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Question 62: My question is this,
my son is most often a very sweet and loving child, and as you understand
he has his moments that include the rages, however I am wonder(ing)
if TS has some effect on the ability to make the choice between right
and wrong. Some times the choices my son makes are very poor even
though I know he knows he shouldn't have made that choice....I am
worried because for the last eight months his choices are for a lack
of a better word ridiculously wrong and inappropriate, I will also
let you know he is on risperidol 1.5.mg per day and when he goes to
his fathers every other weekend he is not always getting this medication,
then when he gets home by Sunday evening he is a handful and very
very angry and hurtful to his siblings and me. Is it a possibility
that the constant interruption of medication causing this inability
to make good choices or does it have to due directly with his TS.
S.H., ON, Canada.
Strictly
speaking this is not an effect of TS itself, however more often than
not (some researchers suggest as high as 90%) of individuals with TS
also have symptoms (if not a diagnosis) of attention-deficit hyperactivity
disorder (ADHD). While most people think of difficulties sustaining
one's focus when they hear about ADHD, the other component of this disorder
is impulsivity -- acting before you think, or "firing before you
aim", much as you describe. As you so aptly put it is not necessarily
about not knowing what the correct choice was. It is more about not
having the ability to put the brakes on your initial gut reaction long
enough to consider and choose between the many other reactions you could
respond with. If your child has never been assessed for having ADHD
this might be an option you'd want to at least explore.
With regards to risperidol causing impulsivity, that is unlikely as
a side effect of this drug. Risperidol is a medication used predominantly
for the treatment of tics and rage, whereas medications such as methylphenidate
(Ritalin) or clonidine (Catapres) are used for controlling ADHD-type
issues. Hence inconsistent use of risperidol would be more likely to
result in the anger and lowered frustration tolerance reactions you
describe rather than impulsivity.
Having said that, though, ANYONE has a more difficult time making the
right choices when they are frustrated, of course -- this is especially
true of individuals with rage issues. If you find that your son's poor
choices ONLY occur when he is angry, then your assessing doctor may
be less likely to see this as an impulsivity problem, more likely to
see this as a result of the rage issues, and would want to discuss with
you ways of ensuring that his medications for this condition are more
consistently adhered to.
I want to close by emphasizing that, not being your doctor or knowing
many details about you, your husband, your son, or the situation, you
should only consider this response as advice regarding possible directions
to explore and questions you should ask. You should consult with your
own doctor (medical and/or Psychologist) and solicit their opinions
on this matter.
