Impulse Control Problems and Tourette Syndrome

Cathy BudmanPresenter: Cathy Budman, MD

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Dr. Budman discussed that people living with Tourette Syndrome often struggle with impulse control disorders. She spoke about the most common features of impulse control observed among children and adults and some treatment options along with the efficacy of those treatments.


  1. NJCTS says:

    Do you find that children with TS and ADHD have difficulty regulating computer game use and is it appropriate to not allow a 9 year old boy to game at all?

    • DrBudman says:

      Some children with TS and impulse control problems will engage in addictive type gaming. These children may begin to increase their daily use of video games, exclude other activities and interactions in preference for gaming, and may actually show symptoms of withdrawal if videogaming is prevented! Therefore it is very important to monitor your child’s use of videogames and limit these activities in terms of time. It is not appropriate for a 9 year old child to spend hours daily videogaming, particularly when it excludes participation in other developmentally appropriate daily activities.

  2. NJCTS says:

    My 6 year old son often has emotional outbursts (2-3xweek), usually resulting after needing to stop an activity (computer/video game, tv) or when attempting to perform an activity and not doing it “perfect” or in a manner acceptable to him. These outbursts are not manifesting in aggressive behavior, but hours of screaming, crying, cant make decisions, cant communicate, almost paralyzed, sometimes throwing/destroying the item that has caused frustration or been taken away. these outburst seem to be coming more frequent and more intense. Could these be related to impulse control disorders? Is it likely for these to become more rage/aggressive or is there another “subgroup” with out the rage. He is recently diagnosed with TS.

    • DrBudman says:

      These symptoms sound like they are causing problems and at least in some instances are resulting in destruction or damage of property. Your description appears to include both impulsive and compulsive features. You mention that your child was recently diagnosed with TS, but you did not mention whether other psychiatric comorbidities were detected and this is very important to exclude. I would certainly mention these episodes to his doctor and seek further assistance in evaluation and management of these symptoms.

  3. NJCTS says:

    Self Injurious Behaviors (SIB) in Students (slapping and hitting self in face and scratching near eyes) – we attempt to block high intensity SIBS and student scratching themselves near or around the eyes to prevent injury to self. Sometimes this helps student deescalate and decrease and other times it only increases the intensity – any suggestions or strategies to use when a student is engaging in SIBS that are a danger to themselves (it is also hard to watch someone hurt themselves and as educators all we want to do is prevent them or at least decrease in intensity.

    • DrBudman says:

      Self injurious behaviors are extremely upsetting for everyone, particularly for the individual experiencing these symptoms. First, you need to make sure that the student’s family and treating clinicians are also aware of these symptoms. The context, frequency, intensity, and duration of these episodes should be noted. When do these behaviors occur? Do these episodes occur only in certain classes, for example? Only when certain demands are made, such as an oral presentation for example? Do these behaviors only emerge in the presence of particular teachers and/or peers? Does the student describe factors that make these symptoms better and other factors that seem to trigger or exacerbate these symptoms? My guess is that anxiety may also play some role, both for the student and also for his/her teacher. Engage the student who experiences this symptom in this discussion and see what potential strategies the student may provide.

      It may be necessary to tmake an adjustment in current treatment – behavioral and/or psychopharmacological treatments. A careful evaluation may reveal that these symptoms are not tics but compulsions and should be treated accordingly, for example. Or if these are self-injurous tics, it is possible that they may be targeted with Comprehensive Behavioral Intervention for Tics (CBIT).
      In some cases, the student may need to wear protective goggles or glasses for a period of time until the symptom wanes.

  4. NJCTS says:

    If you suspect physical or sexual abuse how do you delicately bring it up with the family.

    • DrBudman says:

      Unfortunately, it is not really possible to address abuse indirectly. It is possible, however, to be sensitive to the tremendous denial, shame, and defensiveness that you may encounter when making such inquiries which may necessitate asking about such behaviors several times and in a few different ways.

      The best approach is often a direct, simple, non-judgemental inquiry about whether particular types of behaviors are possibly happening at home or have occurred in the past. You may want to first share that abuse is commonly associated with a range of different types of symptoms and that for this reason you need to ask directly about it. You may also want to emphasize that you are trying to be helpful, not hurtful which sometimes alleviates anxiety about revealing such experiences.