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Question 86: I noticed in your lecture – and you subsequently made mention of – the fact that when you are busy using your energy to present - your symptoms seem to disappear. My son’s symptoms are not that obvious to most - most of the time ( primarily facial twitching and significant eye movement). When he is playing hockey I have observed lately that his head is twitching substantially while he is on the ice. I am somewhat surprised by this as I would have thought the sport and physical demands of the game would have reduced, not enhanced the tourrette symptoms. Any thoughts? S.O., NS, Canada

Good evening Mr. O.:

My apologies for the slow turnaround in responding to you -- the email piles high these days! :) Thank you for your kind comments about my presentation in your beautiful corner of the world!

Everyone's symptoms manifest a little differently, and so it is hard to say. I could make a couple of educated guesses though.

-your son may find playing in a competitive game/in front of people more stressful than other things in his life, which brings out his symptoms more than usual

-he may be suppressing more symptoms than you realize at other times: when he is on the ice he is so "in the moment", and concentrating so much on the game, that his symptoms 'slip past' his guard easier

-playing hockey is a very 'motoric' activity (i.e. lots of opportunity for 'extra' movements to become 'attached' to one another ala my Incidental Associations Model of Tic Formation). It is also an activity where taking your eyes away from the game is VERY deliterious, and likely foremost on his mind. With this amount of energy focussed on NOT having any tics that would interfere with his playing ability (for e.g., NOT moving your head when you are supposed to be paying attention) this in itself could be energizing the very tics he wishes to avoid.

Finally, it might be worth noticing if the tics follow a particular pattern. For example, you may notice that he only tics at "breaks" in the action, just as I tend to tic during my presentations when I stop long enough to take a sip of water or listen to a question being asked.

My two cents! Hope this helps,
Dr. Dunc.

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