f-vigilance. However, some patients seem to gain mastery over their tics almost unconsciously, while others can gain control with only greater inner effort, making diagnosis difficult (1996, p. 89). The nature, severity, frequency, and degree of disruption produced by the motor and vocal tics need to be carefully assessed from the time of emergence until the present (Bruun, 1984, p. 13) Parents of children with TS report their long and difficult journey through a medical maze in search of a diagnosis for their child’s behavior. During the evaluation of a child, family issues, including parental guilt, need to be resolved Cohen, 1988, p. 45). TS children with school performance difficulties often do not clearly have delineated learning disorders, and the average IQ of a TS patient is normal. Careful assessment of cognitive functioning and school achievement is indicated for children who do have school problems (Bruun, 1984, p. 14). If a child has received stimulant medications, it is important to determine what the indications for medication were, whether there were any pre-existing tics or compulsions, and the temporal relation between the stimulants and the new symptoms. Patients and families may be excellent at identifying and reporting side effects, but they may also not appreciate that symptoms such as depression or school phobia are related to neuroleptic treatment rather than to psychological issues (Fowler, 1996, p. 94).A behavioral pedigree of the extended family, including tics, compulsions, attention problems, and the like, is useful. Once determining the use of medication, other medications must be discontinued. Rapid discontinuation from drugs may lead to severe withdrawal effects, including two or three months of any increased symptoms (Kushner, 1999, p. 104). For proper withdrawal, the doctor must plan carefully so that the patient’s life is disrupted as little as possible. Correct withdrawal is an ...
