Explaining Tics
A couple of nights ago I was at our local ADD wise support meeting and was asked about tics, and why they can’t be suppressed. Here’s how I explained them:
Just because a tic can be suppressed for a short time, doesn’t mean they can be suppressed indefinitely. It’s not simply a case of trying harder. Let me give you a practical example….
‘I want you to hold your breath while I count to ten – OK let’s begin:
‘One…Two…Three…Four…Five…Six…Seven…Eight…Nine…Ten!’
‘Now that was quite easy wasn’t it, so I am sure you will have no problem holding your breath for the next half hour or so while I count up to 1000’!
‘…notice also how when you finished holding your breath you had to breath faster or even pant to ‘catch your breath’. Well tics are much the same, though the timescale involved can be a little longer – in my case from a few seconds to the best part of the working day’.
‘Now, I want you to hold your breath again while I slowly count up to ten. But this time I want you to do some mental arithmetic at the same time’.
‘Do you think it might be more difficult doing this arithmetic while holding your breath, compared with not holding your breath? Or might doing the arithmetic make it harder for you to hold your breath’?
‘What if I were to count up to 20 or higher’?
‘Try now to imagine what it might be like trying to do a day’s work as you repeatedly held your breath while counting to ten, with just a single deep breath between each counting. How much work do you think you would get done’?
‘Now imagine what if must be like if you had to do this all day every day, year after year, in fear of being put down and scapegoated by your boss, or bullied and teased by your peers’.
‘Well, you now know what it must feel like being a kid with TS in an unsupportive school environment, that he is compelled to attend by our compulsory education system’!
Tics vary in urgency. Some can be suppressed almost immediately and others can hardly be suppressed at all. This is a bit like the differences between a sneeze, a cough and a hiccup.
Most sneezes can be suppressed almost indefinitely, although this may take some considerable effort on your part. Many of my complex motor tics work like this, but I can’t get rid of them completely until I let them just flow completely uninhibited for a while. Doesn’t it feel great after you have had a really good sneeze!!
Coughs can generally be suppressed for a much shorter time, but soon the urge to cough becomes simply overwhelming. My simple repetitive eyeblinking motor tic works a bit like this.
Then there are hiccups. You know that the next one in going to come real soon, but you can’t tell exactly when – not until it’s too late to stop them completely!
You might just be able to catch the end of a hiccup, though, reducing it to a strangled ‘hi…’ Well this is how my biting tic works – am always biting the inside of my lip, especially when I am eating. But if I am sufficiently vigilant then bite still hurts, but at least I don’t bleed!
It’s much the same for TSers I know who have coprolalia – they swear compulsively. If they try hard enough they can just about keep their utterances to expressing the first syllable only. For example:
‘Fu…..’
Sometimes they can even convert this utterance into a more acceptable phrase, such as:
‘Fu….nny you should say that’!
At the support group I was also asked about medication and why ADDers and TSers on stimulants such as Ritalin don’t always immediately do better at school.
Well, just imagine you are severely short sighted but have never worn glasses in your life, so you are used to everything being fuzzy. By squinting and trying real hard you can just about make out the letters of words. But still you are very slow reader and the effort leaves you feeling completely exhausted or sort of ‘brain-dead’ after just a short time.
Then one day someone gives you a pair of glasses to wear. What a revelation, for you can see clearly at last!
Then the teacher at school gives you a newspaper to read out loud. You can seem them now, but the words and sentences are far longer and more complicated than anything you have every read before, so you keep stumbling and making seemingly stupid mistakes. What’s more, there are many far more interesting things to look at with your new found sight. So you are easily distracted and quickly get bored with the dry newspaper. As your attention wanders around the classroom taking in all these new sights, it looks to the teacher as if your attention is wandering in a way similar to how you were before you could see clearly.
The teacher complains to the supplier of the glasses:
‘See, I told you these Ritalin lenses are no good’!
So the supplier of the glasses – who has had very little practical experience testing eyesight, suggests trying another pair with much stronger lenses.
When these don’t work the teacher insists:
‘Better take them away from him before he gets addicted to them. After all, I’ve heard stories about kids who abuse them by taking them off in strong sunlight and using them to burn holes in things. Now, we don’t want him to get hooked on that sort of thing do we!
‘Who knows, he might even get bullied into sharing them with his mates, or even be persuaded to sell them. Now we don’t want to end up with a school full of young arsonists, do we’!