Ask the Expert
Q&A with Dr. Ruth Nass
Our expert is Dr. Ruth D. Nass, Professor of Pediatric Neurology at the NYU School of Medicine and the Child Study Center. Dr. Nass is also the co-author of 100 Questions & Answers About Your Child’s Attention Deficit Hyperactivity Disorder.
If you have a question you wish to ask Dr. Nass, please e-mail the chapter (email@example.com). We will post Dr. Nass' answer to your question under the Ask the Expert column online and the next newsletter.
Question: My child has just been diagnosed with Tourette Disorder. I am scared, what should I expect?
Answer: Unfortunately that is hard to predict. Some children’s tics are always pretty mild and some children’s tics can be quite severe. You can’t tell when the tics start what the future holds. But most children do outgrown their tics or have a marked decrease in severity in their teens. There are lots of therapies available, both medication and behavioral. You’ll be less scared if you have more knowledge. But beware the internet. Anyone can write anything they please. Use credible sources like the TSA.
Question: Why is my child diagnosed with Tourette’s Disorder and not just tics?
Answer: Tics and Tourette Disorder are really on a continuum. Tics can be motor or vocal. They can be short lived or chronic, particularly the motor tics. By convention Tourette Syndrome is defined as a disorder with both motor and vocal tics lasting more than a year with no tic free periods lasting longer than 3 months. The vast majority of children never have cursing vocal tics even if they have TS.
Question: Sometimes my son does a neck jerk and then that leaves and he begins clearing his throat and then that will go and he begins deep knee bends. Why is he always doing different involuntary movements? Are these all considered tics and why are they always changing?
Answer: These are all tics. We don’t know why they change. Most tic disorders involve the face first and then can move into the neck and shoulders and arms or become more complex like jumping. Most children’s tics stay in the face and include things like blinking, pursing their lips and making little movements with the mouth and tongue.
Question: Will my child be made fun of? How do I protect her?
Answer: Children can be mean, especially third to 6th graders. They can be teasers. But often they simply ask “why do you do that?” Arming your child with information helps him/her answer that question. Providing information to the teachers and the school is also important. The more informed the educator is the more they can educate and facilitate tolerance and understanding of the child’s tics. Teachers cannot say stop it or punish a child for a vocal tic, even if it disrupts class. Sometimes it is worth having a formal educational session for students or teachers or both. The TSA has speakers who can help you structure this for you and your child.
Question: I have heard that Tourette Disorder is associated with other problems besides tics, like attention deficit disorder (ADHD) and obsessive compulsive disorder (OCD). Is this true?
Answer: Doctors call these comorbidities. And yes many children with TS have ADHD, perhaps 50%, and a number have OCD. Usually ADHD presents at a younger age than TS. But it is worth monitoring children with TS for milder forms of ADHD. Sometimes you have to treat both. OCD tends to present later. Again, it is worth watching out for OCD in children with TS and treating it if that is merited.
Question: What kind of Doctor should my child be treated by?
Answer: Your child could be treated by a child neurologist, child psychiatrist or a developmental pediatrician. The most important thing to do is to find someone who is comfortable treating TS and knows a lot about it. Psychiatrists may know more about anxiety and OCD than many neurologists or pediatricians, but it really depends on the individual.