Pediatric Tourette’s syndrome, although only slowly recognized in recent years, has attracted the attention of parents and stakeholders. However, even so, parents are not able to properly select treatment for their children, and they are not guided to do so. Often, they choose to seek medical attention only when their child’s symptoms are more severe, and are at a loss because they cannot find a standardized and effective treatment. It is important to remind parents that some parents often think that their children are naughty when they find these behaviors and do not care about them, so it is easy to ignore the disease, and when the symptoms are serious, it will be more difficult to treat. Therefore, at the initial stage of finding abnormal symptoms in children, the first thing you should do is to take your child to confirm the diagnosis.
First of all, to confirm the diagnosis scientifically: when you find that your child has symptoms such as blinking, throat clearing, head tossing, accompanied by vocalization, etc., you should immediately take your child to the hospital for examination. The usual tests are trace element test, IVA test, IQ and memory test, and EEG test for children if possible. This will better coordinate with experts to confirm the diagnosis of tic disorder or ADHD in the child.
Second, reasonable treatment: Because tic disorder or ADHD is a chronic disease in children, it is necessary to adhere to the treatment plan in strict accordance with the experts during the treatment process to be effective. For children with mild cases, with short onset (generally less than a year) and mild symptoms, the effect is significant in about 1-2 months of medication, and the symptoms are basically controlled or disappear. For severe cases, usually with multi-site twitching and a longer duration of illness (one year or more), the treatment period may vary depending on the severity of the disease, and the child and parents need to cooperate with the treatment to control or disappear the symptoms and consolidate them well.
Symptoms
1.Motor twitching.
(1) Simple motor twitches, such as blinking, eyebrow raising, nose wrinkling, tongue stretching, lip licking, head nodding, head shaking, shoulder shrugging, finger snapping, etc., occur alternately.
(2) Complex motor twitching: the twitching is more complete or slower, such as the rotation of the eyes, the twitching of the face that leads to a particular expression, and the shoulders and arms or hands and feet make a certain posture. If the child suddenly reaches out and slaps people, touches the furniture, hits his own body or has a dystonic posture such as rotating, jumping, standing up or bending the waist and abdomen, he is often misunderstood and disgusted by the people around him, so he has to stop school or stay out of home, and then becomes withdrawn and hostile to others, leading to social function and personality disorders.
2.Vocal tics.
(1) Simple vocal tics are characterized by rapid and meaningless monotonous repetition, such as constant throat clearing, coughing, and involuntary screams such as “uttering…” and “ahhhh…”.
(2) Complex vocal tics: The appearance of meaningful phrases, or more complex sentences, and also some manifest as repetitive, stereotyped complete statements, or even slurs.
3. Other behavioral disorders.
(1) Attention deficit accounts for about 50%, and 30-40% of the children have emotional instability, learning difficulties, and aggressive behavior. Screaming, punching the wall, threatening, attacking others, and abnormal sexual behavior or molestation in some children.
(2) Obsessive-compulsive behavior and obsessive-compulsive ideas, which appear later in the disorder, interfere with the normal life of the child and cannot be shaken off, which is very painful. It is very distressing because it interferes with the normal life of the child and is impossible to get rid of it.
(3) Although the child has learning difficulties, he or she often has a normal IQ. In 50% of children, there may be mild or unstable neurological abnormalities or non-specific EEG changes, and most brain CT examinations are normal.
Preventive measures
Parents of the child should actively cooperate with the specialist during the treatment process and should not scold the child; they should not focus their attention on the child, especially not to gaze at the child when the child is twitching, which will cause a psychological pressure on the child and is not conducive to the child’s recovery. A reasonable approach should be to
1. help the child to develop a reasonable work and rest schedule, not to overexert and to get enough sleep.
2. In the family environment, direct expression of the child’s symptoms in sensitive language should be avoided.
3. Ignore the child’s twitching and turn a blind eye to it.
4.Giving more encouragement to the affected child to build up self-confidence and relieve stress.
5. Do not allow the child to participate in strenuous sports, such as military training, long-distance running, competitive sports activities and heavy physical labor.
6.Study time should not be too long.
7, should communicate with the school teachers, avoid giving sensitive language critical education to the affected children, to cooperate well with the education of the children during the treatment period
8, pay attention to the diet during the treatment period, do not eat greasy, cold, high lead content food, do not eat spicy, seafood, instant noodles, puffed food during the medication, should be light delicacies, appropriate nutrition.
9, seasonal exchange period, especially in spring and autumn for the high incidence of colds, should pay attention to the child’s off, dressing, beware of colds, because colds are very easy to cause relapse or recurrence of symptoms, aggravation.
10. Do not watch TV for more than half an hour a day, and do not watch too intense, stimulating images, and avoid watching TV for those who are seriously ill. Avoid the use of computer, if there is a need to study, each time the use of computer should not exceed half an hour, strictly prohibit the excessive use of computer or game.
11. During the treatment period, you should follow up on time to ensure that the medication is adjusted according to your condition in time to improve the progress of recovery.
Causes
There are many causes of inertia twitching. For example, blinking can be caused by conjunctivitis or foreign objects entering the eyes; frowning and frowning can be caused by wearing a hat that is too small or a frame that is not suitable for glasses; shaking the head or twisting the neck can be caused by tight collars, etc. After the above causes are removed, the action itself has lost its rationality, but because inert foci of excitation have been formed in the cerebral cortex, the twitching action can occur repeatedly. In addition, imitation of similar movements of others, psychological stimuli and somatic diseases can also trigger this disease. Common psychological stimuli include.
(1) frightened, such as being suddenly attacked by a dog or almost crushed by a car while crossing a road.
(2) Chronic anxiety and unhappiness, such as parental discord, long-term parental illness, and the mother giving birth to a child, which distracts from the affected child’s favor. Common somatic factors are: acute tonsillitis, upper whistle infection, etc. and other acute medical conditions.
Pediatric tic disorder treatment medication
1, psychological behavior therapy
(1) Elimination of triggers: In transient tic disorder, especially in children with short twitching time, it is often not difficult to find triggers in behavioral appointments. In young children, the trigger is usually the result of watching stressful television or video programs, playing video games, or hearing and seeing something that scares them, so it is crucial to find the trigger and eliminate it.
(2) Detailed analysis of psychological factors: The pre-morbid psychological factors of the child should be analyzed in detail to identify possible causative factors and then be addressed. Older children often have tics due to accidents, family conflicts, and too much pressure from studies. Mental conflicts and tensions caused by various conflict adjustments, family conflicts, excessive demands and compulsions of parents and grandparents on the child must be resolved. If there are school factors, they should be solved in collaboration with teachers. For factors that cannot be resolved, supportive psychotherapy should be given to help the child analyze the mental triggers and find out the correct way to deal with them.
(3) Give parents the necessary guidance: explain to the parents of the affected child the nature of the disorder and do not panic, which will eliminate the reinforcing effect caused by excessive parental concern. Parents are often overly concerned about tics, so they should be made aware of the triggers for tics and make reasonable arrangements for the child’s life, studies and activities. Do not remind the child of the symptoms of tics. Instead, the child’s tics should be ignored and the symptoms will gradually subside. In most cases, the symptoms will disappear spontaneously after a few months. Help the child to eliminate triggers and provide a good and relaxed family environment.
Muscle relaxation therapy and operant handling are expected to have good results. When the child receives behavioral treatment, it is necessary to obtain the cooperation of the child and parents, and give the parents the necessary guidance to assist in the treatment.
Behavior modification: Encourage the child to control his or her own tics, use positive reinforcement such as rewarding the child for his or her efforts to overcome and reduce tics, and use relaxation methods to reduce the child’s mental tension, which is more effective for young children.
The tics generally do not require medication, but only when the tics significantly affect the child’s movement and speech, interfere with interpersonal relationships and classroom learning, medication is given.
(1) Eliminate triggers: tonsillitis, allergic conjunctivitis, rhinitis, episodes of sensation, etc. are sometimes triggers of tics in children. Therefore, these diseases should be treated first.
(2) Haloperidol (HAL): It can block dopamine receptors. The dose is 0.02~0.05mg/(kg?d), starting from small amount orally, 0.25mg, 2 times/d, and gradually increasing the dose when it is ineffective, until the satisfactory effect, so that the symptoms can be controlled without side effects. In children, it can be 1-6mg/d. This drug is likely to cause extrapyramidal side effects, among which acute dystonia and inability to sit still are the most common. High dose application can also cause myocardial damage. To prevent extrapyramidal side effects, Antan or scopolamine can be used in combination.
(3) For children with severe anxiety, diazepam (Valium) (1.25-2.5mg, 2 times/d) can be added.