The case is presented of a 12-year-old boy who was diagnosed with Tourette syndrome (TS) when he was 8 years of age. The variability of symptoms manifested with the syndrome and the comorbidity of other related disorders were explored by developmental history, parent interviews, survey results, functional analysis and direct observations. The article considers the individual variability of symptoms and the ramifications of this variability in caring for a child with TS. It discusses the difficulties with intervention because of the inherent characteristics of the disorder. The case argues for more expansive attention to be given to a psycho- educational approach in meeting the needs of children with TS.
Achenbach, T.M.
, & Edelbrock, C.S. (1983). Manual for the child behavior checklist. Burlington: University of Vermont.
2.
American Psychiatric Association
(1994). DSM IV: diagnostic and statistical manual of mental disorders (4th edn). Washington DC: Author.
3.
Azrin, N.H.
, & Nunn, R.G. (1973). Habit-reversal: a method of eliminating nervous habits and tics. Behaviour Therapy, 11, 169-180.
4.
Azrin, N.H.
, & Peterson, A.L. (1990). Treatment of Tourette syndrome by habit reversal: a waiting-list control group comparison. Behaviour Therapy, 21, 305-318.
5.
Barkley, R.A.
(1991). Attention-deficit hyperactivity disorder: A clinical workbook. New York: Guilford.
6.
Bronheim, S.
(1991). An educator’s guide to Tourette syndrome. Journal of Learning Disabilities, 24(1), 17-22.
7.
Bruun, R.D.
, & Budman, C. (1993). The natural history of Gilles de la Tourette Syndrome. In R. Kurlan (Ed.), Handbook of Tourette’s syndrome and related tic and behavioural disorders (pp. 27-42). New York: Marcel Dekker.
8.
Burd, L.
, & Kerbeshian, J. (1992). Educational management of children with Tourette syndrome. In T.N. Chase, A.J. Friedhoff, & D.J. Cohen (Eds.), Advances in neurology (Vol. 58, pp. 311-317). New York: Raven Press.
9.
Champion, L.M.
, Fulton, W.A., & Shady, G.A. (1988). Tourette syndrome and social functioning in a Canadian population. Neuroscience and Biobehavioral Reviews, 12, 255-257.
10.
Chee, K.
, & Sachdev, P. (1994). The clinical features of Tourette’s disorder: an Australian study using a structured interview schedule. Australian and New Zealand Journal of Psychiatry, 28, 313-318.
11.
Cohen, D.
, Detlor, J., Shaywitz, B., & Leckman, J. (1982). Interaction of biological and psychological factors in the natural history of Tourette syndrome: a paradigm for childhood neuropsychiatric disorders. In A.J. Friedhoff, & T.N. Chase (Eds.), Advances in neurology (Vol. 35, pp. 31-40). New York: Raven Press.
12.
Cohen, D.J.
, Friedhoff, J.F., Leckman, J.F., & Chase, T.N. (1992). Tourette syndrome: extending basic research to clinical care. In T.N. Chase, A.J. Friedhoff, & D.J. Cohen (Eds.), Advances in neurology (Vol. 58, pp. 341-362). New York: Raven Press.
13.
Comings, D.E.
, & Comings, B.G. (1987). A controlled study of Tourette syndrome. I: Attention-deficit disorder, learning disorders and social problems. American Journal of Human Genetics, 41, 701-741.
14.
Comings, D.E.
, & Comings, B.G. (1993). Comorbid behavioural disorders. In R. Kurlan (Ed.), Handbook of Tourette’s syndrome and related tic and behavioral disorders (pp. 111-147). New York: Marcel Dekker.
15.
Como, P.G.
(1993). Neuropsychological testing. In R. Kurlan (Ed.), Handbook of Tourette’s syndrome and related tic and behavioral disorders (pp. 221-239). New York: Marcel Dekker.
16.
Earls, F.
(1992). Psychosocial factors in Tourette Syndrome. In T.N. Chase, A.J. Friedhoff, & D.J. Cohen (Eds.), Advances in neurology (Vol. 58, pp. 55-59). New York: Raven Press.
17.
Edelbrock, C.S.
(1989). Childhood conduct problems: developmental considerations and a proposed taxonomy. Unpublished manuscript, University of Massachusetts Medical Center, Worcester.
18.
Finney, J.W.
, Rapoff, M.A., Hall, C.L., & Christophersen, E.R. (1983). Replication and social validation of habit reversal treatment for tics. Behavior Therapy, 14, 116-124.
19.
Fuata, P.
, & Griffiths, R.A. (1992). Cognitive behavioural treatment of a vocal tic. Behaviour Change, 9(1), 14-18.
20.
Gaffney, G.R
, Sieg, K., & Hellings, J. (1994). The MOVES: a self-rating scale for Tourette’s syndrome. Journal of Child and Adolescent Psychopharmacology, 4, 269-280.
21.
Goetz, C.G.
, Tanner, C.M., Stebbins, G.T., Leipzig, G., & Carr, W.C. (1992). Adult tics in Gilles de la Tourette’s syndrome: description and risk factors. Neurology, 42, 784-788.
22.
Goldenberg, J.N.
, Brown, S.B., & Weiner, W.J. (1994). Coprolalia in younger patients with Gilles de la Tourette syndrome. Movement Disorders, 9, 622-625.
23.
Grossman, H.Y.
, Mostofsky, D.I., & Harrison, R.H. (1986). Psychological aspects of Gilles de la Tourette syndrome. Journal of Clinical Psychology, 42, 228-235.
24.
Jankovic, J.
(1993). Tourette’s syndrome: phenomenology, pathophysiology, genetics, epidemiology, and treatment. Current Neurology, 13, 207-209.
25.
Kane, M.J.
(1994). Premonitory urges as attentional tics in Tourette’s syndrome. American Academy of Child and Adolescent Psychiatry, 33, 805-808.
26.
Kurlan, R.
(1989). Tourette’s syndrome: current concepts. Neurology, 39, 1625-1630.
27.
Kurlan, R.
(1992). Tourette syndrome in a special education population: hypotheses. In T.N. Chase, A.J. Friedhoff, & D.J. Cohen (Eds.), Advances in neurology (Vol. 58, pp. 75-81). New York: Raven Press.
28.
Lagiewka-Cook, R.P.N.
, Goulet, J.L., Wand, R., & Shady, G. (1993). Tourette syndrome: a psychoeducational presentation. AXON, 89-91.
29.
Lang, A.E.
(1993). Premonitory (‘sensory’) experiences. In R. Kurlan (Ed.), Handbook of Tourette’s syndrome and related tic and behavioral disorders (pp. 17-25). New York: Marcel Dekker.
30.
Leckman, J.F.
, Dolnansky, E.S., Hardin, M.T., Clubb, M., Walkup, J.T., Stevenson, M.A., & Pauls, D.L. (1990). Perinatal factors in the expression of Tourette’s syndrome: an exploratory study. Journal of American Academy of Child and Adolescent Psychiatry, 29, 220-226.
31.
Lombroso, P.J.
, Mack, G., Scahill, L., King, R.A., & Leckman, J.F. (1991). Exacerbation of Gilles de la Tourette’s syndrome associated with thermal stress: a family study. Neurology, 41, 1984-1987.
O’Neill, R.E.
, Horner, R.H., Albin, R.W., Storey, K., & Sprague, J.R. (1990). Functional analysis of problem behavior. Sycamore, NY: Sycamore Publishing House.
34.
Park, S.
, Como, P.G., Lu Cui, & Kurlan, R. (1993). The early course of the Tourette’s syndrome clinical spectrum. Neurology, 43, 1712-1714.
35.
Pauls, D.L.
, & Leckman, J.F. (1986). The inheritance of Gilles de la Tourette’s syndrome and associated behaviours: evidence for autosomal dominant transmission. New England Journal of Medicine, 315, 993-997.
36.
Peterson, A.L.
, & Azrin, N.H. (1992). An evaluation of behavioral treatments for Tourette syndrome. Behaviour Research and Therapy, 30, 167-174.
37.
Prinz, R.
, Foster, S.L., Kent, R.N., & O’Leary, K.D. (1979). Multivariate assessment of conflict in distressed and nondistressed mother–adolescent dyads. Journal of Applied Behavior Analysis, 12, 691-700.
38.
Robertson, M.M.
(1989). Gilles de la Tourette syndrome – the current status. British Journal of Psychiatry, 154, 147-169.
39.
Robertson, M.M.
(1994). Annotation: Gilles de la Tourette syndrome – an update. Journal of Child Psychology and Psychiatry, 35, 597-611.
40.
Sachdev, P.
(1994). Tourette syndrome survey. Sydney: The Prince Henry Hospital.
41.
Sachdev, P.
(1995). Epidemiology: diagnosis and natural history: an overview of Tourette syndrome. Paper presented at the 2nd Australian Conference on Tourette Syndrome and Related Disorders, Park Royal Hotel, Sydney, April.
42.
Santangelo, S.I.
, Pauls, D.L., Goldstein, J.M., Faraone, S.V., Tsuang, M.T., & Leckman, J.F. (1994). Tourette’s syndrome: what are the influences of gender and comorbid obsessive–compulsive disorder?Journal of American Academy of Child and Adolescent Psychiatry, 33, 795-804.
43.
Scahill, L.
, Ort, S.I., & Hardin, M.T. (1993). Tourette’s syndrome, part I: definition and diagnosis. Archives of Psychiatric Nursing, 7, 203-208.
44.
Shapiro, A.K.
, & Shapiro, E.S. (1982). Tourette syndrome: history and present status. In A.J. Friedhoff, & T.N. Chase (Eds.), Advances in neurology (Vol. 35, pp. 17-23). New York: Raven Press.
45.
Shapiro, A.K.
, Shapiro, E.S., Bruun, R.D., & Sweet, R.D. (1978). Gilles de la Tourette syndrome. New York: Raven Press.
46.
Silva, R.R.
, Munoz, D.M., Barickman, J., & Friedhoff, A.J. (1995). Environmental factors and related fluctuation of symptoms in children and adolescents with Tourette’s disorder. Journal of Child Psychology and Psychiatry, 36, 305-312.
47.
Singer, H.S.
, & Rosenberg, L.A. (1989). Development of behavioral and emotional problems in Tourette syndrome. Pediatric Neurology, 5, 41-44.
48.
Stefl, M.E.
, & Rubin, M. (1985). Tourette syndrome in the classroom: special problem, special needs. Journal of School Health, 55, 72-76.
