Abstract
The cardinal characteristics of tic-related disorders are stereotyped motor movements and vocalizations. However, they may be accompanied by non-motor features that appear sequentially during the course of the disorder and can sometimes be more disabling than the tics themselves. This review presents our perspectives on several non-motor aspects of Tourette syndrome based on the long experience of the Neuropsychiatric Tourette Clinic of a tertiary pediatric medical center. The effect of premonitory urges, sensory modulation disorder, tic-related cognitions, and environmental conditions on the expression and intensity of tics is elaborated, with suggestions for treatment approaches to each. We also describe the mediatory effect of parental attachment style on the link between maternal stress and ticcing intensity and the need to adjust psychotherapy interventions to account for the importance of this factor in emotion regulation. This review is intended to direct attention to the non-motor aspects of Tourette syndrome. An in-depth understanding of this complex and debilitating disorder will facilitate the formulation of innovative therapeutic protocols.
Highlights
The stereotyped motor movements and vocalizations that are the cardinal characteristics of tic disorders are often accompanied by non-motor features that appear sequentially during the course of the disorder and can sometimes be more disabling than the tics themselves
We start with premonitory urges, which play a significant role in tic expression and tic sequence, and the impact of acceptance procedures on decreasing their intensity
This is followed by a discussion of sensory modulation disorder (SMD) as an important component of the reaction to premonitory urges and as a comorbidity of Tourette syndrome, in addition to the development of tic-related cognitions and their influence on tics and tic-related behaviors
Summary
The stereotyped motor movements and vocalizations that are the cardinal characteristics of tic disorders are often accompanied by non-motor features that appear sequentially during the course of the disorder and can sometimes be more disabling than the tics themselves. The aim of this review is to share our subjective perspectives on the nonmotor aspects of Tourette syndrome based on findings and observations in our clinic, as presented at the first World Congress on Tourette Syndrome and Tic Disorders [1]. We start with premonitory urges, which play a significant role in tic expression and tic sequence, and the impact of acceptance procedures on decreasing their intensity. This is followed by a discussion of sensory modulation disorder (SMD) as an important component of the reaction to premonitory urges and as a comorbidity of Tourette syndrome, in addition to the development of tic-related cognitions and their influence on tics and tic-related behaviors. There is a section on the relevance of attachment theory and the modulatory role of parental attachment style in the relationship between children with Tourette syndrome and their parents
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