ABSTRACT
In the simplest clinical situations, there is no distinction between the treatment of a discrete disorder and the care of a whole child. We skillfully suture a laceration, treat a sore throat, and send the child and family on their way. In clinical work with individuals with tic syndromes, however, these two clinical activities may become broadly divergent. Even when tics are the ‘‘chief complaint,’’ the times when the clinician in a specialty practice of neurology or child psychiatry need attend only to the child’s tics are rather few and far between. Indeed, the role of tics in the story of the child’s life may be overshadowed by a decade or two of derailment in emotional, educational, and social development; by a saga of treatments tried and failed; by the emotional scarring of disappointments, alienation, and medical side effects; and by profound disruptions in family life and family economics. From these
MD: KURLAN, JOB: 03329, PAGE:
case histories, we can reconstruct the trajectory of a child’s development from first tics to overwhelming obsessions and compulsions, from a childhood full of promise to chronic patienthood. The goal of clinical care of children with Tourette’s syndrome (TS) today is not to eliminate tics but to help assure that development will move ahead as well as possible and to attempt to minimize the likelihood of themost adverse consequences of a chronic childhood illness.
