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Looking beyond the behavior: Diagnosing Tourette’s

In a classroom environment a child may get into trouble for throwing a pencil across the room or barking out a swear word. Irregular motor or mouth movements are often brushed off as an oddity in children.

“The easiest thing in Egypt is for people to say the child is not well-raised,” says Yasmin Galal, a pediatric neurologist, “however, these symptoms are of a neurological disorder called Tourette syndrome.”

While every child who acts up in class may not be suffering from Tourette's, it is important for parents and teachers alike to be aware that the disorder may be the source of some of disruptive behavior.

A patient with Tourette syndrome suffers often from repetitive motor and mouth movements, or from involuntary tics. Galal explains that one theory of the disease attributes this to a problem with neurotransmitters in Tourette's sufferers.

Some extreme cases of tics include sudden body jerks or banging against things, as well as patients suddenly barking out swear words. These minor tics can often be easy to camouflage, such as blinking or the clearing of the throat.

Tourette's is not easily diagnosed because those who have tics are not likely to complain about them. If a person does go to a doctor with these symptoms, Tourette's is usually not the first thing that comes to a doctor’s mind, says Galal.

The occurrence of Tourette's in schoolchildren is 1 percent in the UK.

“It is not connected to ethnicity, therefore this statistic should be common around the world,” says Hala Abdel Hak, a psychology professor at the American University in Cairo.

According to Galal, there are no numbers on Tourette's in Egypt because of the difficulty in diagnosing it.

Tourette syndrome in some cases can be bunched in with behavioral problems such as Attention Deficit Hyperactivity Disorder or obsessive compulsive disorder. In many cases Tourette's may be the source of these secondary problems, making it hard to notice on the surface.

Abdel Hak says she has been working with special needs children since 1993, and in that time has only come across two cases of Tourette's. The first was a young adult who was diagnosed after a long struggle.

“He really suffered and went to many different doctors until he went to the US and was diagnosed there,” says Abdel Hak. The second was an 11-year-old child who also had epilepsy, making the Tourette's diagnosis difficult. “Both suffered a lot before they were diagnosed.”

Kirk Holderman, an assistant middle and high school principal of an international school in Egypt, started his career in education as a special education teacher at a public school in Texas 15 years ago. There he worked with a teenager with Tourette's who needed special class accommodations. The teenager’s is referred to as “Steve” in the interview to protect his identity.

“Steve was a [large-framed] young man and he would walk down the hall and all of the sudden bang himself up against the wall. He would be sitting in class then suddenly push his desk to the front and his chair back, squishing his classmates in front and behind him,” says Holderman.

The public school had a small padded room for Steve and Holderman’s job was to accompany him all over the school and whenever tics began occurring, take him into the padded room to wait until it passed.

Galal says the problem with Tourette's is that the tics can cause self-harm in the short-run and other long-term problems. She believes some Tourette's children should be put in special education settings sometimes to help them cope with their disorder.

“They are often stigmatized if educators are not aware of the problem,” Galal says.

Currently available Tourette's treatments are psychiatric medicine, as well as psychotherapy to help patients cope with the problems they face. “For around 50 percent of children with [Tourette's], their tics will disappear in late adolescence,” says the Tourettes Action website, a UK charity project for people dealing with Tourette syndrome.

Patients with Tourette's can sometimes control the urges that exhibit their tics. However, studies show that if the tic is suppressed, the patient will feel the need to do it later on.

Holderman was sometimes able to anticipate Steve’s episodes because he would often start rocking. Holderman would then take him to his padded room, start talking to him, and try to get him to relax and breath. He would sometimes need to hold his hand as well.

“The age of presentation of Tourette syndrome is 7 to 10 years old and is more common in males,” says Galal. She believes that when there is more awareness concerning Tourette syndrome, children will no longer be brushed off as simply ill-mannered or misbehaved and instead be dealt with appropriately.

Steve was not a social outcast, Holderman says, attributing this to the school handling his situation properly.

“He had friends and his classmates accepted that Steve had a condition.”

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