Original airdate October 16, 2018.

Disclaimer: This show is not a substitute for professional counseling and no relationship is created between the show hosts or guests and any listener. If you feel you’re in need of professional mental health, and are a UA student, we encourage you to contact the UA Counseling Center at 348-3863. If you are not a UA student, please contact your respective county’s crisis service hotline, or their local mental health agency. or insurance company. If it is an emergency situation, please call 911 or go to your nearest emergency room.

Dr. BJ Guenther: Hey, it’s 6:00 and time again for Brain Matters, the official radio show of the UA Counseling Center. We are broadcasting live from the WVUA FM studio 90.7 The Capstone, on the campus of the University of Alabama. Good evening, my name is Dr. BJ Guenther and I’m the host of the show.

Dr. BJ Guenther: In case you don’t know, this show is about mental and physical health issues that affect college students, and in particular, UA students. You can listen to us live each Tuesday night at 6PM on 90.7 FM or you can go online at wvuafm.ua.edu, or you can also download the Crimson White app, and click on 90.7 live streaming link. As always, we’ll be taking questions via email. So if you have questions for myself or my guests, email those to brainmattersradio@wvuafm.ua.edu.

Dr. BJ Guenther: Also, if you have any ideas for upcoming shows, please email those to me. I’ll try to give the email address out periodically, and if you have ideas for upcoming shows, you can go ahead and email those to me, and I will definitely consider that. We’re always getting new ideas and trying out new topics for the shows coming up. We’ve got most of our shows for the fall planned out and scheduled and committed to by guests but for the spring, I’ll need some new … Usually we do about 12 to 13 shows a semester, so I’ll need some new topics or something interesting or trending in the world of mental health.

Dr. BJ Guenther: Tonight’s topic is one that I’ve been interested in in a long time and I just didn’t know who I could ask to be on the show, and I’ll tell you a little bit about my guest in just a minute. But the show I’m calling tonight is Tics, Twitches and Tourette’s. You may have noticed someone with Tourette’s in that the individual would have a motor or a vocal tic that’s noticeable. I mean imagine feeling as if your chair is falling over but this would be 24/7, and then you have no idea why. This is the feeling described in one of the articles I’ve read about Tourette. Tourette’s Syndrome is actually what it’s called.

Dr. BJ Guenther: My guest tonight is Sheryl K. Pruitt. Sheryl is the clinical director of Parkaire Consultants in Marietta. Georgia. It’s a clinic she founded to serve neurologically impaired individuals. Sheryl is also an author and a speaker who educates children, adolescents, and adults about neurological disorders and the coping skills needed to remediate deficit areas caused by these disorders. She speaks locally, nationally, and internationally on neurological disorders and she also teaches professional seminars and learning courses for healthcare professionals and educators.

Dr. BJ Guenther: I came across Sheryl’s name while researching Tourette’s because I knew I wanted to have this topic, but in researching, you just cannot not come across her name when you Google Tourette Syndrome research. I knew she’d be the perfect specialist I needed to invite to be in the show. So welcome Sheryl Pruitt. Are you there?

Sheryl K Pruitt: I’m there and I’m glad to be here. Thank you for having me.

Dr. BJ Guenther: Thank you so much for being on the show. Tell the listeners a little bit about yourself and your credentials and why you’re interested in Tourette’s.

Sheryl K Pruitt: Well, I’m an educational therapist and I’m clinical director of the neurological clinic that you talked about. But my real credentials are that I knew something was wrong with my older son, and this was a long time ago. He’s going to be 50 this year, so that tells you how long ago this was.

Dr. BJ Guenther: Wow.

Sheryl K Pruitt: No one in the Southeast was diagnosing Tourette’s. It turned out no one in the Northwest or the Southwest was diagnosing. It turns out, in the entire world, there was only one doctor in New York City diagnosing Tourette’s at the time. Since he didn’t live in Atlanta it was a bit of a problem to find out what was going on.

Sheryl K Pruitt: So I had a clinic already before that, and one of the clients moved here from New York City and he had Tourette Syndrome. When he walked in, I had no idea that that’s what it was. That’s how we found out what my son had. Then what we did was start becoming a Tourette specialty clinic. We were the first private clinic in the Southeast to see Tourette Syndrome and then we wound up publishing books about what we had learned and different information. I was a learning disability and behavior disorder teacher at one point, so I had developed a lot of tricks for kids who had issues and different neurological disorders because of my interest in the family.

Sheryl K Pruitt: And then my second son, Jory, wound up having Tourette Syndrome, and then we had a granddaughter who developed tics. Then we had different disorders in the family, like the average Tourette family has an ADHD dad and a obsessive-compulsive disorder mom and they get a Tourette child, and it’s the first time they’ve seen tics in the family. But it’s a cumulative disorder. So it’s normal to have it here after several people get together who have similar disorders.

Dr. BJ Guenther: It almost sounds like you self-diagnosed your son because there was no one to diagnose him.

Sheryl K Pruitt: I did self-diagnose, but it was interesting because what we did after that was get together with the Tourette’s Association, the name of the organization at the time, and in the Southeast then start a campaign to do education. So we very quickly got medical people involved and Tourette started being diagnosed in the South.

Dr. BJ Guenther: Describe what Tourette’s is. Can you give us a definition? Where did the name come from? Why is it a syndrome?

Sheryl K Pruitt: Also, you suddenly got very quiet, so it’s hard to hear you.

Dr. BJ Guenther: Did you hear me?

Sheryl K Pruitt: But I think I can hear you enough to get the answer.

Sheryl K Pruitt: Tourette Syndrome came from a man named Gilles de la Tourette who lives in Tourette, France and on a winery. I’ve actually been given Tourette wine.

Dr. BJ Guenther: Wow.

Sheryl K Pruitt: He was at the Charcot, which is a famous hospital in Paris. The Charcot was sort of like the impressionists in Paris were the painting, the Charcot was doctors. Freud was there. Jung was there. The person who founded special ed was there. It was a very amazing group of doctors. He had a case and he named it. He named it after him because he identified this person who had Tourette. That’s when it started.

Dr. BJ Guenther: Why is it-

Sheryl K Pruitt: You want to know the definition of what Tourette is and how you diagnose it?

Dr. BJ Guenther: Yeah. Why is it called a syndrome?

Sheryl K Pruitt: It’s called a syndrome because if you have a group of symptoms that have consistently occurred together, a condition characterized by a set of associating symptoms, they name it a syndrome. It has recently been renamed a disorder in the DSM, but most people who work with it still call it Tourette Syndrome.

Dr. BJ Guenther: Okay, I was wondering about that because some of the articles I read said disorder and some said syndrome, so that’s one of the things I wanted to ask you tonight is what happened. What’s the appropriate thing to call Tourette’s? I guess it’s either.

Sheryl K Pruitt: Well, the people who work with it most still call it Tourette Syndrome. But a lot of new people have to use the diagnostic code because of insurance.

Dr. BJ Guenther: That’s right. That’s right.

Sheryl K Pruitt: But we frequently know if someone knows a lot about Tourette’s. If they call it Tourette Disorder, they frequently haven’t worked with it a long time, so it’s interesting how things change. A group of people get together and vote on the DSM every few years and the names can change.

Dr. BJ Guenther: Yeah. I read an article today and this is the title of it, Birmingham Program Attracts Tourette’s Patients From Across the Nation. The article was written in 2013. It says in the article that Children’s Hospital of Alabama in Birmingham houses the first Tourette and tic disorder program, an eight-week program to treat children with tics or Tourette Syndrome without the use of pharmaceuticals. I was really shocked to know that. I had no idea and really was not even looking for anything near me, Birmingham, just Googling Tourette’s, articles about Tourette’s Syndrome.

Dr. BJ Guenther: Is that true?

Sheryl K Pruitt: Okay, Doug Woods and a doctor named [inaudible 00:09:01]. There were several people who got together and they created a program called Comprehensive Behavioral Intervention for Tics. They call it CBIT. CBIT is a nonmedical, cognitive program to interrupt tics. The important thing about CBIT is it … And Doug Woods, who is one of the leading instructors of CBIT, will tell you that they do not recommend CBIT as the first line to treating tics in Tourette. They don’t recommend medicine for Tourette. What they recommend first is the associated and comorbid disorders …

Sheryl K Pruitt: One of the things that you’re going to find is that there are several things … Like the comorbid disorders is a term for the ones that come with it the most often and the most closely. That would be ADHD and obsessive-compulsive disorder. But there are also associated disorders which come with it very frequently. They are other anxiety disorders, mood disorders such as major depressive disorder or bipolar, sensory defensiveness and hygiene problems, learning disabilities and the two that are most common are written expression and math calculations.

Dr. BJ Guenther: Wow.

Sheryl K Pruitt: Social pragmatic disorder which is difficulty socializing, executive dysfunction which is all that organization, planning that people need, sleep abnormalities, and there are other things that come with it. If you treat the mood, the ADHD, and the anxiety in that order sometimes the tics go way down. So stress of those disorders can cause the tics, exacerbate it. You always try and treat the associated comorbid first if you can.

Sheryl K Pruitt: If you have a harmful tic or a particularly embarrassing tic, you can go ahead and skip to using CBIT initially.

Dr. BJ Guenther: Say that again. If you have a noticeable tic, you can-

Sheryl K Pruitt: If you have a tic that’s not bothering you, then you might not want to do CBIT.

Dr. BJ Guenther: Right, right.

Sheryl K Pruitt: But if you have a tic that is either embarrassing socially or physically hurts you, then you might want to do CBIT first before you do the associated disorders.

Dr. BJ Guenther: Oh, okay. Sure. One of the articles I read, it talked about some people don’t believe Tourette’s exists. It’s hard for me to understand that. I don’t know if they meant, in the article, that they feel like some people are faking it is what they said. Have you ever heard of that, or is that just totally off the wall or just one article?

Sheryl K Pruitt: I think it’s probably one article. The vast majority of people could not physically fake Tourette.

Dr. BJ Guenther: No. No.

Sheryl K Pruitt: Your muscles can’t do that.

Dr. BJ Guenther: I know.

Sheryl K Pruitt: The only muscles they could fake would probably be the eye blinking consistently because your eyes are made to blink. So you could probably do that, but paying attention to ticking in that kind of rhythmical way, consistent way would be very difficult to do anything else when you’re trying to fake it.

Dr. BJ Guenther: How do people-

Sheryl K Pruitt: I have never had a case, and I have seen probably as many Tourette people as anyone in the world because I travel around the world, seen … and then we have people coming from all over to our clinic. I have never had anyone that was faking Tourette.

Dr. BJ Guenther: No.

Sheryl K Pruitt: Or I’ve never heard.

Dr. BJ Guenther: No, because it would be so hard. Well, and I was shocked too when I read that. I didn’t know where that came from or who would ever say that. But I wanted to ask you about it at least.

Sheryl K Pruitt: These people saying it because of ignorance? I’ve had people tell kids if they were faking it-

Dr. BJ Guenther: Oh my gosh.

Sheryl K Pruitt: … they’re just helping their father [crosstalk 00:12:32].

Dr. BJ Guenther: Oh yeah.

Sheryl K Pruitt: But you cannot believe how difficult it would be to fake Tourette.

Dr. BJ Guenther: Oh yeah. Nowadays, how is it diagnosed?

Sheryl K Pruitt: Okay, it’s diagnosed and the problem we have is what we call it TV Tourette’s. TV Tourette’s interferes with the diagnosis. On TV, they like to show the people who have Tourette, they curse involuntarily. That is a very tiny percentage of kids with Tourette. That’s not the normal Tourette Syndrome. So a lot of doctors think that’s it and they’re looking for something more severe. The average face of Tourette would be like this. You would say, have an eight-year-old, who came in who started eye blinking. He would eye blink for several months and he’d wind up probably at the ophthalmologist and the ophthalmologist might say, “Well, that’s just a habit. Don’t worry about it.”

Sheryl K Pruitt: And then he might do absolutely no tics for four months. And then after the fourth month, he might start sniffing, just sniffing in a rhythmical way, and he’ll probably wind up at the allergist. The allergist will probably say, “No, it’s just a habit. Don’t worry about it, it’s not an allergy.” Then now it’s been 12 months and say in the 13th month, he started moving his neck in a crackling way and did it rhythmically. Well, that would be 13 months with two motor tics and one vocal tic being recorded. That would be the definition of Tourette Syndrome.

Sheryl K Pruitt: That’s why many doctors will not diagnose it until they see a history of more than 12 months. If you have less than 12 months, you have transient tic disorder of childhood. If you have more than 12 months and you just have the motor or the vocal, then you have chronic motor or vocal tic disorder.

Dr. BJ Guenther: So it has to be the three and the timeframe?

Sheryl K Pruitt: Yes.

Dr. BJ Guenther: Got it. Is there a possibility, is there a chance that someone has a minor tic and is never diagnosed?

Sheryl K Pruitt: The chance is many times that people have tics and they’re not diagnosed.

Dr. BJ Guenther: Wow.

Sheryl K Pruitt: Most of the parents that will come in who do have tics have never been diagnosed and didn’t know they had Tourette. They’re coming in because of their child and no one even thought about it. They would just say, “Well, that’s just John. He does that.”

Dr. BJ Guenther: Did I hear you say when we first started talking, the father usually is diagnosed with ADHD and the mother is diagnosed with what?

Sheryl K Pruitt: No, no. Many times the parents are not diagnosed, but once they’re in here they find out that they … The dad has ADHD, for example, and the mother might have an anxiety disorder or obsessive-compulsive disorder.

Dr. BJ Guenther: Okay, yeah.

Sheryl K Pruitt: So that would be our typical parent that comes in the most often and has for the first time in their life a tic disorder kid.

Dr. BJ Guenther: At what age are kids usually diagnosed?

Sheryl K Pruitt: The most common diagnosis we see in our clinic is between eight and 10. But you can have them come in at four years old or you can have them come in at 20 years old. The thing that is the most clear for us is that they frequently come in after years of not being diagnosed, or being misdiagnosed with other things. So we rarely get them at the very beginning unless it’s a much more severe set of tics.

Dr. BJ Guenther: What’s the most common tic? Is it eye blinking?

Sheryl K Pruitt: Eye blinking is the most common tic. And the most common vocal tics are throat clearing and sniffing.

Dr. BJ Guenther: So some of the tics might not even be noticeable to people?

Sheryl K Pruitt: A lot of the tics are not noticeable to people and the very clever kids and students with Tourette’s have learned how to mask it by the way they move.

Dr. BJ Guenther: Right.

Sheryl K Pruitt: If they’ve got one where their forehead might move, they might just brush their hair back and it would look like they’re just brushing their hair back.

Dr. BJ Guenther: Exactly.

Sheryl K Pruitt: Some kids have learned to mask it, especially in middle school, high school, and college.

Dr. BJ Guenther: Yeah. One of the articles I read said that you can learn to do that.

Sheryl K Pruitt: Right.

Dr. BJ Guenther: And it won’t be as obvious, I guess you could say. Do you know the statistics on Tourette’s? How many people have Tourette’s in the United States, for instance?

Sheryl K Pruitt: Okay, one in 100 boys and one in 200 girls.

Dr. BJ Guenther: So it’s more common in boys than it is in girls.

Sheryl K Pruitt: Yes.

Dr. BJ Guenther: Do you have any idea why?

Sheryl K Pruitt: Well, one of the things that we always have said in special ed is there’s always more boys in special ed than girls and the reason is because of the y chromosome frequently. But in this case, I don’t know if that’s it because of the way Tourette’s is done. I will tell you though, that the other thing you need to know is obsessive-compulsive disorder is the same family of genes as the tic disorders. So if you have a son, let’s say, that has Tourette’s, you should screen the sister for obsessive-compulsive disorder-

Dr. BJ Guenther: Oh my goodness.

Sheryl K Pruitt: … even though that can both have both.

Dr. BJ Guenther: I never thought … Say that again. That is so interesting. If you have a boy with OCD, you should screen the sister for Tourette’s?

Sheryl K Pruitt: No, I said if you have a son who has ADHD and Tourette’s. You should screen the sister especially for obsessive-compulsive disorder.

Dr. BJ Guenther: Oh. That’s really interesting because I have several students right now with diagnosed OCD and I’m going to have to ask them if they have brothers with ADHD and/or Tourette.

Sheryl K Pruitt: Yes. There’s different types of OCD. The OCD in Tourette’s is not the same as the television version of the cleanliness OCD. It has different symptoms, so if you have the plain OCD, your brother and sister may not have that. But if you have the just right, kind of moral policeman, a lot more obsessions and very few compulsions, they’re more likely to have a brother who might have ADHD or tics.

Dr. BJ Guenther: What about scrupulosity?

Sheryl K Pruitt: Scrupulosity is much more common in the Southeast. Because scrupulosity is when you think that God is mad at you because of all the yucky things your brain is making you think of if you have OCD or major depressive disorder or bipolar with Tourette’s.

Dr. BJ Guenther: Uh-huh (affirmative). What kind of OCD are you talking about?

Sheryl K Pruitt: The kind of OCD is an entirely different group of symptoms. The OCD that Tourette’s has, you’ll see things like it’s a lot of counting, there’s a lot of it just doesn’t feel right or it’s not right. There’s a tremendous amount of moral policing going on.

Dr. BJ Guenther: Wow.

Sheryl K Pruitt: You get upset when other people don’t do the right things. Sometimes these kids are having an anxiety disorder, or these students, and they don’t even know what’s wrong until all of a sudden something is in the right way and all of a sudden they can stop. But they couldn’t have told you what that was ahead of time. There’s a huge amount going on inside their head and not very much going on outside.

Dr. BJ Guenther: I see. It does run in families, doesn’t it?

Sheryl K Pruitt: Okay, your voice is fading where we can hardly hear you. Can you talk a little bit louder for me?

Dr. BJ Guenther: Okay, I said it does run in families, doesn’t it?

Sheryl K Pruitt: It does, and people don’t think so when they’ve never had a tic in the family because they don’t realize it’s a cumulative disorder, so then all of a sudden you have enough genes to have the tics.

Dr. BJ Guenther: Okay. And cumulative meaning nothing, nothing, nothing and then it builds up and then a child is born and has Tourette’s.

Sheryl K Pruitt: No, what I mean by cumulative is you take the ADHD gene, say, from dad and the OCD genes from mom and they get together and all of a sudden you have Tourette’s.

Dr. BJ Guenther: Okay.

Sheryl K Pruitt: It’s certain genes coming together.

Dr. BJ Guenther: Let me ask you about college students because we are on a college campus. I’ll be honest with you, Sheryl, I’ve worked here 14 years and I have never seen a student with Tourette’s, but now that we’re talking about this, maybe I have and it’s been so minimal that either they didn’t know it and were not diagnosed or either I didn’t recognize it.

Sheryl K Pruitt: I will promise you, you’ve had a student probably with Tourette’s because of the prevalence. But I will tell you that most people do not know that. The other thing that the reason that you may not have noticed it, and if they had Tourette’s, is that a tremendous amount of the kids, not all of them at all, but a tremendous amount of kids that have Tourette’s, their tics get much better after 15. So in college, you might not notice it as much as you would have noticed it in high school or middle school because the tics would have been more severe.

Dr. BJ Guenther: Do they-

Sheryl K Pruitt: Now there are a group of kids that still maintain the severity of their tics throughout their life.

Dr. BJ Guenther: Wow. And so-

Sheryl K Pruitt: There’s a large percentage that do have tics go down once they get to college.

Dr. BJ Guenther: Is it just-

Sheryl K Pruitt: College is less stressful than high school.

Dr. BJ Guenther: And that’s what I was going to ask. Is there something that affects their tics lessening, or do they kind of grow out of it, or what is it that affects it?

Sheryl K Pruitt: Well, they’re not sure of the mechanism, but they do know that stress has a big impact. Of course, obviously adolescence is the most stressful time of your life and it is the time of the worst tics.

Dr. BJ Guenther: Okay. I can understand that. Do you know-

Sheryl K Pruitt: That’s not true of everybody. We have adults with very severe tics.

Dr. BJ Guenther: Do you know the prevalence rate for Tourette’s among college students?

Sheryl K Pruitt: It would be the same. One in 100 boys and one in 200 girls, so it may not demonstrate it and they may not even know it because the symptoms may have decreased.

Dr. BJ Guenther: Do you have any idea how it impacts their success in college?

Sheryl K Pruitt: I think it totally depends on how the person has been treated growing up with it and how much they’ve gotten help. Like I’ll give you an example. My two sons, with the way they were raised was everybody’s got something, you’ve got Tourette’s, let’s just do what you’re supposed to do about it. There is no pity party. There is no, “I have Tourette’s therefore I can’t do something.”

Dr. BJ Guenther: Yes.

Sheryl K Pruitt: So if you were raised with everybody not being ashamed of it and not being embarrassed by it, and everybody accepting it and being okay with it, that helps a lot. Because how you and your family feel about Tourette’s is how you’re going to feel about it and how you feel about it decides how you’ll treat it. But if you feel okay about it, then people are going to be okay with you. They might say, “Well, why are you doing that?” And if you go, “Well, it’s just my Tourette’s. No big deal.” Then they’re probably not going to do much about it. But if you say, “Oh my God. I don’t want to talk about it.” Then all of a sudden, you have an issue.

Dr. BJ Guenther: Then you get a lot of attention from it too.

Sheryl K Pruitt: That’s right.

Dr. BJ Guenther: Okay, we’re going to take our first break here. When we come back, I want to follow up on this question. I want to talk about social participation and social impact of Tourette’s on college students or this age group. So Sheryl, if you’ll stay on the line, we’ll take a short break and we’ll be right back. You’re listening to Brain Matters on 90.7 The Capstone.

Ham Bagby: (singing)

Ham Bagby: Hey, what’s up? This is Ham Bagby and you’re listening to WVUA 90.7 The Capstone.

Ham Bagby: (singing)

Paul Janeway: This is Paul Janeway of St. Paul and The Broken Bones and you’re listening to 90.7 The Capstone.

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Disclaimer: This show is not a substitute for professional counseling and no relationship is created between the show host or guests and any listener. If you feel you are in need of professional mental health and are a UA student, we encourage you to contact the UA Counseling Center at 348-3863. If you are not a UA student, please contact your respective county’s crisis service hotline or their local mental health agency or insurance company. If it is an emergency situation, please call 911 or go to your nearest emergency room.

Dr. BJ Guenther: Hey, you’re back listening to Brain Matters on 90.7 The Capstone. I’m BJ Guenther and my guest tonight is Sheryl Pruitt. She’s the clinical director of Parkaire Consultants in Marietta, Georgia, a clinic she founded to serve neurologically impaired individuals. We’re talking tonight about Tourette Syndrome. Also, Sheryl is an author and we’re going to get to that in just a minute. I want to talk about some of your books, Sheryl. Can you hear me?

Sheryl K Pruitt: I’m glad we’re back.

Dr. BJ Guenther: Yeah, let me give the email out if anybody has any questions for myself or Sheryl. The email is brainmattersradio@wvuafm.ua.edu. And we left off talking about some impact that Tourette’s has on college students on their success. But I wanted to talk a little bit about social participation. What about the impact on individuals who are diagnosed with Tourette’s and social participation especially among college students in organizations on campus or whatnot?

Sheryl K Pruitt: Well, first of all, you have a visible disorder so the awareness on the campus is crucial. I have gone to many campuses and to different schools and done awareness for the faculty and for the students. So the more that the campus knows about it and knows what it is, the more likely the person will be treated with respect and understanding. So the visible disorder is one issue.

Sheryl K Pruitt: Secondly, the anxiety and depression, organizational difficulties that go with it could also affect the social because depression can affect your desire to get up and go out. And then the anxiety, you can have social anxiety with this, not everybody does, but some do. That can affect your socialization. Like I said, it depends how much the person’s getting treated and remediated. Some kids are on medication for their anxiety and depression which makes it [inaudible 00:28:33] tic that much.

Sheryl K Pruitt: If you’ve done therapy, you’ve done medication, and you’ve gotten yourself feeling good about what you have, then frequently we see good social outcomes.

Dr. BJ Guenther: You mentioned depression and anxiety. In your work at your clinic, how prevalent is anxiety and depression? Is everybody who has Tourette’s, do they usually have depression and/or anxiety?

Sheryl K Pruitt: That’s not true for everybody, but let me just explain that because we’re a clinic, most of our referrals come from either parents who know people who have Tourette’s or from psychiatrists or other doctors. We have a clinical bias, so it is very rare. In the 31 years we’ve been here, we have had one kid walk in with just tics and he just wanted to meet and talk about it.

Dr. BJ Guenther: Wow.

Sheryl K Pruitt: The vast majority of the other kids have had other comorbid and associated disorders.

Dr. BJ Guenther: What do you see? Do you see many college students in your practice?

Sheryl K Pruitt: Yes, we do. We even have a group of college students here.

Dr. BJ Guenther: What are the struggles that they face with Tourette’s? Not just a mood issue or even anxiety, what else? What other struggles do they have or do they express?

Sheryl K Pruitt: Well, sometimes they’ll have a tic that hurts, but that’s not real common. But it’s true sometimes, especially like a neck tic. That’d be really painful. Now one time, we had a kid who developed a bladder tic in the middle of final exams. He was too embarrassed to say anything, so he just walked out and left the final. Because sometimes it’s just hard to say something about it when it’s an embarrassing thing.

Sheryl K Pruitt: The other thing that we see is the executive function that can go with it sometimes or the ADHD that can go with it, means that you might have organizational problems. The obsessive-compulsive disorder though affects term papers in a way that people don’t realize. If you’re trying to do a perfect job, it’s almost impossible to do a perfect job. So I have a kid who wrote for a college paper and spent three weeks on it, hours and hours every day and couldn’t get it perfect. He couldn’t hand it in because he didn’t think it was good enough. The teacher accused him of being lazy because he didn’t do it and he had worked harder than any other kid in the course.

Dr. BJ Guenther: You mentioned tics that hurt. I mean this will be an obvious question, but does sometimes people with Tourette’s injure themselves?

Sheryl K Pruitt: Sometimes they do. I had a young man who had a tic where he jumped down with his knees on the floor, and he hurt his knees badly. We’ve had several of those in the more extreme cases. That’s not the common group of Tourette’s kids though. Those are the more rare cases.

Dr. BJ Guenther: Does every case of Tourette’s include tics?

Sheryl K Pruitt: By definition.

Dr. BJ Guenther: Okay, so yes.

Sheryl K Pruitt: You have to have the two motor and the one vocal to have Tourette’s. By definition, you have to have tics.

Dr. BJ Guenther: Okay. We’ve talked a little bit about sometimes they get better, but do they ever change? Like if you have eye blinking, does that ever go away and then pick up with some other tic?

Sheryl K Pruitt: Very common.

Dr. BJ Guenther: Really?

Sheryl K Pruitt: That’s one of the harder things about Tourette’s is that it’s hard to get used to it because all of a sudden you can develop a new tic. I had a young girl who was in high school and was on a date and was in a movie theater and developed a cooing tic and then got thrown out of the theater.

Dr. BJ Guenther: Oh my gosh.

Sheryl K Pruitt: But you just don’t know what’s going to happen, but you can wake up and have a new tic. It’s a common occurrence.

Dr. BJ Guenther: I’m assuming certain stresses might cause that to happen. I mean what makes them change?

Sheryl K Pruitt: Well, it’s the deregulation of the neural transmitters, especially dopamine would be one example that causes them to change. But when you say stress, it’s very important to recognize that the brain considers happy excitement as stressful and bad things could happen. So right before Christmas, right before your birthday, when a special event’s going on, you might increased tics.

Dr. BJ Guenther: Hmm. Even on a date at the movies.

Sheryl K Pruitt: Absolutely. Depending on how stressful or exciting it is.

Dr. BJ Guenther: I guess so. Are individuals with, well, I’ve already asked you this about the injury. But what are some specific interventions? You talked about CBIT at Children’s Hospital in Birmingham and that program that does not use medication. But is the standard treatment to use medication and is that most successful?

Sheryl K Pruitt: The standard treatment is to do … You have to be very clear. There is no standard treatment. Every individual comes in and there are thousands and thousands of ways genetically just to have ADHD, [inaudible 00:33:30]. So I have never met two kids alike. So when you say standard treatment, one kid might need medication for his depression in order to decrease the tics, to get rid of them, or might need medication for the obsessive-compulsive, or might need a cognitive behavioral intervention for obsessive-compulsive disorder, which is called Exposure Response Prevention Therapy, which comes even before medicine for OCD as a standard treatment.

Sheryl K Pruitt: So you’ve got different cognitive therapies that are helpful. You’ve got relaxation and relaxation breathing techniques which reduce stress. For example, Tai Chi is an active meditation. Yoga is good for reducing stress. Different exercises reduce stress. So exercise is always excellent medication for anything that’s going on.

Dr. BJ Guenther: So if-

Sheryl K Pruitt: But not every kid’s on medication, but some kids have to be on medication to function.

Dr. BJ Guenther: So if you can control the stress sometimes, that will lessen the tics, is that what you’re saying?

Sheryl K Pruitt: Frequently. Now they’ll be an exception to everything I say with one [inaudible 00:34:35]. But in general, if you reduce the stress, like we had a kid who had an undiagnosed learning disability and he kept flunking the same course. He was extremely stressed and once he got that diagnosis and treated he wasn’t as stressed. Sometimes it’s an act without any intervention.

Dr. BJ Guenther: Yeah. Is medication helpful with the tics?

Sheryl K Pruitt: There are medications for the tics, but we tend to go after the comorbid first before we do that. We do medicate the tics if they are causing dysfunction, but that is rarely the first thing we do.

Dr. BJ Guenther: Okay. Well, with regards to college students, what services on campus would benefit someone diagnosed with Tourette’s?

Sheryl K Pruitt: Okay, the best thing is for the accommodations and remedial strategies, to go to Disability Services and to register on campus when you sign up for college. We ask all of our kids to do that as it’s extremely helpful. And immediately if you … For example, that kid who had the bladder tic, if he had accommodations and if the professor had a letter then they can explain what happened and get help. We encourage everybody to have an up-to-date neuropsychological eval before they go to college to make sure that they can get which accommodations they need if there are any learning issues that need to be accommodated.

Sheryl K Pruitt: And then the other thing is to, like I’ve said, just do as much as you can before you go to college, to get as comfortable as you can with who you are, and to recognize the tics don’t define you.

Dr. BJ Guenther: Yeah. So prepare and plan-

Sheryl K Pruitt: Absolutely.

Dr. BJ Guenther: … and maybe try to educate. Are there certain things professors or the faculty can do for students with Tourette’s?

Sheryl K Pruitt: Well, sending a letter from the Disability Services to the professors explaining what’s going on and having the professors educated. We usually send a letter out which explains Tourette’s that we have the college kid add to those letters. It’s good to have information on that. And then to have them know which things would be the accommodations they need for different things. Like if they have a slow processing speed disorder with Tourette Syndrome, then they’re going to need extra time. If they have obsessive-compulsive disorder, if there’s the stress of timed tests they’re going to need extra time.

Dr. BJ Guenther: Right.

Sheryl K Pruitt: Having extra time can reduce the stress, which reduce the tics, which means that’s what we want to see.

Dr. BJ Guenther: And they could possibly offer them more individual time to take their test in a private location.

Sheryl K Pruitt: Especially if they have any vocal tics, then they don’t want to interfere with the class-

Dr. BJ Guenther: That’s right.

Sheryl K Pruitt: … because it would be stressful socially and therefore they would be by themselves and then they’ll be less stressed and they’ll do less thinking and that would help.

Dr. BJ Guenther: If someone has never interacted or worked with an individual with Tourette’s, what advice would you have?

Sheryl K Pruitt: Well, I think learning about the different cognitive therapies. For example, we have many people coming here with obsessive-compulsive disorder and Tourette’s and no one has ever mentioned Exposure Response Prevention Therapy for the OCD.

Dr. BJ Guenther: Really?

Sheryl K Pruitt: Which is the therapy that reduces OCD stress the most. Or they haven’t understood the relaxation techniques or the need for mindfulness, meditation, the different things that reduce stress in your life, having a good exercise program, having a good psychiatrist who’s trained in the comorbidities. Because people frequently will go to a neurologist because it’s a neurological disorder, yet if you have a comorbid anxiety and depression then you need a psychiatrist to treat those.

Dr. BJ Guenther: That’s right.

Sheryl K Pruitt: Frequently, we’ll send them to the psychiatrist and he will treat the comorbid disorders and they don’t have to go to the neurologist ever.

Dr. BJ Guenther: What about how can we learn to be more sensitive and understanding? I guess it’d be the same, just educate yourself but what would you say-

Sheryl K Pruitt: Well, there are good screening instruments which are also helpful. So if I were a professional and I had a Tourette kid walk in the door, I would want to look through all the planning instruments and look at the information ahead of time for what’s the comorbidity going on, what things I should be looking for. Should I be screening for ADHD? Yes. Should I be screening for anxiety disorders, all the different ones? Yes. Should I be screening for mood? Yes.

Sheryl K Pruitt: And then, one that they don’t mention very often is sensory. I have yet to see an anxiety disorder, OCD, Tourette kid who didn’t have sensory issues, which means they were over-reactive, especially to tactile and auditory.

Dr. BJ Guenther: Oh yeah. Mm-hmm (affirmative). Mm-hmm (affirmative).

Sheryl K Pruitt: So that needs to be looked at also because sometimes that needs to adjusted. We have several kids who’ve got that who are in college and needed a private room because they couldn’t handle the sensory responses of the other students. They needed a place to go to calm down and get less sensory input by themselves.

Dr. BJ Guenther: We talked about what professors can do for students with Tourette Syndrome. One of the articles I read had a list of what professors can … top 10 things college professors can do for students with Tourette Syndrome and one of those, I want to see what you think about this, is ignore the symptoms. Ignore the symptoms that can be ignored is what it says. This demonstrates acceptance and normalizes Tourette Syndrome and other related symptoms. What do you think about that?

Sheryl K Pruitt: I think if it’s a symptom that can be totally ignored, you should absolutely always do that. But if you think you can’t ignore it, then you need to talk to the student privately with Disability Services and decide what you’re going to do. Some kids have asked someone like me to come in and talk to the class or talk to the faculty or talk to the students, especially if it’s something that’s going to be so obvious that everybody’s going to be looking at it or curious about it. Because what we don’t want is anyone to be teasing this child, but if the college student does not want anyone to talk about it, then you have to honor that.

Dr. BJ Guenther: That’s right. That’s right. One of the things that it mentioned is don’t ask them. If you notice a tic, but they have not told you they have Tourette’s, then respect the privacy of the student.

Sheryl K Pruitt: Well, the other thing is they may not know they have a tic.

Dr. BJ Guenther: Well, that’s exactly right. That’s exactly right.

Sheryl K Pruitt: And if you were to ask them about it, you’d be diagnosing them.

Dr. BJ Guenther: Yeah, you would. Hey, how can we promote a better understanding and acceptance of individuals with Tourette’s and the syndrome within the community?

Sheryl K Pruitt: Well, there’s the Tourette Association of America which is the national resource in America for Tourette’s. There are also many different people in different states who are trained in Tourette’s. We actually see a lot of people from Alabama at our clinic here. It just depends on what resources you need. One thing that you need to do for awareness is some campuses have an awareness week for ADHD, Tourette’s, OCD, because easily 15% of this campus has what we’re talking about, ADHD and depression and OCD and the different things. That’s a huge amount of your population. So having a week in which you celebrate and talk about and do awareness activities is always helpful.

Dr. BJ Guenther: That’d be good. We’re going to-

Sheryl K Pruitt: The other thing that I think is important is to give access to information. I think some teachers that we’ve had in college have asked us for resources, what to read, what to look at. There are good materials that you can get. Like I said, the Tourette’s Association has an education department and they can give you resources. We’ve done that. We’ve taught courses on how to teach teachers about this. So finding resources and information, the web has wonderful places and terrible places.

Sheryl K Pruitt: For example, the association is one place. The Canadian foundation, Tourette’s Foundation Canada has a good website. You’ve got National Institute of Mental Health. You’ve got Johns Hopkins and Yale and Harvard are good websites. You’ve got Stanford and UCLA have good websites. You want to go to places that are Tourette-centered because there’s a lot of misinformation on the web.

Dr. BJ Guenther: Well, we’re going to take another short break, Sheryl, but when we come back in our last short segment I want you to talk about your books that you’ve written because those sound so interesting to me. If you’ll stay on the line just for a few minutes, we’ll take another quick break. You’re listening to Brain Matters on 90.7 The Capstone.

Disclaimer: This show is not a substitute for professional counseling and no relationship is created between the show hosts or guests and any listener. If you feel you’re in need of professional mental health and are a UA student, we encourage you to contact the UA Counseling Center at 348-3863. If you are not a UA student, please contact your respective county’s crisis service hotline or their local mental health agency or insurance company. If it is an emergency situation, please call 911 or go to your nearest emergency room.

Dr. BJ Guenther: You’re back listening to Brain Matters on 90.7 The Capstone and we’re talking tonight with Sheryl K. Pruitt. Not only is Sheryl the clinical director at Parkaire Consultants in Marietta, Georgia, a clinic she founded to serve neurologically impaired individuals, she’s also an author and a speaker.

Dr. BJ Guenther: Sheryl, tell us a little bit about any upcoming events you’ve got, where you’re going to be presenting on Tourette’s.

Sheryl K Pruitt: Well, it’s not just on Tourette’s. I’m presenting at Chicago, a three-hour seminar on neurological disorders that go with theory of mind, which includes Tourette’s, ADHD, OCD, and mood disorders.

Dr. BJ Guenther: Wow.

Sheryl K Pruitt: The theory of mind is the newest thing that we’ve been talking about because the new research is showing it outside of autism.

Dr. BJ Guenther: When is that? When are you going to be speaking there?

Sheryl K Pruitt: It’ll be the first week in November in Chicago.

Dr. BJ Guenther: Oh fun. It oughta be nice and chilly up there.

Sheryl K Pruitt: As an educator, if you’ve never been to the educational therapists’ convention, you should look it up.

Dr. BJ Guenther: Yeah. I will.

Sheryl K Pruitt: It’s a very sophisticated, educated affair.

Dr. BJ Guenther: I sure will.

Dr. BJ Guenther: Tell us a little bit about your books, Teaching the Tiger.

Sheryl K Pruitt: Okay, well, Teaching the Tiger was my first book and it is out of date. It’s been replaced by Tigers, Too which is executive functions, speed of processing, and memory, and ADHD, Tourette’s and OCD. It’s got two supplements, one of which talks about assessment and the different neuropsych tests and the other one which is probably more beneficial to a lot of the people that you see, Classroom Objectives and Interventions. Then another book that I didn’t write, but we have with that, is one by Leslie Packer called Find a Way or Make a Way which gives a list of accommodations by each disorder for kids in college.

Dr. BJ Guenther: Okay. Say that again. Find a Way or Make a Way?

Sheryl K Pruitt: [crosstalk 00:45:52] parents and in general for people to read it, Challenging Kids Challenge Teachers. It’s in an ebook copy, but Parkaire’s about to produce the written copy again because the publisher decided not to and a lot of our people don’t want just ebooks. But it is available through Woodbine House through ebook.

Dr. BJ Guenther: Okay. That’s fantastic. The name again, Find a Way or Make a Way.

Sheryl K Pruitt: It’s the one for accommodations and Tigers, Too Checklist is the one for the short-term objectives.

Dr. BJ Guenther: Why’d you name it that?

Sheryl K Pruitt: Say that again, please.

Dr. BJ Guenther: Why did you name it that? Why did you-

Sheryl K Pruitt: Why is it the tigers?

Dr. BJ Guenther: Yeah.

Sheryl K Pruitt: Okay. Well, my first book, Teaching the Tiger is because I was trying to find a way for people to understand that if you have someone and think, if you were holding your hand up, that would be your arm and your thumb would be your animal brain. Your fingers would go across your animal brain and control it. Tourette’s issues are located in the basal ganglia, is one of the big places, in the animal brain. What happens is, your animal brain takes over and the blood leaves your frontal lobe and your human brain goes off and you’re sometimes dealing with an animal brain.

Sheryl K Pruitt: So I wanted people to recognize that it would not be good to go confront a tiger when he’s angry.

Dr. BJ Guenther: There you go.

Sheryl K Pruitt: And so that’s how we named it. My older son, Darin, has a website and a thing online called the Tourette tiger because he was our first tiger.

Dr. BJ Guenther: Yeah. That’s original.

Sheryl K Pruitt: We really were trying to get across the fact that you would not go towards a tiger when he’s angry.

Dr. BJ Guenther: Exactly.

Sheryl K Pruitt: When these kids are angry, they just need to be left alone.

Dr. BJ Guenther: Mm-hmm (affirmative). Is anger a big issue, anger and frustration?

Sheryl K Pruitt: If you have a mood disorder, the most common symptom in children and young adults with depression is irritability. Anxiety makes you irritable because you’re so obsessed all the time. Tourette’s by itself only makes you irritable if the tics are humiliating or hurt. And then ADHD makes you irritable because you’re always forgetting things.

Dr. BJ Guenther: That’s true. That’s true. That is true.

Dr. BJ Guenther: Hey, thank you again for being on the show and taking the time out to talk to me tonight. This is so interesting and I’m about to make an announcement. Our shows are usually podcasts and recorded, so if you … If people have missed this show, they’ll be able to find it on our website. But I really appreciate you taking the time because I know you’re very busy and I know the clinic’s very busy and you’re going around speaking and writing books. I mean, you are the authority on Tourette’s it feels like.

Sheryl K Pruitt: Well, I appreciate that. We’ve been doing this a long time and we are glad to get the word out any time we can.

Dr. BJ Guenther: Yes. Thank you so much. Take care.

Sheryl K Pruitt: You too. Thank you.

Dr. BJ Guenther: Don’t forget our shows are recorded and podcasted on the audioboom.com website. Just type in Brain Matters and you’ll find some of our past shows. There’s also a link to Audioboom on the Counseling Center’s website at counseling.ua.edu.

Dr. BJ Guenther: I want to make a quick announcement on behalf of Lizzie Zeman who’s not here tonight. She’s one of my production assistants, but it’s about childhood hunger. Tackling childhood hunger is a no-brainer. Wear your favorite sports jersey and join us for a night of trivia on October 18th from 5:00 to 9:00PM at Rounders Rooftop Bar. Help tackle hunger with Secret Meals for Hungry Children. Think you know a lot about Crimson Tide football? Come test your knowledge for a chance to win prizes, including a signed Minkah Fitzpatrick jersey and you can hang out with Big Al and enter the silent auction to win a football autographed by Nick Saban.

Dr. BJ Guenther: You can purchase a pre-sale wristband for $5 or get yours at the door for $10. All proceeds will benefit Secret Meals. For more information, visit secretmeals.org.

Dr. BJ Guenther: I always like to thank some people who’ve made this show possible and usually the first person I start with is our executive director, Dr. Lee Keyes of the Counseling Center. And then of course Terry Siggers, he basically runs the station here, but he’s from the Office of Student Media. And of course my production assistant tonight, Catherine Howell, who I cannot do this without. My colleagues at the Counseling Center, the WVUA staff, and my guest tonight, Sheryl K. Pruitt.

Dr. BJ Guenther: I want you to join us next week when the show topic is going to be, Are suicide prevention strategies working? So hopefully we’ll see you here again next week. Thanks for listening to Brain Matters on 90.7 The Capstone.

Disclaimer: This show is not a substitute for professional counseling and no relationship is created between the show host or guests and any listener. If you feel you’re in need of professional mental health and are a UA student, we encourage you to contact the UA Counseling Center at 348-3863. If you are not a UA student, please contact your respective county’s crisis service hotline or their local mental health agency or insurance company. If it is an emergency situation, please call 911 or go to your nearest emergency room.