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Tourettes and Co-Morbidities PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Tourette’s & Co-morbidities" by Lauren Smith.
This medical PowerPoint presentation talks about the common co-morbidities of Tourettes syndrome.
Tourettes syndrome is a neurological disorder that is characterized by repetitive, involuntary movements and vocalizations called tics. While tics are the most well-known symptom of Tourettes, the disorder can also be associated with several co-morbidities, or additional conditions that occur alongside Tourettes. the most common co-morbidities of Tourettes include ADHD (Attention Deficit Hyperactivity Disorder), OCD (Obsessive-Compulsive Disorder), Anxiety and Depression, Learning Disabilities and Behavioral Problems etc.

Tags : co-morbidities of Tourettes syndrome, Tourettes syndrome, neurological disorder, tics, Child Neurology PowerPoint presentation, Neurology PowerPoint presentation

Published on : Mar 21, 2023 | Views : 991 | Downloads : 0

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Slide 1-

Tourette’s & Co-morbidities Lauren Smith Registered Psychologist
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Introductions: who is this random person talking you… Registered psychologist – been registered 6 years Currently working at MoE Previously worked in disability ABA trained – apologies in advance if some of the approaches seem random ;) I was diagnosed with TS when I was roughly 9-10 years old Todays talk is a mix of research, my own experiences with TS and practical info and strategies from doing field work
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Let’s get started… Tourette’s doesn’t usually play alone – it can have 1 or more friends that like to join the game Research actually suggests that this is the rule rather than the exception This of course makes a complex situation even more complicated! The majority of the co-morbid disorders seen with TS are brain based; they may not be neurological (as in neural pathways are affected) but there is an issue organically within the brains structure that may be having an impact, or the way in which neurotransmitters function is a bit wonky Where do we even begin? Maybe at the beginning…
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Tourette's Syndrome (TS) Diagnostic Pathway Currently no set pathway for diagnosing Does not meet criteria for developmental pathways Does not meet criteria for Mental Health pathways Limitations of the current pathway Given that TS is classed as a neurological disorder it doesn’t fall into any of the well established diagnostic pathways. This presents difficulties not only with diagnostics but also for accessing further supports
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Common co-morbidities
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Common co-morbidities In the DSM-V, TS belongs to the neurodevelopmental disorders group which also includes ADHD, ASD and specific learning disorders. This group includes conditions that frequently co-occur and have a "similar genetic background with other neurodevelopmental disorders” research highlights the complexities of these individual disorders. When they are co-morbid the complexities increase significantly For the most part the aetiology is unknown but research suggests that there are multiple neurological pathways involved.
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Attention Deficit Hyperactivity Disorder (ADHD)
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Attention Deficit Hyperactivity Disorder (ADHD) ADHD “is a condition that makes it unusually difficult for children to concentrate, pay attention, to sit still, to follow directions and to control impulsive behaviour” (Child Mind Institute, 2016, p. 2.) Types of ADHD Combined type: characterised by impulsive and hyperactive behaviours as well as inattention and distractibility Impulsive/hyperactive type: characterised by impulsive and hyperactive behaviour without inattention and distractibility Inattention/distractibility type: characterised predominately by inattention and distractibility without hyperactivity Symptoms: Inattentive symptoms: Easily distracted Makes a lot of mistakes Appears not to be listening Difficulty following instructions Has trouble arranging/organising belongings/task requirements Finds sustained effort challenging Can be very forgetful, loses items
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Attention Deficit Hyperactivity Disorder (ADHD) Symptoms: Hyperactive & impulsive symptoms: Restlessness, fidgeting Difficulty waiting for turns Trouble staying still Difficulty playing quietly Calling out Extreme impatience Always on the go Excessive talking, interrupting Difficulty not getting own way Assessment: Pathway through Mental Health Services Psychometric testing: Child behaviour checklist can provide a screen Conners 3rd Edition: Questionnaire of about 100 questions relating to the child’s behaviour and functioning across the main ADHD traits. Also screens for associated disorders such as Oppositional defiance Disorder and Conduct Disorder School, home and self report Observations
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TS & ADHD: implications for the classroom ADHD Difficulty following instructions Executive functioning (self regulating skills we use to carry out and complete tasks) difficulties: Planning Organisation of time and materials Transitioning between activities & places Controlling emotions Making decisions TS Disrupting learning – not hearing or seeing instructions Being distracted or preoccupied by the need to tic/trying to hold them in Perception of not listening or being non-compliant Impacted learning Writing can be affected by tics – messy etc Reading can be affected by eye twitching Sometimes this can appear to be specific learning difficulties The stress of being in the classroom and struggling to hold tics can result in emotional outbursts for some children
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Intervention & strategies
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Intervention & strategies Executive functioning support Single desks can he helpful where all of the child’s books and stationary can be placed in one place – rather than having to find what they need from different places in the classroom Visual aides For reading, writing, maths Visual schedules Task strips that outline the steps needed for tasks Teaching replacement behaviour/skills Practicing things like raising hand, waiting etc. High rates of positive reinforcement for desired behaviour
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Anxiety
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Anxiety
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What is anxiety?
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What happens when you get anxious?
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What happens when you get anxious? Something happens in the environment to trigger anxiety Information is sent to the brain to process Brain has to decide what response to make Adrenaline and cortisol are released into the body in preparation for response Physiological changes to the body take place (increased heart rate etc.) Psychological changes take place – hyper vigilant Preparing for fight/flight/freeze
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What happens when you get anxious?
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What does anxiety look like?
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Anxiety & TS Anxiety increases tics Increased levels of anxiety can create higher tic rates Increased stress hormones likely to impact Tics increase anxiety Social anxiety – people staring, laughing, teasing, bullying Interrupted learning and engagement at school Managing the anxiety is probably more important than trying to reduce tics. It’s often overlooked as a trigger to increased ticcing or the emphasis is on reducing the symptoms rather then potential cause
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Why does anxiety occur?
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Managing Anxiety https://confidentcounselors.com/2018/01/11/de-escalation-strategies/
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Managing anxiety
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Managing anxiety: strategies Recognising early signs of stress/anxiety Pre-determined safe place to go to calm down/have quiet time Deep breathing 3 breaths in, 7 breaths out Belly breathing https://www.youtube.com/watch?v=_mZbzDOpylA Straw breathing Deep, controlled breathing helps to calm the body physiologically (lowers heart rate, rapid breathing etc). When our bodies feel calmer, we feel calmer; we don’t have the tense of panic as a result of fast heart rate etc.
Slide 25-

Managing anxiety: strategies
Slide 26-

Back to basics
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Suggestions for school planning
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Adapting plans to work for TS/Tics What do your child’s tics look like at each stage of an escalation Lower-level tics when relaxed & calm? Increase in frequency and intensity as escalation continues? Become more complex the more escalated?
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Managing anxiety
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Obsessive Compulsive Disorder (OCD)
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What is OCD? “Children with obsessive-compulsive disorder have intrusive thoughts and worries that make them extremely anxious, and they develop rituals they feel compelled to perform to keep those anxieties at bay” (Child Mind Institute, 2016, p.2). Anxiety disorder Can have either obsessions or compulsions or both Compulsions are unwanted and intrusive thoughts, images or impulses. Although the thoughts can be irrational they are very difficult to ignore and can create significant anxiety and fear. Common obsessions include: Consistently worrying about locking doors Something bad occurring Fear of contracting germs Can be infrequent, only occurring at some times, and at other times can occur frequently Becomes problematic when the obsessive thoughts start to interfere with an individuals day to day functioning, relationships and schooling
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What is OCD? Compulsions “Repetition of certain behaviours or actions with the aim of alleviating the fear or anxiety resulting from the obsessive thoughts” “The compulsive behaviour neutralises the distressing obsessions” Common compulsions include: Repetitive hand washing Repeatedly checking locked doors Counting, ordering, arranging https://yourmindmatters.net.au/understanding-obsessive-compulsive-disorder-ocd/
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https://yourmindmatters.net.au/understanding-obsessive-compulsive-disorder-ocd/
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OCD & TS Can be difficult to separate what are tics and what are compulsions Look at the context at which repetitive behaviours are occurring to get a better understanding of whether they are tics or compulsive behaviours trying to reduce obsessive thoughts The stress/anxiety of obsessions and the need to carry out compulsive behaviour is likely to increase the frequency and intensity of tics Within this dynamic it might be more important to manage the OCD rather than focusing on trying to reduce the physical tics themselves Easier said than done, right?!
Slide 36-

How can we support OCD? Cognitive behavioural therapy Helping your child understand how OCD works; putting it into a context that will understand. E.g. explaining that OCD is like a bully: “if a bully asks for your lunch money and you give in because you’re afraid, then the bully will be happy and go away. But the next day the bully will come back for more, because he knows you’re afraid. The more you give in to the bully the more he will ask for” (Child Mind Institute, 2016, p.4) OCD works the same way The goal of treatment is to help children stand up to this bully OCD is a complex disorder that requires specialist intervention that is provided in a safe environment for the child Intervention can include slowly exposing the child to the things that trigger the anxiety response and help them to manage through the response without resorting to compulsive behaviour The child might be able to work with a therapist to create a hierarchy of triggers/things that cause them anxiety and fear and then in a very supported and safe way start to work through them until the fear subsides. This is complex work and needs to be managed well
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Conversion Disorder/Functional Neurological Disorder
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What is Functional Neurological Disorder (FND)/Conversion Disorder? Condition where an individual shows physical symptoms without a medical reason for it e.g. paralysis, blindness. Research suggests that it is unclear what the cause is but it is a brain based disorder to do with how the brain functions rather then damage to its structure Research suggests that it could be triggered by stressful situations and that the response is the reaction to the stress Behavioural models “recognize the role of conversion symptom in alleviating stress and the emphasise the importance of reinforcing factors that maintain symptoms” (Bryant & Das, 2011, p. 289). Behavioural models are based on antecedents and consequences/maintaining variables – if behaviour is reinforced then increases the likelihood of the behaviour occurring again in the future – not to say that CD is a conscious response being made by the individual but somewhere within this dynamic the response is being reinforced – something stressful has been removed as a result or something has been gained as a result
Slide 39-

Diagnostic criteria
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Just a suggestion for gathering some info… Try the ABC’s Note what happened prior to the behaviour (however CD presents) antecedent/setting event/trigger (A) Who was there, what were they doing, what was your child doing, had they been asked to do something, was it really noisy, busy etc. Describe in as much detail what the behaviour/response looked like – note duration (B) Describe what happened afterwards – how did people around respond, were demands removed, anything stressful removed, was a lot of attention paid etc., consequence (C) Trying to look for any emerging patterns in antecedents and/or consequences If patterns emerge we can identify triggers or setting events and prevent where possible If patterns emerge to show there are consequences that could be maintaining these responses then changes to responses can be made
Slide 41-

CD & TS
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Autism Spectrum Disorder (ASD)
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How is it diagnosed?
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ASD Spectrum based – wide range of behaviours associated with ASD that all look different for each child Social communication will vary depending on situations/environments Difficulty with diagnosing ASD is that it is very deficit focused Children diagnosed with ASD often have social interests and topics that they are experts in – these are skills and areas that should be explored and used where possible to promote positive skill based approaches Rigidity/inflexibility (difficulty with changes to routines etc, need for sameness) are set in anxiety based responses – when things are always the same, they are predictable which means we know what comes next or what is expected of us When there are unforeseen changes and things become unpredictable then anxiety and stress can start to take over – meltdowns Sensory overload is much the same – sensory sensitivities are often a trigger to meltdowns as everything becomes too much to process and respond to
Slide 45-

Supporting ASD at school (and home) Visual aides such as visual schedules provide a lay out for what is expected during the day Where possible forewarning of changes should be provided A certain degree of flexibility should be maintained where possible so that we don’t support too much rigidity The use of timers to alert the child to an upcoming transition between activities or places – hour glass, beepers, visual timers (whatever is preferred) Often children on the spectrum cannot shift from one thing to another as quickly as adults want them to and this can create tension in the classroom Offer reminder statements as the transition time is approaching Transitions are often highlighted as being difficult due to the increased movement of other students, packing up, increased noise, often there are multiple steps the children have to carry out in a short space of time (put maths book away, get reading book, sit on the mat etc. ) Make the most of their interests; this will increase their willingness to try things/engage in activities Often children on the spectrum do not see the relevance in a lot of what they are asked to do – making it relevant can increase motivation to engage Identify triggers to increased anxiety/escalated behaviour – these will be different for every child Include sensory related triggers, any social interaction difficulties (initiating, maintaining interactions) Environmental modifications can be made when patterns have been noted Refer back to the use of the ABC’s
Slide 46-

Supporting ASD at school (and home) Predetermined safe places to go when needing a break Adults need to be aware of what this looks like for each child so that they can support Its important to teach the child what they need to do when they feel they need a break but this depends on the child's age and level of self awareness To begin with we require the adults to support adult co-regulation This means the adult becoming aware of the early signs of a possible meltdown and responding early by acknowledging to the child that they have noticed they look worried or angry and then offering a way to provide support such as having a break, quiet time, a talk etc.
Slide 47-

Sleep disorders/difficulties
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Common sleep difficulties Sleep disturbances include: Night terrors Sleep walking Falling asleep quickly but waking soon after and staying awake Difficulty falling asleep Tics getting in the way of falling asleep Tics still occurring during sleep Disrupted sleep can have a significant impact on daily functioning; Mood Tolerance Concentration And of course can increase tics
Slide 49-

Supporting sleep
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Escalated behaviour
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Questions