The most important treatment is whatever intervention is needed to maintain their self confidence. I think that living with Tourette Syndrome can turn from a problem to an opportunity for self growth, self strengthening and actually learning how to cope with life’s problems. I think that is the most important message for a youth with Tourette Syndrome.

This is a complicated question. First of all non-responsive; In my career I’ve almost never found a patient who was non-responsive. It does take a lot of experience and knowledge to work with these different medications. One has to do it very carefully, often very slowly, and often using a variety of combinations of medication. I have seen many many times, patients who have come in saying they didn’t tolerate a particular drug, say Risperidol, but when I started them on small doses just at bedtime and adjust the medication very carefully almost always we get a good response and the medication is tolerated. I think it’s really few and far between for patients who really are unresponsive to medications. There are also different medications other than those I’ve listed in the course of the webinar. There are a lot of variations of medications that can be tried. I’ve almost never seen a patient who is totally unresponsive to medications.

Now the issue of OCD and RAGE attacks is an interesting one. In most people’s experience RAGE attacks does tend to occur most commonly in children and individuals who have OCD and many times this is because the OCD results in a mindset that everything has to be a particular way. This is called mental inflexibility. We call it my way or the highway or my way or the wrong way. Children with OCD are really very stuck in how things are supposed to go and if there is a change without a lot of warning they are often thrown into a RAGE attack. So we do find treating the obsessive compulsive disorder with cognitive behavioral treatment or SSRI medications are often a critical first step in trying to get RAGE attacks under control. At the same time as educating the parent about how OCD can in fact precipitate a RAGE. For these children for example you almost never want to change your plans. You want to inform the child as far ahead as possible that what they expect to happen that day has changed and give them plenty of time to plan. They are never last minute people. And very interestingly OCD is genetic in families, one often has a child with OCD bumping heads with a parent with OCD. Both think they are right and they obsessively believe the other is wrong. This can precipitate RAGE attacks and so really understanding the dynamics of what goes on in the family and the thinking process is really important particularly when RAGE attacks co-exist with OCD.