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Minor manifestations of Tourette's syndrome of childhood are so
common as to be considered a normal stage of development. Many
children when over tired or stressed will blink or grimace and
minor vocal tics as they are called - throat clearing, coughing
or grunting - are similarly common in some older children. As the
brain cannot be expected to grow and develop in perfect harmony
it is to be expected that minor signs such as these can be produced
particularly when it is having a hard time. Generally as the areas
of the brain that generate these often worrying symptoms catch
up in terms of development the motor escapes cease. However, it
is not uncommon to see minor facial tics often on the left side
of the face of worried parents and I have seen many an eminent
lecturer tic before and during delivering a lecture. Next time
you are watching the television look out for minor facial tics
and involuntary movement of the limbs of the game show presenter.
Again minor obsessive traits are often a feature of normal development.
Parents and some professionals become concerned when a child lines
up their cars or adopts a routine that must be followed at bedtime.
While the right side of the brain is growing and developing order
and routine is often necessary in order to help the right side
of the brain to be able to cope. The reason why is that the right
side of the brain is the 'approach/withdrawal' side of the brain
and it is this right prefrontal cortex that has to decide if a
new situation is safe or possibly presents a danger. If the right
side of the brain is struggling then the avoidance of new and possibly
threatening situations is preferred and the child adopts routines
thus avoiding change. It is therefore very important when assessing
young children to differentiate between routines/minor ritualistic
behaviour patterns and signs of potential obsessive traits.
To date I have yet to see a child that has Tourette's syndrome
in isolation. Every child that has attended the clinic supposedly
with Tourette's syndrome has in fact other signs/symptoms of developmental
delay. Attention deficit, attention deficit with hyperactivity,
obsessive compulsive traits and dyspraxia go hand in hand with
motor escapes. Only when it is appreciated that all these so-called
conditions are nothing but symptoms of developmental delay and
symptoms that will always appear in comorbidity, can the underlying
cause be uncovered and appropriate treatment put in place.
Whereas dyslexia tends to be a left brain based problem, Tourette's
syndrome, OCD, ADD, ADHD, phobias, anxiety and autism are symptoms
of a right prefrontal cortex that is struggling to develop. It
is a very interesting fact that the bulk of the second-wave of
brain cells which principally develop some 4 months after birth
end up in the right prefrontal cortex and in those areas of brain
that have been implicated as being the sites of developmental delay
symptoms. For instance, the right anterior cingulate gyrus is where
a great many of the von Economo spindle neurons (one of the second-wave
brain cells) migrate to and it is this area that has been cited
as being the area which when under functioning is the cause of
the symptoms associated with ADD, ADHD and Tourette's. The other
area that is heavily populated by von Economo spindle cells is
the fronto-insula region of the prefrontal cortex. It has been
suggested by Prof. John Allman that the absence of von Economo
spindle cells is associated with true autism. It is my opinion
that when these cells are present in this area of brain but they
are struggling to make their presence felt that autistic traits
appear and this may lead to a child being labelled as autistic.
The reason that I mention this is that I believe the ever increasing
number of labels for these supposed conditions is obscuring the
real underlying cause of these symptoms of developmental delay.
Dorsal Ant. Cingulate
Functions in;
- Cognitively demanding tasks
- Has increased activity in anxiety,
phobic states & OCD
- Reduced levels of activity found in
ADHD
Ant. Cingulate / F Pole / Infraorbital Areas
Functions in;
- Guiding attention (ADD) error correction
- Control of autonomics
- Non-mimetic facial expressions
So what are Tourette's and OCD in reality? They are I believe
symptoms that appear in comorbidity with dyspraxia, attention deficit
and attention deficit with hyperactivity. They are symptoms that
always appear in various combinations and are a manifestation of
developmental delay. Developmental delay as the name would imply
is a slowing or delay in the maturation of the brain in general
but more specifically in the development, migration and synaptogenesis
of the second-wave of brain cells that includes the von Economo
spindle cells. Various theories have been put forward to date including
a genetic predisposition and this may well prove to be true. However,
as the majority of geneticists involved in this area of research
are looking for genes specific to disorders that I believe do not
exist, to date no clear evidence is to be found. Perhaps if the
geneticists looked for the genes that control the development of
the second-wave cells an answer might be found. In a recent study
of developmental delay we found the most striking figures occurred
with a family history of developmental delays but also with the
Ventouse assisted delivery and foetal distress without birth interventions.
Can developmental delay be treated? I believe the answer is a
very positive yes. If we accept that Tourette's syndrome of childhood
is no more than a symptom of developmental delay and we can relate
the symptoms to specific areas of brain then I believe a great
deal can be done to treat this very distressing condition.
The holistic approach:
- Make the brain generally healthier by providing a diet as free
as possible from bad e-numbers, artificial sweeteners and excessive
processed carbohydrates.
- Reduce bad fat and supplement with
essential fatty acids.
- Provide specific physical exercises
that will afferentate (stimulate) areas of the central nervous
system.
- Provide computer generated programs to stimulate very
specific areas of the brain.
Unfortunately, getting the right balance of foods is not as easy
as you might think particularly when so many children with DDS
are fussy eaters or sugar junkies. Also, we have to consider hydration,
sleep and exercise - both specific and general. Therefore, I am
currently working on a new book in collaboration with Carina Norris
the nutritionist and author of numerous books including You
Are What You Eat: the meal planner that will change your life and the
academic brains behind Channel 4's Turn Back
Your Body Clock.
So how can we help? Click
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