A reduced or severely compromised ability to inhibit sub-conscious and conscious impulses is one of the greatest difficulties to negotiate for many people with Tourette Syndrome and one that leads to prejudicial attitudes in others and is often a key aspect in bullying of children with TS. Dysinhibition is absolutely intrinsic to Tourette Syndrome - the fallacy that TS consists of just vocal and motor tics is hopelessly outmoded. A central problem with TS is impulse control which appears to involve regions of the basal ganglia of the brain, in which one of the key neurotransmitters involved is dopamine. TS is a spectrum disorder and the concept of it being a collection of psychiatric co-morbidities with vocal and motor tics representing the TS component really has little clinical or scientific basis. Dysinhibiton is usually regarded as a psychological behaviourism and something that can be ameliorated by therapising or using medication to improve executive control. A similar situation is seen in 'Attention Deficit' disorders (ADD/ADHD) where poor impulse control affects the ability to focus thoughts, concentrate on one task at a time, filter sensory stimuli and not act impulsively or reactively. The reduced control of impulses in TS affects motor, vocal and thought processes as well as incoming sensory signals such as auditory, visual (e.g. reading), tactile, proprioception etc. The basal ganglia appears to have a significant role in filtering of 'information' and, when compromised, leads to greater expression of impulses and also inhibition of incoming stimuli. People with TS often have to 'consciously' perform these filtering functions which in other people are performed with ease and mostly without conscious awareness. The need to label the derivative or consequential aspects of TS separately, and align them with current psychiatric 'disorderism' is unecessary.
Can anyone who has first hand experience of TS imagine a person (and especially a child) with TS not experiencing difficulties with attention deficit, impulsiveness, poor inhibition (dysinhibition), hyperactivity, uninhibited vocal expression and movements? Any reduction of the ability to filter incoming sensory input leads to problems with 'making sense' of the environment and opens the possibility for misinterpretation or over-reactiveness to sensory input. Many individuals with TS suffer with 'low latent inhibition'. They may 'see' the world around them in extraordinary detail (vision, hearing, tactile etc.) and so find it difficult to focus on the essential information that is only relevant to their interaction with it and other people. A child may seem to be daydreaming, indecisive or in a 'fog' when they are in reality experiencing racing and complex thoughts or may be overloaded with stimuli. Some parallels may be drawn with the sensory 'hypersensitivity' that is seen in autistic spectrum disorder (autism, Asperger's) which is thought to lie at the heart of the disorder. Individuals may shy away from sensory bombardment (sound, visual stimulation, tactile contact, taste, social interaction and sources of strong emotional stimuli (e.g. eye contact, questioning, physical contact) in order not to overwhelmed. This has been described with great eloquence by many with high-functioning autism including Dr Temple Grandin. People with autism will often find solace in and feel they gain some control over the environment, which 'impinges' upon them, by using ritualised comfort behaviours. These may include 'stimming', rocking, physical confinement, focusing on patterned and predictable structure etc. Some of these behaviourisms are interpreted by others as being obssessive and anti-social and that appropriate therapy is needed to get the person to take on the reality of the world. Strangely many people with autism, far from 'hating' physical contact at any cost, may sometimes crave physical contact and would love to be hugged or comforted but wish for this on their own terms, when and how they need it, but not always when others impose on them in an overly presumptive and unexpected way.
