Tourettes's Tics and OCD Should Not be Mistaken for Stims

© Donna Williams

Tourette's can occur from the age of 2. Around 30% of folks on the autie spectrum are thought to have Tourette's or Obsessive Compulsive Disorder. For some, vocal tics (involuntary and compulsive repeated words/phrases/sounds) are so severe it takes over their communication to the point it becomes utterly dysfunctional and they may lose faith in pursuing communication at all (there is a prevailing myth that these are always swear words, in fact only a small percentage of those with Tourette's experience the swearing tics). Movement/motor tics can include jumping, flapping, slapping, biting, blinking, grimacing, hand movements, finger movements, tapping, smelling, squeezing, shrugging, hair flicking, etc and of course compulsive breath holding, coughing, sniffing, throat clearing. If severe, these tics can take over and interrupt most interaction.

Many children with autism are known to have tics and because others have 'stims' (self stimulatory behaviours) actual involuntary tics can often be mistaken for voluntary indulgence in 'stims'. If this misinterpretation happens and the 'stims' are drawn attention to, or there are constant attempts to suppress what are actually tic, the tics generally become entrenched and more severe. So understanding the difference is ESSENTIAL. Many children with severe and disabling levels of tics and OCD get no medical treatment for these as they are simply assumed 'stims' and part of Autism.

OCD co-occurs often with tics. These are more complex and ritualised and are not 'stims' nor should they be confused with 'obsessional interests'. 'Stims' and 'obsessional interests' involve volition. OCD and tics do not (even though one may enjoy or be amused by some of them at times, though mostly they are exhausting, annoying and invasive). They are involuntary and compulsive and like tics, if suppressed OCD rituals often become entrenched and more severe.

Involuntary avoidance, diversion, retaliation responses of Exposure Anxiety are often seen in Autism and I believe that where this pattern co-occurs with Tourettes/OCD the biochemistry of Tourette's/OCD co-opts the involuntary avoidance, diversion, retaliation responses which can trigger as tics in response to social 'invasion' or the daring of initiation which might draw praise or attention. There is a specific approach I outline in working with EA.

In all three cases, Tourette's, OCD and EA, the use of conventional ABA should be used with great caution in order for the technique itself not to exacerbate these conditions. Similarly many common stimulant medications are known exacerbate tics as may certain antidepressants. Where involuntary and compulsive tics and OCD are present, medications might need to take account of dopamine mechanisms involved in tics and OCD regardless of whether the client comes in with the label of Autism.

Temple Grandin has written and lectured about the benefits of Prozac (and enjoys a diet high in meat). Though Prozac is one of the medications used to treat both depression and OCD it is not suitable for all people with Tourettes. The chemistry of Tourette's is believed to cause excess Norepinephrine (the fight-flight messenger) in some people, responsible for manic episodes. In fact, whilst those with Tourette's certainly do not usually have Bipolar, bipolar in those with Tourette's is being studied as to whether it is in part a by product of the chemistry of Tourette's. Those with this type of pattern would be at risk of exacerbating the mania if given amphetamine or antidepressant medications and are instead treated with medications that balance rather than simply raise mood.

So everyone is different. I have had success with very small doses (0.5mgs) of Risperdal (Risperidone) in the treatment of tics, OCD as well as Exposure Anxiety and whilst this also addresses bipolar, I'd have become utterly manic on an antidepressant and my involuntary behaviours may well have gone through the roof (low doses of Risperdal is currently used extensively in the autism field for involuntary behaviours. I have since replaced it with a small dose of Seroquel). What Temple Grandin is on works for her. What I'm on (which includes diet and supplements as well as medication) works for me. My medication and diet may well have no effect or adverse effect on Temple and vice versa.

It is also worth keeping in mind that as the body chemistry and sensitivity of people is very individual some cases of Tourette's tics are more manageable with small amounts of medication than others and for some people such large doses of medication are required that it becomes a choice to live with the tics or the side effects of medication. Hence many for who their tics are neither endangering, intrusive, severe or chronic enough to cause them significant impairments choose to manage without medication. Where severe chronic tics co-occur with co-morbid mood or anxiety disorders, however, the level of impairment may well be far greater than the risks and challenges of side effects from medication. But in the world of medication, seeking medication simply for the sake of 'looking normal' needs to be challenged if it is the carer's self consciousness and social judgement issue more than the issue of the person with the tics.

Parents considering medication shouldn't blindly follow the example of any one person. Instead they may have to decide for themselves what is more likely to work with their child, not on the basis of the word Autism but on the basis of what gut/immune and biochemistry challenges their particular child's autism is comprised of. It is a maze. I hope those looking to find their way through it succeed.

Please find below interesting and important information re medication and dietary interventions for the involuntary tics of Tourette's and involuntary compulsive rituals of OCD. For your information, though the medical field has yet to really understand the involuntary self protection responses of Exposure Anxiety, my Exposure Anxiety disappeared after medication used for Tourette's and OCD (also used for bipolar). This was repeated for many of my clients with a similar pattern. I hope the medical field one day understand a lot more about this aspect of autism.

I hope this has been of use to those who are challenged with chronic involuntary behaviours and dysfunctional vocalisations.

For those who (often happily) have 'stims' and obsessional interests rather than involuntary behaviours, I hope you will find this interesting in understanding a bit about the difference given that those from both groups can be equally labelled 'Autistic' yet require very different approaches. And of course some people have bits of both.