Tourette’s syndrome is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. It is named after Georges Gilles de la Tourette, the pioneering French neurologist who first described the condition in 1885. Tourette’s is classified as a neurodevelopmental disorder and disability that begins in childhood, usually around the ages of 3-9 years old. Let’s take a closer look at what type of disability Tourette’s is.
Neurological Disorder and Disability
Tourette’s syndrome is considered a neurological and neurodevelopmental disorder because it affects the functioning of the brain and nervous system. Specifically, it involves problems with the basal ganglia, a part of the brain that helps regulate body movement. Abnormalities in the basal ganglia cause imbalances in neurotransmitters, the chemicals that nerve cells use to communicate with each other. This leads to problems controlling muscular movements and vocalizations.
Tourette’s is classified as a disability under the Individuals with Disabilities Education Act (IDEA) and the Americans with Disabilities Act (ADA). This means that Tourette’s meets the legal definition of a disability, which is a physical or mental impairment that substantially limits one or more major life activities. The tics and vocal outbursts associated with Tourette’s can interfere with daily activities, learning, work, and social interactions. Treatment is often necessary to help manage symptoms. Classifying Tourette’s as a disability ensures access to accommodations and protections against discrimination.
Motor Disorder
One of the hallmark symptoms of Tourette’s syndrome are motor tics – involuntary, sudden movements or twitches of the face, limbs, or trunk. Common motor tics include eye blinking, shoulder shrugging, head jerking, mouth movements, jumping, hopping, tapping fingers, grimacing, and more. These tics are classified as motor disorders because they involve abnormal and uncontrolled body motions.
Tourette’s is considered a hyperkinetic movement disorder characterized by unwanted movements. Other examples of hyperkinetic disorders include dyskinesia, chorea, athetosis, dystonia, hemiballismus, myoclonus, and tremor. In contrast, hypokinetic disorders like Parkinson’s disease involve a paucity or slowness of movement.
The motor tics of Tourette’s are classified as habits, mannerisms, and stereotypies. They are repetitive, recurrent, non-rhythmic motor behaviors that seem purposeless. The tics can fluctuate in severity and change over time. Stress and anxiety often worsen tics. Tics are suggesting to originate from problems with the cortico-striato-thalamo-cortical circuits that regulate motor control.
Vocal Tic Disorder
In addition to motor tics, many individuals with Tourette’s also experience vocal tics. These tics involve involuntary sounds and utterances, such as grunting, throat clearing, shouting, whispering, sniffing, snorting, barking, yelling obscenities (coprolalia), repeating words or phrases (palilalia), and more.
Vocal tics represent a separate neurological disorder called vocal tic disorder. The vocal tics of Tourette’s are not due to a secondary cause like medication. They are sudden, rapid, recurrent vocalizations that seem aimless and non-communicative. The vocal tic symptoms of Tourette’s usually start after the onset of motor tics. Like motor tics, vocal tics tend to fluctuate in severity and change over time.
Both motor and vocal tics are classified as primary tic disorders. Primary indicates they are not caused by another medical condition or substance. The specific tic disorder is classified based on duration of symptoms. To be diagnosed with Tourette’s, an individual must have multiple motor and one or more vocal tics persisting for more than one year.
Neuropsychiatric Disorder
In addition to motor and vocal tics, Tourette’s syndrome has neuropsychiatric components as well. A majority of those with Tourette’s also have co-occurring psychiatric conditions like:
- Attention deficit hyperactivity disorder (ADHD)
- Obsessive compulsive disorder (OCD)
- Anxiety disorders
- Mood disorders
- Impulse control disorders
- Sleep disorders
- Self-injurious behaviors
These associated neuropsychiatric disorders contribute significantly to functional impairment in Tourette’s. The combination of tics and psychiatric symptoms means Tourette’s affects multiple domains of mental and behavioral functioning. This suggests it likely involves disrupted connections and brain circuitry between motor, limbic, and cortical regions.
Some experts have proposed that Tourette’s be re-classified as a neuropsychiatric illness rather than a movement disorder. The psychiatric symptoms are increasingly recognized as core features inherent to Tourette’s rather than separate comorbidities. Viewing Tourette’s as a neuropsychiatric disability could improve diagnosis and treatment approaches.
Developmental Disability
Tourette’s syndrome emerges in early childhood, so it is also categorized as a developmental disability and disorder. Developmental disabilities originate during the developmental period (birth to 22 years old), typically in childhood, and affect day-to-day functioning. In addition to Tourette’s, other examples of developmental disabilities include autism spectrum disorder, ADHD, learning disabilities, intellectual disability, and cerebral palsy.
The early onset of Tourette’s means it can disrupt education, learning, socialization, and emotional development. Tics and psychiatric symptoms often first appear between 3 and 9 years old. On average, the worst tic severity is reached by age 12. Many children with Tourette’s require special education services or accommodations. Early intervention is crucial.
Tourette’s meets the criteria for a developmental disorder because:
- Onset is in childhood
- It is a chronic condition
- It causes impairment in personal, social, academic, or occupational functioning
- It requires medical, educational, psychosocial support
Classifying Tourette’s syndrome as a developmental disability ensures children receive needed services and accommodations.
Neurodiversity
Some advocates have proposed viewing Tourette’s through the lens of neurodiversity. The neurodiversity paradigm views conditions like Tourette’s as natural variations in the human brain and nervous system rather than diseases or disorders.
From this perspective, neurological differences like Tourette’s contribute valuable diversity to the human ecosystem. The goal becomes finding ways to embrace and accommodate all neurotypes rather than trying to “cure” them.
Viewing Tourette’s as an aspect of neurodiversity has both advantages and critiques. On the positive side, it reduces stigma and challenges the medical model that sees disability as something “wrong” that must be fixed. It values the strengths and perspectives people with Tourette’s contribute.
However, others argue this perspective underestimates the real disability and impairment associated with severe Tourette’s. They believe it remains important to find medical treatments to reduce suffering in those most severely affected. The neurodiversity model also risks obscuring the need for support services, accommodations, and disability rights protections.
In summary, Tourette’s syndrome affects multiple aspects of neurological functioning. It straddles boundaries between movement, neuropsychiatric, developmental, and neurodiversity frameworks. No single perspective fully captures the heterogeneity of Tourette’s as a disability. The best approach seems to be utilizing different lenses when most helpful while respecting the individuality and self-conception of each person with Tourette’s.
Diagnostic Classification
To receive an official diagnosis of Tourette’s syndrome, a person must meet diagnostic criteria outlined in the medical classification systems ICD-10 and DSM-5.
ICD-10 Diagnosis
The International Classification of Diseases, 10th Revision (ICD-10) contains the following criteria to diagnose Tourette’s:
- Onset before age 18 years old
- Multiple motor tics and one or more vocal tics at some point during the illness
- Tics occur many times a day, recurrently throughout more than one year
- Symptoms fluctuate in frequency, location, type, and severity over time
- Tics are not attributed to effects of substances or another medical condition
Under ICD-10, Tourette’s is classified as a disorder of psychological development (F80-F89). The specific code is F95.2.
DSM-5 Diagnosis
The Diagnostic and Statistical Manual, Fifth Edition (DSM-5), published by the American Psychiatric Association, lists these Tourette’s diagnostic criteria:
- Multiple motor and one or more vocal tics present at some point during the illness
- Tics may wax and wane in frequency but have persisted for more than one year since first tic onset
- Onset before age 18 years
- Tics not attributed to physiological effects of a substance or another medical condition
Under DSM-5, Tourette’s is classified as a Neurodevelopmental Disorder (category F80-F89). The specific disorder is Tourette’s Disorder, code 307.23 (F95.2).
Eligibility for Disability Benefits
Given its status as a neurological, neuropsychiatric, and developmental disability, Tourette’s syndrome can potentially qualify an individual for certain disability benefits and services if it causes substantial impairment. Possible disability benefits include:
Special Education Services
Under the Individuals with Disabilities Education Act (IDEA), U.S. children with disabilities are entitled to free special education services and accommodations in school when needed. An individualized education program (IEP) is created. Tourette’s may qualify if it negatively impacts educational performance.
Social Security Disability Insurance
Adults unable to work due to Tourette’s may qualify for Social Security Disability Insurance (SSDI) if they have a sufficient work history paying into Social Security. SSDI provides monthly income and Medicare benefits.
Supplemental Security Income
For low-income adults with Tourette’s, Supplemental Security Income (SSI) provides cash assistance and Medicaid coverage. SSI does not require a work history.
Reasonable Accommodations
Under the Americans with Disabilities Act (ADA), employees with Tourette’s are entitled to reasonable accommodations in the workplace when needed, such as flexible schedules or modified duties.
Other Programs
Other disability programs like housing assistance, state vocational rehabilitation, and disability parking permits may also be available to those who qualify. Documentation of diagnosis, symptoms, and functional limitations is typically required.
Severity and Impairment
Not everyone with Tourette’s requires disability services or benefits. Eligibility often depends on the severity of symptoms and degree of impairment.
Tourette’s occurs on a spectrum of severity. Tics and comorbidities range from mild to severely disabling. Average onset is around 7 years old. Tics typically peak in severity between ages 10-12, wane in late adolescence, and plateau or improve in early adulthood. About 10-15% of cases are considered severe.
Factors affecting severity and impairment include:
- Type, frequency, intensity, complexity, and location of tics
- Age of onset
- Presence and severity of comorbid conditions like OCD and ADHD
- Resulting difficulties with activities and functioning
- Access to treatment and management
- Psychosocial stressors
Those with milder tics or impairment may not require any accommodations or services beyond monitoring. Severe, disabling tics combined with significant psychiatric comorbidity are more likely to cause substantial interference in school, work, activities, and quality of life. Each person must be evaluated individually.
Treatment and Management
While there is no cure for Tourette’s, various treatment options exist to manage symptoms:
Medications
Medications that may help reduce tics include antipsychotics, alpha-adrenergic agonists, antihypertensives, and botox injections for motor tics. Antidepressants, stimulants, and other medications can help manage comorbid conditions.
Behavioral Therapy
Behavioral approaches like habit reversal training and comprehensive behavioral intervention for tics (CBIT) are first-line non-medication treatments. They help teach tic suppression strategies.
Deep Brain Stimulation
For those with debilitating tics who do not improve sufficiently with other treatments, deep brain stimulation (DBS) may be an option. This surgically implants a device that delivers electrical impulses to targeted parts of the brain.
Accommodations and Support
Classroom accommodations, workplace modifications, assistive technology, counseling, social skills training, disability services, and support groups can also help maximize functioning and quality of life.
With proper treatment and support, many people with Tourette’s can live full, productive lives. Understanding Tourette’s as a complex neurological, neuropsychiatric and developmental disability can help ensure access to needed services and respect.
Conclusion
In summary, Tourette’s syndrome is classified as a neurological disorder, neurodevelopmental disability, motor and vocal tic disorder, and neuropsychiatric condition. It involves motor and vocal tics plus frequently associated conditions like OCD and ADHD. Tic onset is before age 18, lasting more than one year. Tourette’s can substantially limit functioning, qualifying individuals for disability services and benefits depending on severity. Treatment focuses on medication, behavioral therapy, and accommodations to manage symptoms. Understanding Tourette’s as a multifaceted disability can help promote respect and inclusion.