The Tourettic Triad
Understanding the Tourettic Triad
Have you been diagnosed or suspect you may have Tourette’s Syndrome (TS), ADHD, OCD later in life? You might be exploring what’s known as the Tourettic Triad – the frequent co-occurrence of TS, ADHD, and OCD.
This unique neurodiverse profile can present some challenges, it can be a frustrating journey and feel very lonely and confusing without support, but with the right strategies, you can begin to navigate them with more confidence and embrace your strengths and unique profile. Autism is also a large factor in the Tourettic Triad, and it is common to have a mixture (if not, all of these conditions together)!
Here are some neuroaffirming tips to manage the Tourettic Triad:
⦁ Educate Yourself: Understanding how TS, ADHD, and OCD interact is key. Knowledge empowers you to advocate for your needs. Gather an understanding of each condition individually and how they all interact with each other. This could be through coaching and psychoeducation. It is important to recognise what condition you may have to fully address them. Without all the puzzle pieces it can be difficult to figure out the best course of action, strategies, medications and treatments. Quite often, individuals with these conditions are diagnosed later in life, having been through CBT, various medications and other modalities that haven’t quite worked or addressed their neurodiverse symptoms as they are often missing the important puzzle pieces that make up the whole person.
⦁ Mindfulness & Relaxation: Techniques like meditation and deep breathing can help reduce stress and manage symptoms. This is important for all of these conditions, finding ways to regulate yourself. This is highly individual as meditation may not work for you if you have ADHD, mindfulness may be difficult. Its often about experimenting and finding out what works for you. Relaxation could look like watching a comforting TV programme, listening to music, listening to an audiobook. Movement is always good to help relax the nervous system. Relaxation is particularly important with tourettes syndrome and managing tics. Fidget toys can be a great way to regulate and help manage restlessness when having to sit for longer periods, they can also help you focus. Coloring books and doodling may be good if you have to focus on a meeting or manage hyperactivity.
⦁ Structured Routine: Establishing a daily routine provides stability and helps manage ADHD, Autistic and OCD symptoms. This can be very hard if you have ADHD. Individuals with ADHD may find it difficult to follow a routine, but need one to function. This can contradict with the need for novelty vs the need for routine if you have Autism. Flexible routine may work – having strategies in your toolbox that you can use at different times. For example, perhaps you can only focus for half hour, and then need to change task. Having a list of tasks you can do in between and pick and choose could be a good idea to fufill the need for novelty but also provide a sense of security and predictability. This could be things such as watching TV, playing a video game, a hobby you like, exercise. Perhaps things you do on a daily basis that you can work flexibly into your day.
⦁ Sensory-Friendly Environment: Create a calming space with soft lighting, noise-cancelling headphones, and clutter-free areas to reduce sensory overload. There is much more to explore here, and sensory difficulties can hugely impact tourettes, ADHD, hyperactivity and overwhelm. Addressing these are key and there are so many strategies and products you can use to help with sensory needs. Seeking out support from a coach, or sensory integration specialist may be useful for you to help identify these and what you could try to support yourself.
⦁ Masking: Identify when you may be masking and hiding your symptoms to fit in with others, this can be a difficulty especially if you are diagnosed later in life and had not realized you were neurodivergent. You may have adapted your way of being in the world in order to appear ‘normal’. Exploring this concept and breaking down these barriers and being your authentic self can really help reduce overwhelm, and anxiety.
⦁ Seek Support: Connect with professionals and support groups that understand the Tourettic Triad. Sharing experiences and strategies with others can be incredibly helpful. In particular to obtain the right diagnosis, understand your individual needs and how they interact. Other professionals could be a neurodiversity coach, therapist, sensory integration professional, occupational therapist, nutritionist and of course psychiatrist if medication is something you wish to consider.If you are at perimenopause age, consider seeking support from GP as this can make symptoms more intense and unmanageable when our hormones are out of balance. Another way to seek support is to think about things like a cleaner if you struggle to keep up with housework, or meal delivery instead of going shopping.
⦁ Managing Pain and triggers for tics: Managing pain can be key with tourettes syndrome and can be a major trigger for more tics. My tips would be deep tissue massage, heat and ice packs, deep heat, painkillers, movement if you can and as much rest as you can give yourself when you need it. Working to identify your tic triggers is important, and therapy such as habit reversal therapy may be useful for you if you have troublesome tics. Once you have identified your triggers, adapting your life around these can help hugely. This may be reducing anxiety, adapting the sensory environment, more relaxation, identifying certain foods or products that are triggers and asking for accommodations at work. Exploring where parts of your life are triggering you, and adapting these to reduce overwhelm can be very helpful.
⦁ Tackling sleep issues: Difficulty with sleep is a big factor in how our ADHD and tourettes impact us. Dealing with sleep issues can make a huge difference. Try to not watch screens 1 hour before bed, sleep in darkness without a light on, and maybe try something like a lumie light to simulate sunrise and sunset and help your circadian rhythms get into a better balance. Try to limit caffeine before bed and try to go to bed at a reasonable time. This can be difficult with ADHD, but it can make a big difference.
⦁ Get accommodations at work if you are employed: Speak to your employer if you are comfortable, obtain access to work funding for some neurodiversity funding for a coach and workplace training. Ask for what you need. Examples of this could be software to reduce fatigue such as read and write software, dictation software, additional breaks, altered workload, support from a colleague, or equipment to manage restlessness, pain and fatigue such as chairs, wobble cushions, stand/sit desks. This is highly individual dependant on needs and the organization you work for.
⦁ Have a dopamine menu: This will identify activities you can do when you have low energy, high energy, short or large amounts of time to bring variety to your day and keep your dopamine topped up. As a lot of people with ADHD find boredom incredibly difficult and physically uncomfortable. This will enable you to refer to a list of ideas for different stages of your day to keep you busy but to also allow for relaxation and variety.
⦁ Focus on Strengths: Celebrate your unique abilities and talents. Embracing your strengths can boost self-esteem and overall well-being. It is ok to be good at some things, and struggle with other things. Neurodiverse people often have whats called a spiky profile, meaning they could excel at some things, yet really find certain tasks hard like tasks involving executive functions. Find what makes you happy and what you are good at and do more of it. Most of all be kind to yourself! It is absolutely ok to rest, you do not need to meet societal expectations and it is ok to just be you and advocate for what you need.
Remember, your neurodivergent brain is a part of what makes you uniquely you! Let’s continue this journey of understanding and acceptance together.
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