Case Study: Kelli

A 15-year-old girl, Kelli, is referred to a neurologist due to unexplained symptoms of

involuntary, uncontrollable behavior that includes eye-blinking, shoulder shrugging, frequent

throat clearing, and randomly moving her arm around in circles. These symptoms have been

present since she was in preschool and have increased in intensity. She told the doctor that she

had difficulty reading because she was constantly blinking and had to re-read sentences over and

over. She tried to control the behaviors at school because kids in her class called her “weird” and

“freakshow,” but by the time she got home she was exhausted, experienced more involuntary

movement, and had difficulty completing homework. When asked how she felt about her

symptoms and experience, she began crying and asked if there was medication to “just make

everything stop” so she could be “normal.” Her teacher conducted daily narrative reports on

Kelli’s day to day activities and compiled all her outputs. Her case was then forwarded to the

behavioral specialists of Department of Education. The behavioral specialist carefully explained

to the parents about their child’s case.

FINDINGS AND EXPLANATION OF BEHAVIORAL SPECIALIST

The reason/meaning/function behind each of the Kelli’s behavior/ Factors affecting Kelli’s

behavior.

Tourette syndrome is a neurological condition that involves various physical tics and at least one

vocal tic that a person cannot control. A few people with Tourette syndrome unintentionally utter

inappropriate or obscene words. A number of treatment options are available.

A tic is an unusual movement or sound that a person has little or no control over. It may include

eye blinking, coughing, throat clearing, sniffing, facial movements, head movements, or limb

movements, or making unusual sounds.

A facial tic, such as eye blinking, may be the first sign. However, each person is different.

A tic may be:

Physical: Motor movements include blinking or jerking the head or another part of the body.

Phonic: The person may utter sounds, such as grunts or squeaks, and words or phrases.

There are two main classifications:

Simple tic: This may involve moving just one muscle, or uttering a single sound. Movements are

sudden, short lived, and often repetitive.

Complex tic: The physical movements are more complex, and the phonic tics may include long

phrases. Complex tics involve several muscle groups.

People with Tourette have a combination of phonic and physical tics, which may be simple or

complex.

Simple physical tics

Examples of simple physical tics may include:

eye blinking, eye darting, grinding the teeth, head jerking, neck twisting, nose twitching
rolling the eyes, rotating the shoulders, shoulder shrugging, sticking the tongue out

Simple phonic tics

Examples of simple phonic tics may include:

barking sounds, blowing, clearing the throat, coughing, grunting, hiccupping, sniffing,

squeaking, yelling and screaming

Advanced warnings

Most people will experience unusual or uncomfortable sensations before the onset of a tic.

Types of advanced warning include:

a burning feeling in the eyes that is only alleviated by blinking

increasing tension in the muscles that can only be alleviated by stretching or twitching

a dry throat that is only alleviated by grunting or clearing the throat

itching in a limb or joint, where the only relief is achieved by twisting it

Situations that may cause tics to worsen include:

anxiety or stress, fatigue, or tiredness, illness, especially a streptococcal infection

excitement, a recent head injury.

Causes of Tourette and risk factors

The exact cause of Tourette syndrome is unknown. However, it appears to stem from an issue in

the basal ganglia, the part of the brain that is responsible for involuntary movements, emotion,

and learning.

Experts believe that abnormalities in the basal ganglia may cause an imbalance in levels of brain

neurotransmitters, which transfer messages from one cell to another. Abnormal neurotransmitter

levels may disrupt normal brain function, resulting in tics.

Parkinson’s disease, Huntington’s disease, and other neurologic conditions affect the basal

ganglia.

Tourette syndrome is believed to have a genetic link and to be hereditary. A person who has a

close family member with a tic is more likely to have one, too.

Treatment

Kelli may benefit from a course of comprehensive behavioral intervention for her tics in addition

to psychotherapy to treat any comorbid depression she experiences from isolation and bullying at

school. Psychoeducation and approaches to reduce stigma will also likely be very helpful for

both her and her family, as well as bringing awareness to her school and those involved in her

education.

How they, as parents, can help in the process of the behavioral plan

These tips can help kids with Tourette syndrome cope:

Get involved. Some experts say that when kids and teens are focused on an activity, their tics are

milder and less frequent. ...Lend a helping hand, Embrace creativity, Find support, Take control.

Parents’ Roles

As a parent whose child has Tourette Syndrome, you are often required to wear many hats –

educational advocate, service coordinator, and emotional ally.

Educational Advocate

To make sure your child is receiving appropriate school services, it’s important to address any

difficulties you notice that may be related to school behavior, performance, and socialization.

These can include a negative change in attitude about school, a decline in grades, reports of

bullying, an increase in symptoms, or increased frustration.

Parents should, as the coordinator of the educational team, make sure their child is getting

effective:

Accommodation (such as a private space for testing)

Support (such as use of a computer to type answers to a test instead of writing them)

Understanding (such as an informational program about TS for students and staff)

Service Coordinator

It’s important that parents work to obtain all the services their child needs to make life

productive and satisfying. In addition to appropriate educational services, a child with TS might
benefit from psychological counseling, which can help with issues of self-esteem, social skills,

and even habit reversal to help control some TS symptoms.

Although most children with TS do not require medication, sometimes the severity of symptoms

and the co-occurring conditions warrant their use. Since Tourette Syndrome is a complex

condition and the associated symptoms can be difficult to manage, it’s important for parents to

work with a physician familiar with treating TS. Occupational therapy may also help with some

specific neurological components of TS, such as visual-motor coordination.

Emotional Ally

Clearly, the reaction of others to the symptoms of TS can have a tremendous impact on a child’s

self-esteem and self-confidence. It’s critical that parents help their child develop a healthy self-

esteem, learn to successfully navigate social interactions, and accomplish important goals.

In order to help their child with TS, parents must deal with their own responses to the diagnosis,

as well as the response of the rest of the family. These responses may range from denial and guilt

to anger, fear, and isolation. By reacting to these responses with accurate information and

effective support, parents and, indeed, the child’s entire family, can become powerful allies with

the child with TS.