usually starts during early childhood. Scientists believe that the tics that affect children with TS are caused by faulty wiring in the brain that leads to hyper excitability in the brain regions controlling motor function.

In adolescence, there is a period of ‘pruning back’ in which redundant brain connections are removed and other structural and functional brain changes occur.

During this time, around one-third of children with TS will find that their tics disappear and another third are able to more effectively control their tics. Unfortunately, the remaining third of individuals will see little or no change in their tics and are likely to remain troubled by their TS symptoms into adulthood.

This clinical observation suggests that there are mechanisms in the brain that are involved in controlling tics and undergo development or re-organisation during the teenage years.

Amelia Draper added: “The research is based on the general hypothesis that an area in the brain called the striatum is overactive as a result of alterations in the early development of the brain. As a result, the signals that are relayed to the brain’s cortex region lead to hyper-excitability and cause tics to occur.

“We have looked at how that hyperactivity and the resultant tics might be controlled by finding a way to ‘turn down the volume’ on that ‘cortical excitability’. This is potentially extremely important as the parents of children with tics are desperate to find a safe and effective therapy that is an alternative to drug treatments.”

Unwanted movements

In the current study the team used a method called Transcranial Magnetic Stimulation (TMS) in which a magnetic field is passed over the brain to produce a weak electrical current which stimulates motor function to induce a twitch response.

By delivering TMS at different points in time as participants were about to undertake a hand movement, the researchers were able to measure alterations in brain excitability ahead of the movement and chart the differences between each person.

The study showed that subjects with TS, unlike those of a similar age without the condition, were least able to modulate the hyperactivity in the brain.

Professor Jackson said: “If there is a relationship between this cortical excitability or hyperactivity and tics then this is really important as it means that there may be something that we might be able to do to help children with TS to better control these unwanted movements.”

Further research by the team has involved the use of a similar type of brain stimulation called transcranial direct current stimulation (TDCS) to study the brains of children with TS. Early results suggest that TDS can be applied to decrease neuronal excitability and this may be effective in suppressing tics for extended periods. In addition, if another form of TDCS is applied, one that increases neuronal excitability, it may act to improve learning and memory function, particularly in the context of behavioural therapies. Following use of these treatments lasting effects can be applied to the brain.

Effective and longer lasting

If proven to be effective, the technology could be adapted into a TENS machine-style device that would offer a cheap, portable and individualized therapy for children with TS.

Professor Jackson added: “For the one-third of people who aren’t going to get better this could offer them a much needed assistance with controlling their tics, while relying less on other conventional pharmaceutical therapies which can have associated side effects such as weight gain or tiredness.

“It can be applied at home while the child is watching TV or eating their cornflakes so it would reduce the amount of school they would miss and potentially we can use the TDCS to both control the tics and make that control more effective and longer lasting.”

As part of her work Amelia Draper is also using MRI scanning technology to examine the potential relationship between cortical excitability and a brain chemical that appears to be strongly linked to neuronal excitability in TS.

Rod Shaw, Chief Executive of the James Tudor Foundation, said: “We’re glad to see that the funding we have given to this project is producing some interesting and potentially useful results.”

Professor Jackson’s research is a key project within the University’s appeal, Impact: The Nottingham Campaign, which is delivering the University’s vision to change lives, tackle global issues and shape the future

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Tourette’s Disorder Symptoms

The essential features of Tourette’s Disorder are multiple motor tics and one or more vocal tics, expressing themselves many times a day. These may appear simultaneously or at different periods during the illness.

The anatomical location, number, frequency, complexity, and severity of the tics change over time. The tics typically involve the head and, frequently, other parts of the body, such as the torso and upper and lower limbs. The vocal tics include various words or sounds such as clicks, grunts, yelps, barks, sniffs, snorts, and coughs.

Coprolalia, a complex vocal tic involving the uttering of obscenities, is present in a few individuals (less than 10%) with this disorder.

Complex motor tics involving touching, squatting, deep knee bends, retracing steps, and twirling when walking may be present. In approximately one-half the individuals with this disorder, the first symptoms to appear are bouts of a single tic, most frequently eye blinking, less frequently tics involving another part of the face or the body. Initial symptoms can also include tongue protrusion, squatting, sniffing, hopping, skipping, throat clearing, stuttering, uttering sounds or words, and coprolalia. The other cases begin with multiple symptoms.

Specific Symptoms of Tourette’s Disorder

• Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently. (A tic is a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization.)
• The tics occur many times a day (usually in bouts) nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months.
• The disturbance causes marked distress or significant impairment in social, occupational, or other important areas of functioning.
• The onset is before age 18 years.
• The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington’s disease or postviral encephalitis).

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What are your tic triggers?

When someone talks about what causes TS, they’re usually referring to the underlying genetic factors that lead a person to be born with it. But when a person talks about what triggers a tic, that’s entirely different. They want to know the proximate or immediate cause of a tic.

So what does trigger tics? Do any patterns exist, or is it different for everyone? Well, to start with, it’s helpful to divide tic triggers into three categories: environment, ingested or dietary items, and mood/feelings.

When the Association for Comprehensive NeuroTherapy surveyed people about what triggered their tics, it’s no surprise that stress was the most common response. In addition to stress, anxiety, excitement (good or bad) and feeling sick or hungry are also known triggers or factors that can contribute to increased ticcing.

In terms of dietary or ingested items, common tic triggers include: caffeine, alcohol, sweets, sodas, artificial colors and flavors, certain foods like dairy, oranges, gluten, preservatives, monosodium glutamate, and dust and pollen.

For some (not everyone), ADHD medications can worsen tics. The Canadian Guidelines for the Evidence-based Treatment of Tourette Syndrome states that when people first start taking Ritalin or Methylphenidate or their dosage increases, their tics may worsen. It also states that worsening of tics may occur with doses of Dextroamphetamine (Dexedrine or Dextrostat) that are higher than or equal to 25 mg per day.

Video games, light (flashing, bright or fluorescent), cell phone use, smoke or smoking, scented products, computer use, stadium or amusement park lights, watching TV or movies (especially in the dark) are also triggers for tics in some people.

What are your tic triggers? Do you know what they are? Do you ever record them? Have you ever tried to eliminate them? If so, did this reduce your tics? Please leave a comment below.

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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.

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