Case Study of a Young Man with Tourette Syndrome

"Simon" is a seventeen-year-old Caucasian boy currently managing a mild case of Tourette syndrome. He attends mainstream high school and is a moderately successful student with a normal amount of friends. He enjoys playing video and computer games instead of doing his homework, although he does like his math and science classes. When he was 9, Simon's family moved to another part of town where he had to switch schools. He began showing signs of Tourette syndrome at his new school. He displayed peculiar physical tics as well as repetitive throat clearings-despite the fact that he rarely had mucus or anything else bothering his throat. His physical tics consisted mainly of accentuated blinking (hemifacial spasms) and clenching/extending movements of the hands and sometimes feet (athetoid movements). The former occurs irregularly, repetitively, and unilaterally and affects the eye's muscle groups. The latter occurs slowly and also irregularly and often has a writhing appearance.

Simon has an aunt with controlled obsessive-compulsive disorder on his mother's side and also a cousin with attention-deficit hyperactivity disorder. Both disorders are closely related with Tourette syndrome and often can occur simultaneously. It is believed that Tourette syndrome can be inherited; the dominant gene(s) may cause different symptoms in different family members (Barbara A. Moe). This might explain the differences between Simon and the disorders of his aunt and cousin. Also, at the time of perceived on-set, Simon was battling a bad case of streptococcus infection (strep throat) which is often associated with the worsening of Tourette syndrome tics.

Due to Simon's family financial disadvantages, his parents were unable to provide professional psychological assistance for many years after becoming concerned about his symptoms. In other words, Simon had to deal with his disorder on his own-and often ineffectively-although he did read books on coping with Tourette syndrome along with his mother. For the first few years, until about age 11, Simon dealt mainly with his eye blinking and hand clenching tics and also the throat clearing. Since they occurred mainly in mild bouts, Simon easily functioned in the school setting.

Around the onset of puberty, Simon's bouts began occurring more frequently, especially in uncomfortable social situations and when his allergies began to perk up. In some extreme cases of being uncomfortable, Simon displayed complex vocal tics like palilalia (repeating the last word or so of a sentence) and echolalia (repeating the last word or words of others). These instances, although rare, bothered Simon and his loved ones.

By the age of about 15, Simon outgrew these more extreme tics and dealt more effectively with his challenge by employing "calming" techniques. Now, at age 17, Simon is attending a support group for Tourette syndrome, although he still seeks professional help (his family's financial situation has improved) due to his increasing sleep problems and frequency of tics. As school work has increased, so has his stress level and in turn his ability to fall asleep and/or stay asleep has lessened. Simon wants to take serious control of his Tourette syndrome for good.