American Medical Association Family Medical Guide - American Medical Association [189]
Most children with Tourette syndrome also display the hallmark symptoms of ADHD (inattention, hyperactivity, and impulsiveness) and obsessive-compulsive disorder (intrusive thoughts that trigger compulsive and repetitive actions). Their poor impulse control and inability to control anger can lead to outbursts of temper and aggressive behavior. Some children with the disorder injure themselves by biting, scratching, hitting, or banging their head.
Diagnosis and Treatment
Doctors diagnose Tourette syndrome from a thorough medical history, a physical examination, and the observation of tics. The presence of ADHD and obsessive-compulsive disorder and a family history of related symptoms confirm the diagnosis.
The treatment of Tourette syndrome depends on the child’s particular symptoms. Behavior modification techniques may be used to try to reverse the habit of expressing a tic, to correct behavior problems, or to prevent the compulsive behavior triggered by an obsessive thought.
Doctors usually prescribe medications when the child’s symptoms are so severe that they interfere with relationships with friends, school performance, or daily activities. In general, doctors target the most bothersome symptoms first. The tics themselves may be treated with medications called neuroleptics (such as haloperidol or pimozide), which block dopamine receptors in the brain. ADHD is treated with central nervous system stimulants such as methylphenidate. Obsessive-compulsive disorder is treated with serotonin reuptake inhibitors (SSRIs) such as fluoxetine, fluvoxamine, or sertraline.
Try to minimize your child’s exposure to stress, because stress can make the condition worse. Be careful not to scold your child for his or her uncontrollable behavior, because scolding can increase your child’s distress. Talk to your child’s teachers to make sure they understand the condition, and ask if they can make any changes in the school environment that would make it easier for your child. For example, educating your child’s peers about Tourette syndrome through a video presentation might make your child more accepted in school.
Sleep Problems
In the early weeks of life, many babies wake every 2 or 3 hours to feed, even during the night. But by the time they are 9 months old, most babies sleep through the night without waking. At 1 year of age, babies sleep an average of about 16 out of every 24 hours; about 3 of these 16 hours are used for two daily naps. By the time they are about 15 to 18 months old, many babies go from two naps a day to one.
By toddler stage (about 18 months old), children begin to vary in the amount of sleep they need. Some toddlers wake up very early each morning, are very active during the day, may not take an afternoon nap, and do not become tired until bedtime. Other toddlers may need an afternoon nap to get through the rest of the day. By age 3, many children no longer take an afternoon nap, and by age 5, nearly all children stay awake throughout the day.
Difficulty falling asleep or sleeping through the night
Some children may have difficulty falling asleep or sleeping through the night. If this occurs, try not to make yourself too easily available, because your child could come to expect the attention and have more difficulty falling asleep and staying asleep. For example, if your baby cries after being fed at night, do not immediately go and pick him or her up. Instead, listen for a few minutes outside the door of his or her room. He or she will probably stop crying after a few minutes and go back to sleep. If the crying continues, go in to check on the baby, but don’t play with him or her. Meet the baby’s needs (for example, by feeding him or her or changing a diaper) and then leave the room.
Make sure your child isn’t sleeping too much during the day. Establish a bedtime routine. Read a bedtime story. Eliminate unnecessary noise such as an older sibling repeatedly entering the bedroom. Sometimes leaving a radio playing music softly or tuned to static (white noise) will help mask disturbing