Often, parents of ASD-diagnosed children question whether their child may also have Tourette's Syndrome (TS). TS is a neurological condition characterized by repeated and uncontrollable tics or vocalizations or both. This syndrome is diagnosed symptomatically, as there is no laboratory test to confirm the diagnosis. Signs include:
Involuntary tics that are impossible to control for any extended period of time
Tics that appear in repeated and consistent patterns
Several motor and vocal tics that may or may not appear simultaneously
Symptoms that occur for more than one year
Symptoms that increase or decrease in severity over time
Symptoms that manifest before the age of eighteen or twenty-one, depending on diagnostic criteria
TS was first documented in the nineteenth century by Georges Gilles de la Tourette, a French physician. It is considered a spectrum disorder in itself, with different degrees of severity. Some people with TS have barely noticeable symptoms; others have problems with normal daily activities because the rapid movements associated with this condition interfere to a great degree.
There is controversy and confusion about whether the incidence of Tourette's is higher in children who have ASD, despite the fact that no known link has been proven. Some of the symptoms of Tourette's appear very much the same as the symptoms of autism, thus adding to the confusion. Some confusion also exists in diagnosing TS, because TS and obsessive-compulsive disorder (OCD) are linked and OCD and ASD are also linked.
Coprolalia and Copropraxia
One of the most recognizable symptoms of Tourette's syndrome is coprolalia—the uncontrollable utterance of obscenities. However, this is seen less in children with autism due to their communication issues. It is often combined with a gross motor tic called copropraxia, which is the use of obscene gestures.
Coprolalia affects only 30 percent of patients with TS, although it is the most commonly known symptom of the syndrome. Individuals with this syndrome try desperately to mute the socially unacceptable words but, as with other types of tics, doing so only increases the compulsion. Ultimately, this effort increases, rather than decreases, the behavior.
Anxiety disorders are closely related to TS. The affected person can control the tics to some extent; however, this control comes at great expense. Finally allowing the tics to occur after holding back for a period greatly increases their severity as well as the patient's anxiety. It becomes a vicious cycle as the patient seeks to control the tics for social acceptablilty. When control is lost, the tics become more dramatic. This increases the anxiety, which aggravates the tic disorder.
Tics are the involuntary movements that can occur anywhere on a person's body, although the face, neck, and shoulders are the most common locations for tics. Uncontrollable sounds made by a person are called vocal tics and can be very disturbing to others and embarrassing for the person uttering them.
Autism and Tourette's Syndrome
For a child to be correctly diagnosed, it is important to determine if the child has autism and Tourette's or if his tics may be due to autism alone. Many children with autism have a series of tics that appear to be out of their control. With the repeated rhythm and compulsion to act out these tics, it is easy to confuse the two syndromes, but the compulsive aspects of autism are enough to cause this behavior.
If a child with an ASD has TS as well, it can be treated with various medications. However, medications should only be used if necessary, and a definite diagnosis is needed before such medications can be prescribed. A qualified physician should determine the specific diagnosis and prescribe treatment for the disorder.