Tourette's - An Insider View

Editor and Founder Vrinda Pendred discusses how those ‘raging hormones’ in adolescence can make Tourette’s Syndrome worse – and how to cope.

So far in this series on Tourette’s Syndrome, we have discussed what Tourette’s is, the causes and triggers, key medications (including anti-depressants), as well as alternative treatments, such as diet and vitamin regimes, and even more extreme measures. We then talked about the grief process and how it relates to Tourette’s, how being diagnosed can be scary, and having to deal with bullying and teachers. If you missed any of these articles, please click one of the links above to read them.

We all know about ‘raging hormones’ in adolescence. I think most of us are aware that the key hormones involved in puberty are oestrogen (for girls) and testosterone (for boys), the production of which increase dramatically within the body during that difficult time. But what’s not often talked about is how those hormonal changes affect neurotransmitters – chemicals in the body that pass information from one neuron to another – particularly, dopamine and serotonin.

The impact on these neurotransmitters during adolescence means it is likely to be an especially challenging time for a child diagnosed with a condition like ADHD, OCD, autism or, of course, Tourette’s Syndrome. No one told me this, when I was a teenager, but it is such an important topic and one that is not commonly understood by parents and teachers alike, so I want to spend some time discussing it here.

Rising Dopamine Levels

Dopamine is a key component in learning, memory, concentration, mood stability and (of most direct relevance to Tourette’s Syndrome) motor control. It also keeps us motivated and raring to go. Too little dopamine and you can become moody, unfocused, unsettled, depressed, disinterested in life or, in extreme cases, catatonic.

Adolescents face the opposite problem: dopamine levels rise during this time of life. This leads to a low boredom threshold and a keen desire for thrills and instant gratification, not to mention periods of elevated mood and poor impulse control – essentially, a feeling that they can do anything and somehow they’ll get away with it. For some, it can be a dangerous time. Thankfully, for most of us, this feeling eases off in our late teens, as we move into adulthood and develop ‘cognitive control’.

Notably, Tourette’s is all about being unable to control yourself; and studies have shown that Tourette’s typically ‘calms down’ in late adolescence / early adulthood, the implication being that tics are at their worst during adolescence – when hormones are at their most chaotic. But how can someone with an uncontrollable nervous disorder develop that ‘cognitive control’ needed to stay calm and safe? There’s no simple answer, but I would say it comes down to finding healthier ways to channel the tics, or ways to distract yourself from them.

To give a personal example, I’ve always found dance to be a positive release of the nervous energy surging through me much of the time. I also love nothing more than to lose myself in a good book, which takes me away from my immediate surroundings and, after a time, makes me forget about my body…and miraculously I ‘forget to tic’ for a time. This gives my body time to calm down and heal itself, so it isn’t quite as ravaged by the tics when they return later. Similarly, my husband and I have noticed that our 11-year-old son ‘forgets to tic’ when he’s absorbed in a video game or drawing. It gives him a little time of reprieve, so he doesn’t kill his muscles with uncontrollable spasms. Scientists can’t explain why this happens, but it does.

Dopamine, Addiction and Medication

On another note, increased dopamine increases our susceptibility to addiction, which I think may tie in with the repetitive behaviours involved in Tourette’s. The body feels a nagging need for the tic, just as bad for you as any drug. This is also why I think it’s wise to proceed with caution when considering Tourette’s medication. My personal experience was one of my body developing a dependency on the drug; and during such key formative years in my life, I’m certain this played a part in shaping my adult brain. I don’t know exactly who I would be today if I hadn’t spent three years on mind-altering prescriptions. I’m not saying don’t try them – just: proceed with caution.

Dopamine Overload

On the more extreme end of the spectrum, too much dopamine is linked to paranoia, suspicion, aggression, wild mood swings and social withdrawal (symptoms of schizophrenia) – as well as OCD and ADHD. This can be induced with drugs such as amphetamines (historically used to treat ADHD) or very high levels of Selective Serotonin Reuptake Inhibitors (commonly prescribed to treat anxiety and depression), but it can also occur naturally within the brain. For instance, schizophrenia is a genetic condition one can have without any history of medication. There is also a modern argument that bipolar disorder and schizophrenia may actually be the same disorder.

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In any event, no two people have the same level of dopamine (or any other bodily chemical, for that matter). Some have more, some have less. In my case, I think I have naturally elevated levels of dopamine, because my experience with antidepressants used to treat my Tourette’s induced symptoms of schizophrenia. I suspect our eldest son may have elevated dopamine, too – and now that he is entering puberty, I can see that dopamine has shot sky high in his body. It manifests in extreme mood swings, where he is the model child one moment and then suddenly he’s screaming, slamming doors, kicking his desk and throwing things, before collapsing into hysterical fits of tears. He also has moments when he is convinced virtually everyone in the world hates him, before finally remembering he’s actually very popular. He has been known to imagine his father is giving him weird looks, and to react accordingly. As you can imagine, it doesn’t make life easy.

How does this relate to Tourette’s? Because Tourette’s, like any health condition, is worsened by stress – and all of this is highly stressful! To give a concrete example, the other day our son had to do some maths homework. He went into it in a bad mood and returned the homework to me covered in scribbles, which he said were caused by tics. I tried to tell him that wasn’t just tics, that was rage, but I didn’t get to speak much before he was screaming at me again. The fact is, I believe it was tics – but it was caused by unnecessary anger launching him into a state of extreme stress. Later on, he understood this and was quite regretful of his behaviour. I tried the maths with him again the following day, when he was in a better mood. Guess what? He finished it in about five minutes, with a positive attitude and perfect handwriting, no scribbles to be seen.

This is tricky because in school, he often marks up his work with scribbles and pen stabs and dots, and some of the teachers don’t believe that it’s tics and therefore unavoidable. I can’t help but notice this only happens in certain classes, where I know our son doesn’t like the teachers. In other classes, where he loves his teachers, his work is strong and easy to read. What does this come down to? How relaxed, focused and engaged he feels in the lessons. The more bored, the less he is able to control the fidgeting (ADHD) and tics. I relate to this. Force me to sit through a long seminar and I end up ripping up all my fingernails because I simply cannot sit still – and I’m not an adolescent anymore. And that’s not just ADHD; some of that is Tourette’s.

Serotonin – the Highs and Lows

Dopamine goes hand in hand with another key neurotransmitter, serotonin, which plays a vital role in mood regulation, emotions, sleep and appetite. Serotonin levels fluctuate dramatically during adolescence. This is especially hard on girls, because serotonin is so closely linked with oestrogen, which rises and falls every month, right through to menopause (a topic for a future article).

Low serotonin levels are linked with eating disorders, loneliness, depression and self-harm – all commonly associated with adolescence, especially girls – as well as insomnia, panic attacks, anxiety, obesity, OCD, digestive problems and pain. In today’s world, such symptoms are usually treated with prescription medications – but in my personal experience, these problems naturally ease off as you move into adulthood. If you believe in evolution, there must be some reason these hormones and neurotransmitters shift in this way, at that period of life; we just aren’t channelling it the right way in modern society. We aren’t nomadic, we no longer settle down with someone at 15 and immediately start having babies, we do not hunt for food, etc. Our stress does not come in the form of threats from another tribe or a dangerous wild animal; it comes from final exams and the fear that we don’t wear the ‘right’ clothes to be considered cool.

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And once again, all this stress worsens Tourette’s – not to mention associated conditions. It’s hard to separate labels like Tourette’s, ADHD and OCD at this age (or, maybe, at any age). They seem to bounce off each other until you feel like you’re going to lose your mind. I remember how hard it was, when I was younger, but at 34, it almost feels like it happened to another person and I just inherited her memories. Watching our son go through it is another matter.

I have faith that, as difficult is it is for him now (and as difficult as he is for the school and for us), he will sort of ‘grow out of it’, in time. I’ve had a motto since he was about seven: ‘He’ll be fine when he’s 25.’ People usually laugh when I say that, but I mean it – because I started to feel okay around that age. I never thought it was possible to feel as settled as I do today, but it really did somehow work out in the end – and I know it will for our son, as well.

Closing Thoughts

The point of today’s article is to emphasise that, if you have a teenager/pre-teen with Tourette’s, not only are they dealing with all the ups and downs of adolescence, but they’re dealing with the exacerbated medical symptoms associated with those ‘raging hormones’. That means it’s especially hard for them, right now – but it also means it will get better, for them and for you.

But if your child is not yet 12, like ours, the journey to adulthood can seem a long way off. While you wait, you might try encouraging your child to get plenty of exercise, to lift those serotonin levels, ease the stress with natural endorphins, sleep better, and channel the energy in a healthy way. Stretching is also great for similar reasons: it relaxes the body, allows time for meditation, and it can loosen muscles that have been tensed all day from tics.

Make sure they eat well, partly because they just should, but also because conditions like Tourette’s are influenced by diet. You may also consider giving your child supplements to help them along, especially if, like us, you can’t get them to eat properly at school. Bananas are great for increasing serotonin. I’ve also just today discovered the world of herbs that naturally reduce dopamine levels. I’ve done some personal research and started up a collection of strange sounding herbal remedies from all over the world. If any of it works for our son, I’ll be sure to share that experience, but for now, I encourage you to do your own research and find what works for you.

In our next article, we’ll be talking about how Tourette’s affects self-esteem, especially during adolescence. Please be sure to subscribe to this blog so you don’t miss out. Finally, if you’d like to read a detailed depiction of what Tourette’s is really like to live with, please read my short story The Passenger, available on Amazon Kindle and the Kindle phone/tablet app.  US Readers  UK Readers

Until next time….

Vrinda Pendred - Editor & Founder of Conditional Publications

Vrinda Pendred is a graduate of English with Creative Writing at Brunel University. She completed work experience with Random House and proofread for Mandala Publishing. She is married with two children and lives in Hertfordshire, England, where she does freelance editing and proofreading. She is also a writer, and you can learn more about her personal work here.

Vrinda has five neurological conditions: Tourette’s Syndrome, Obsessive-Compulsive Disorder, ADHD, High-Functioning Autism and bipolar disorder.  In 2010, she founded Conditional Publications with the intention of providing a creative outlet for people, and (hopefully) changing a few minds out there about what neurological disorders really are – including not just the limitations, pain or frustration, but also the more positive, beneficial ‘symptoms’ of these strange conditions.

She made three contributions to Conditional Publications’ debut release Check Mates: A Collection of Fiction, Poetry and Artwork about Obsessive-Compulsive Disorder, by People with OCD. Since then, she has released a novel entitled The Ladderinspired by her personal struggle with bipolar disorder, as well as a number of short stories, and a YA sci-fi /fantasy series called The Wisdom, all available for purchase from Amazon.

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