Tourette’s Syndrome (TS) isn’t a rare disorder. There are no specific diagnostic tests for TS. The diagnosis depends upon the observation of signs and symptoms by an expert physician. As many as 1 out of 100 kids may have TS and similar Tic Disorders in the world.
Stuttering is another common speech disfluency-cum-disorder. It involves repetitions, blocks, and prolongations in speech.
A person with stuttering typically begins showing signs and symptoms by the time s/he is 2 to 4 years old.
Around 1% of the world’s population or 70 million people stutter.
What’s the Common Link Between Stuttering and Tourette’s Syndrome?
Early research on TS in 1996 showed that 3 genes are common in five disorders – stuttering, TS, attention deficit disorder, obsessive-compulsive disorder, and tics.
The 3 genes are responsible for controlling the release and levels of dopamine.
In individuals with at least one of the 5 disorders, these 3 genes are permanently switched on.
Research also notes the use of dopamine antagonist drugs like Haldol for the control of tics as well as a severe stutter.
Sadly, the efficiency of the drug to reduce stutters is only between 30% and 50%, with serious side effects.
Hence Haldol is no longer used to treat stuttering.
There are times when experts have commented on TS as “stuttering with the extremities”.
Both disorders are susceptible to physical and emotional stress.
People who stutter (PWS) often experience worse blocks, repetitions, and prolongations when they try to control it forcibly.
People with TS report similar experiences with their tics.
Is Stuttering A Part of Tourette’s Syndrome?
De Nil et al (2005) conducted a study on 69 children exhibiting symptoms of TS from the Toronto Western Hospital and 27 children without TS from the General Medical Clinic.
While no medicines were altered during the study, the researchers recorded the prescribed drugs in the case of each individual.
According to results, the atypical disfluencies were not exuberantly high in those with TS, as one would expect. In fact, they were quite comparable to the disfluencies the researchers noted in the children without TS or the control group.
However, the disfluencies of the control group decreased in frequency with age. The noted disfluencies in the group of 69 children with TS didn’t decrease.
It would be ill-considered to conclude the nature of stuttering in TS based on one study.
A comparative study from the University of Akron infers that stuttering in Tourette’s may be a result of the combination of multiple disfluencies.
What Is The Treatment for Tourette’s Syndrome?
There is no cure for TS, but there are quite a few options available that can reduce tics and improve speech.
According to the Tourette Association of America, 6 different therapies may work for someone with TS –
1. Medication
In some countries, along with behavioral therapy and deep brain stimulation, experts at times recommend the use of alpha2-adrenergic agonists such as clonidine, CNS stimulants, and atypical neuroleptics for managing severe symptoms of TS.
2. Comprehensive Behavioral Intervention for Tics (CBIT)
A child study published in 2010 in the Journal of the American Medical Association (JAMA) shows that 52.5% of the participants who received CBIT exhibited reduced intensity of symptoms as compared to the 18.5% who were the control group (no CBIT).
Similar results in adult studies (38% of adults responding positively to CBIT) shows that this form of treatment may be useful in controlling and reducing the intensity of symptoms associated with TS and other tic disorders.
3. Speech Therapy
Speech-language pathologists (SLP) can help with the conditions that typically co-occur with TS including stuttering.
Other co-occurring conditions include social language impairment, OCD, and ADHD.
Children and adults with TS with one or multiple of these co-occurring conditions can benefit from speech therapy.
Very often these individuals have language-based learning challenges.
They have difficulty in learning new words, word relationships, and language syntax.
They may also face difficulty in understanding questions, asking questions, following or giving directions, and understanding sentences they hear.
The intervention of an SLP can help them with expanding their vocabulary, gaining an understanding of spoken language and written language.
4. Medical Marijuana
The effects of marijuana on TS are not well-explored in many parts of the world. The restrictions of research on marijuana have limited the studies of its effects on various chronic diseases and disorders.
However, several publications from across the globe show that THC (delta-9-tetrahydrocannabinol), a component of marijuana can reduce the intensity of TS symptoms.
Currently, studies from Germany, Canada, and Israel report the use of cannabis extracts and medical marijuana in reducing the tics associated with TS.
CBD (cannabidiol) extract, oil, capsules, and edibles are now easily available across several countries which makes the studies on the effects of CBD and THC on people with TS much accessible.
5. Deep Brain Stimulation (DBS)
DBS is a new technique that uses an electrode implant in the brain.
It is used to treat Parkinson’s disease, OCD, and dystonia as well.
Currently, DBS is only used for patients who don’t respond to traditional Cognitive Behavioral Therapy (CBT), or medicines.
It is an invasive procedure with promising results for the treatment of TS.
However, it has both short and long-term potential complications. Primary ones include local bleeding, accidental stroke, unintentional alteration of speech, or vision.
6. Dental Device
Dental orthotic devices have been in the discussion for the last few years as a potential treatment for TS.
These devices may potentially reduce the muscular tics of TS when individuals with TS wear them in the mouth.
Research is still ongoing on the effectiveness of dental devices in the treatment of TS.
Not a lot of material is available, but the Tourette Association of America has dedicated resources to several dental organizations, research, and clinical experts in TS to explore the possibilities of the treatment.
What Is The Treatment For Stuttering?
The treatment for stuttering depends upon several factors including the severity of the stutter and the age of the PWS.
A few therapies are common between stuttering and TS. Potential treatment for stuttering involves the following –
1. Speech Therapy
For children, the method is indirect. Most children under the age of 6 years have the chance of recovering quickly since their secondary behaviors have not set in.
Including speech exercises in their daily routine may disrupt their journey to natural recovery.
Older children, adolescents, and adults may benefit from regular speech therapy under the guidance of an SLP.
Speech therapy may teach you how to stutter on purpose so you can gain a better understanding of your stuttering.
It can teach you proper breathing techniques that relax all muscles involved in the production of speech.
The aim of speech therapy is not ridding a person of his/her stutter, but to make him/her stutter with ease.
With therapy, you may find speaking to be less of a struggle.
2. Electronic Devices
Technology has played a key role in the treatment of stuttering.
Delayed auditory feedback (DAF) techniques have been popular and effective in the treatment of stuttering. It involves introducing a delay of a few microseconds between the spoken words and the person’s hearing.
Another similar method mimics one’s speech to make it sound like choral speaking.
Choral speaking/reading has been very effective in treating stuttering in the past.
The use of technology ensures that a single person can enjoy the benefits of choral speaking/reading on his/her own during private therapy or at home.
3. Cognitive-behavioral Therapy
CBT is critical for adolescents and adults who stutter.
Stuttering typically has lasting negative effects on mental health.
Emotions like anxiety, fear, and shame make their association with speaking as the PWS grows older.
People with mild stuttering often shy away from speaking in public situations to hide their stutters.
While those with severe stuttering often don’t apply for jobs due to their experience with bullying and discrimination.
CBT can help people recover their mental wellbeing while giving them the necessary courage and confidence to embrace their stutter.
Additionally, it can address fatigue, stress, and self-esteem problems than often have a detrimental effect on speech fluency.
How Are Tourette’s Syndrome And Stuttering Related?
Both Tourette’s Syndrome and stuttering present themselves early in children.
A child aged between 2 and 4 years can present symptoms like the twitching of lips, rapid blinking, shrugging, grimacing and nose twitching if they have TS.
Similarly, a child with stuttering may exhibit blocks, repetitions, and prolongations as early as 2 years of age.
While early-onset stuttering might go away on its own, TS never does.
Since some of the symptoms of stuttering overlap with Tourette’s Syndrome, it’s often difficult for parents to tell the difference.
Sometimes, children with TS also exhibit repetitions, blocks, and prolongations. However, that is more likely to be a co-occurrence of TS and stuttering rather than an additional symptom of TS.
There is no evidence to link Tourette’s to stuttering. However, often these two disorders occur together.
There is no test for the diagnosis of Tourette’s.
The diagnosis requires expert eyes and experience. Typically, motor tics and vocal tics are telltale signs of Tourette’s, although both may not occur at the same time.
