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Communication in Children with Tourette Syndrome

  • Author / Creator
    Feehan, Angela (M.)

  • Tourette syndrome (TS) is a neurodevelopmental condition involving motor and vocal tics that begins in childhood. Children with TS often present with other co-occurring conditions such as Attention-Deficit/Hyperactivity Disorder and some have challenges in communication development. The overall purpose of this research was to improve understanding of communication development in children with TS. The aims of the research were to collate and summarize past research, measure communication skills, explore how psychosocial skills and co-occurring conditions relate to communication skills, and describe communication in day-to-day contexts. Three studies were conducted to address these aims.
    The first study was a scoping review that maps, describes, and summarizes the literature reporting on the language and social communication skills of children with TS and identifies knowledge gaps. It is described in Chapter 2. A systematic search of six electronic databases revealed 56 studies that measured language or social communication. The majority of identified studies measured verbal IQ or verbal fluency. This literature suggests that children with TS have strengths in verbal intelligence, story/sentence recall, categorisation, and performance on tasks at the single-word level. Moreover, a subset of children with TS had language disorders and social communication challenges, with rates of language delay/disorder being higher in children with co-occurring conditions (i.e., 20-45%). There was little research investigating language beyond the single-word level as well as a lack of detailed reporting about the nature of language and social communication challenges in children with TS.
    Using a series of parent questionnaires to measure communication skills and psychosocial skills, the second study describes the proportion of children in a North American sample of children with TS who present with challenges in communication development, compares communication skills to a normative sample, analyzes how co-occurring Attention-Deficit/Hyperactivity Disorder, Obsessive Compulsive Disorder, and Anxiety relate to communication skills, and investigates if communication skills correlate with psychosocial skills. This study is described in Chapter 3. Information was collected using the Children’s Communication Checklist, Second Edition and the Strengths and Difficulties Questionnaire. Sixty-two percent of children received scores indicating age-expected communication skills and 38% obtained scores suggesting communication challenges. Mean scores for the children with TS were significantly below age-expected norms for general communication and social-pragmatic composites, as well as for multiple domain subscales. The presence of co-occurring conditions did not predict communication challenges. There was a negative correlation between communication scores and psychosocial scores: when communication scores decreased, psychosocial challenges increased.
    The third study was a scaffolded mixed methods case series that aimed to describe language development and day-to-day communication in five children with complex TS (i.e., TS with other co-occurring conditions). This study is described in Chapter 5. The study reports language scores across core language, narrative language, high-level language (e.g., inferencing), and social communication domains of language development. Communication log books and semi-structured parent interviews were used to understand day-to-day communication. School accommodations, extra services, or alternative education options were being accessed by many parents. Parents used proactive approaches to manage day-to-day communication in the home and they strategized to keep the environment calm and productive. Parents also adopted attitudes of acceptance and understanding. In some cases, parents provided social coaching and created intentional social experiences so that their children could be successful.
    The combined findings of this research indicate that many children with TS will develop age-appropriate language skills; however, many others may experience challenges across a range of language and social communication areas. The second and third studies provide evidence that young children with TS are at risk of having their communication challenges overlooked. For children referred to a speech-language pathologist, assessment should go beyond investigating core language skills, considering narrative language, high-level language, and social communication. I also recommend collecting background information about co-occurring conditions, the severity of the tic disorder, and levels of psychosocial functioning. Treatment approaches should consider the child’s psychosocial and emotional-behavioural needs. Creating a calm environment can help a child manage anxiety and other tic triggers. A flexible approach can help children participate in traditional forms of intervention. The SLP can also have a role in shaping positive social environments for children by educating others about TS and promoting acceptance of the social differences that go along with this neurological difference.

  • Subjects / Keywords
  • Graduation date
    Fall 2024
  • Type of Item
    Thesis
  • Degree
    Doctor of Philosophy
  • DOI
    https://doi.org/10.7939/r3-711b-nt83
  • License
    This thesis is made available by the University of Alberta Library with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.