Coprolalia Myths Demysified

Coprolalia Myths Demystified

There are several common coprolalia myths one may encounter when learning about Tourette Syndrome.  The first big myth is that most people with Tourette Syndrome have coprolalia.  This is what is known as TV Tourette…  In reality, only 10-15% of people with Tourette have coprolalia and even then it waxes and wanes as do all Tourette Tics.  Here are some other Coprolalia Myths…

Coprolalia Myths #1:

Children with coprolalia come from homes where they are exposed to obscene language and/or inappropriate material.   False!

Children who have neurological differences with the symptom of coprolalia have brains that work atypically.  Despite often being diagnosed with Attention Deficit Disorder, children with ADD or ADHD are not lacking in attention ability but their attention works differently than a typical child.  A typical child’s attention manages their environment by attending to what is important, (or what they are directed to), in the particular immediate situation.  A child with ADD/ADHD has attention but it most often easily drawn outside the immediate situation and the child is said to be highly distractible.  It is not an attention deficit at all but rather the inability to focus that attention where it should be.  Often attention is drawn to and captured by what is brightest, what is loudest and what is most inappropriate.  There attention flickers through all the available stimuli and if it settles it will do so on language, actions and social situations that are most different, most exciting and socially taboo or inappropriate.

Actually the diagnosis Attention Deficit Disorder is misleading.  Ask any parent who’s ADHD child can play video games or watch TV for hours but can’t attend long enough to brush their teeth properly.  This phenomena is called hyper focusing and very common in ADHD children.  To further add to this, it is easy to focus on things that are interesting, exciting or unusual to us.  It takes mental maturity, skill and focused attention to attend to things that we find boring.

So, the stage is set.  Their brilliant minds are primed to pick up the most unusual and inappropriate data their roaming focus can find.

By walking through stores, to and from school, around the mall, and every where else, a child with ADHD or TS has their attention pulled to any inappropriate language, visual material and actions of others they find different or interesting.  They notice the teens huddled in the corner smoking, using bad language, or spitting on the ground.  They notice how they dress, how they look at each other and how others look at them dissatisfied with their behaviour.  They notice reference to sexual behaviour and materials and how society tries to shield them from it.  They often get adult sarcasm, hints and inferences.  They quickly learn what is inappropriate from all these cues and because of the hyper focus and attention to the behaviours, they stick in the child’s mind like glue.  My son from a very young age was particularly drawn to teen behaviour.  Walking through a mall with him was a struggle.  It took a great deal of effort to keep him on task and with me and I could tell instantly when there was some alternate social teen behaviour happening around us.  Suddenly he would be still and silent, watching and listening and soaking it all in.  He would then recount aloud what he had heard or saw repeatedly and he never forgot his observations.  And he was never reluctant to share them with others.

As an example:  (Caution:  Contains Coprolalia)

 These cases are not bad parenting, or abuse or access to adult material that could be prevented.  It is simply a hyper attentive mind doing what it does most easily and effectively…finding and perpetuating that which is most exciting and most instigating.

 

Coprolalia Myths #2:

 Children with coprolalia need firmer and more consistent discipline.  False!

Children with coprolalia know what they are saying (or doing in the case of copropraxia) is socially unacceptable.  That is how they were drawn to learn it.  As a matter of fact, the more they understand the behaviour is unacceptable and the more unacceptable it is, the more they will be driven to do it.  Simply stated, the worst possible thing to say or do becomes the hardest thing not to say or do.  Ask any child if they know what they are saying is wrong or inappropriate and they will tell you, yes.  Often they are embarrassed and ashamed by their own uncomfortable symptoms.

Correcting the child or punishing the child is counterproductive and can dramatically increase the chance of it’s occurrence.  It creates a dialogue in the child’s head that tells them not to say “@!”, because they will be punished.  Don’t say “@!”.  My dad really hates when I say “@!”.  It’s wrong to say “@!”.  I will be sent to my room if I say “@!”.  The child ends up consumed with thinking “@!” reinforcing the tic’s neurobiological pathway and making it that much more difficult to prevent its expression.  This process of negatively reinforcing the coprolalia adds to the child’s stress level which ultimately makes tics, including coprolalia worse.

The child already knows it is wrong and is usually already punishing themselves internally, creating a negative impact on their self esteem and self worth.  Imagine the feeling of being obsessed with doing something you know causes a negative reaction from everyone you care about.  The time spent obsessing and worrying about coprolalia leaves the individual less able to manage everything else.  Ideally, understanding and knowledge about coprolalia, for the child and adult, helps create a caring environment where the child can grow.

Educate yourself and avoid coprolalia myths.

 

Rage 2 Taking on Rage: Look, Listen and Focus

Rage 2 Neurologically Gifted image 1

Rage 2 Taking on Rage: Look, Listen and Focus

LOOK, LISTEN AND FOCUS

Rage triggers a biochemical response which “over-rides” cognitive processes such as choice, reasoning, perception, rational thinking and self-control.  (See Neurologically Gifted’s article: Rage 1: About Rage for a full discussion about Rage).  By the onset of a rage episode, the sufferer is cognitively “paralyzed” by the body’s chemical and hormonal changes.  At this point, calming and coping strategies initiated by other people become ineffective.  Recurring rage tends to make families feel hopeless and out of control.  The individual with rage typically feels shame and guilt after they have calmed after a bout of rage.  Everyone can become fearful and feel powerless against the rage.

On the other hand, (and where hope lies) there are deliberate choices and coping strategies that can be used to prevent the onset of a rage.  Finding the right timing and the self-motivation to employ the coping strategies is a tremendous mental challenge that requires practice and support.  Learning and using strategies to prevent rage is a challenge for both the individual with rage and the family.  It takes time and effort, but through repetition and practice, rage episodes become less volatile.  When I explain this challenge in my presentations I draw upon my life experiences.

Stop, Look and Listen

In young children, rage can quickly become default behaviour.  By age 6, our son’s default behaviour was full-blown rage, and he would be very quick to attack his mother verbally and physically.  As he grew, he was getting bigger and eventually could no longer be tucked under the arm and carried to his room.  His mother’s default behaviour became fearfully tip-toeing around her son, in the hope that this would keep him from raging and protect herself.  She had a “safe room” in the house – a crawl space with a door that opened outward so he couldn’t kick it in, a phone to call for help if he was unsafe, tissues for her tears and book and a chair to wait out the storm.

Rage 2 Neurologically Gifted image 1

The first step to changing the rage cycle is to scrutinize the way rage manifests itself in your family.  Carefully observe your family members reactions to rage.  What feelings does it elicit in each member of the family?  What are your family’s responses when a rage occurs?  Typically a pattern of behaviour will become entrenched along with the attached feelings.  These are your default behaviours which will need to change as you provide a new response to rage.

Carefully note what is occurring now.

What are your child’s default behaviours when rage occurs?  How does your child express his rage?  Is it verbal or physical or both?  Is their rage directed toward a certain member of the family?  Your child will tend toward these responses during a rage, so knowing what they are will be key in finding a way to intervene and make change.  Look for warning signs in their behaviour prior to a rage episode.  Are there clues that warn of an impending rage?

Know your child’s triggers.  Observe and record what brings on their rage.  Be aware that the rage may look to be triggered by a single event but usually this event is trivial and just the last drop in the bucket, so to speak.  Recognize the pressures unique to your child throughout the hours before the rage occurred.  If they have Tourette Syndrome of ADHD, have their symptoms increased?  Have they been trying to suppress their symptoms and are wearing down?  Have there been additional stressors in the recent past?  (See Neurologically Gifted’s article:  Mental Health Challenges in Neurological Disorders for clues to your child’s inner stresses prior to the rage – coming soon.)  Learn what predisposes your child to rage and conditions that can add up to outburst of rage.  Some common conditions that can add stress to a situation could include noises or specific sounds, temperature, crowds, certain people, being rushed, clothing sensations, frustration or simply mental exhaustion.  Note that stressor may be positive or negative.  A birthday party can be just a stressful as a losing a privilege.  (See Neurologically Gifted’s Article:  Emotional Dysregulation for more on this – coming soon.)

Once you have listed the possible triggers, think of strategies you already use to eliminate or minimize your child’s exposure to those triggers and conditions that predisposes your child to rages.  It is important to note that in minimizing triggers you cannot remove everyday normal activities.  That is not a realistic expectation.  You cannot create an environment that is impossible to maintain, and creates an unrealistic idea of daily life.  Keep in mind that you are preparing your child for life in the real world.

You will note that as you stop and observe how rage manifests itself in your family you will be forced to disengage your own feelings and reactions during the situation.  This will be an important strategy once you are prepared to take on rage in your home.  Practice disengaging now as you gather the information you need to proceed

Focus On Rage

Rage 2 Target Neurologically Gifted image 3

As you develop goals to change your child’s default behaviours, (those that they always turn to) you must focus on the real problems, not your “wants”, (don’t sweat the small stuff).  You may have to set some things aside while you tackle rage.  Realizing we couldn’t fix everything at once, my wife and I spent two full years focused on developing my step-son’s social skills and skills of self-regulation to eliminate rage responses.  Academics took a back seat.

When required to choose between social skills and academic skills, choose social skills.  Social skills are required for peaceful coexistence and success for life on our planet.  As an educator, I believe that academics are of secondary importance if a child cannot function in society.  I have always stated that I’d rather have a well behaved, caring child rather than a horribly behaved one who had straight A’s.  Besides, a child will be unable to learn if they are constantly flying into rages (I’ve seen it).  Your focus must be the foundation on which all other skills are based.  Focus on positive, self-regulated behaviour.

With my own step son, his mother and I gave his teachers, principal, and support team consent to place social instruction before academic instruction.  In the past two years, my step son’s learning plan has been focused on developing his skills to :

  • be aware of his own behaviour and see when he was not behaving appropriately, or about to lose control (taking personal inventory)
  • know and use appropriate words to express his feelings in a controlled way to de-escalate potential rage situations (communication)
  • know and use appropriate strategies to control his responses to frustrating situations (self-calming)

Another point for teachers and parents:  Don’t sweat the small stuff:  Do not “nit-pick” by expecting perfection in school work.  You must appreciate the student’s monumental accomplishment in overcoming their neurological weaknesses to complete school work.  Their success lies in the fact that they completed the task they were challenged to perform, not that is was done perfectly.

Going Forward

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Rage is insidious and becomes a large part of your family’s dynamics and day to day functioning.  It is common to block out how things are occurring and to avoid  thinking about them.  Take time to observe what is happening and how it happens.  Give yourself plenty of time to prepare yourself to finally take on Rage.

See Part 1, Part 3 and Part 4 of Neurologically Gifted’s Series on Rage

Coprolalia Part 1: The Nature of Coprolallia

Coprolalia NeurologicallyGifted.ca

COPROLALIA PART 1: THE NATURE OF COPROLALIA

Coprolalia

The term coprolalia is used to describe involuntary vocalizations that are obscene or socially inappropriate.  Coprolalia includes swearing, but also includes saying things that are culturally taboo, socially unacceptable or inappropriate due to age or context.

For example, a child using any kind of obscene language, or anyone saying negative comments about another’s ethnicity or physical appearance or anyone screaming “bomb” or “fire” in a public place are all considered coprolalia. Coprolalia may also refer to these phrases or words being said inside the persons head or kept quietly to themselves, which may also cause intense internal distress. Copropraxia refers to gestures and actions of the same nature as coprolalia.  Coprolalia can be a symptom of some neurological disorders as well as certain brain injuries and is a rare symptom in Tourette syndrome.  As infrequent as it occurs, it is most often misunderstood, and often glamourized by media as a definition of Tourette Syndrome.

Coprolalia 1 Neurologically GiftedCoprolalia can occur in Obsessive Compulsive Disorder as well as Tourette Syndrome.  People who have Obsessive Compulsive Disorder as well as Tourette Syndrome have a greater struggle as the two disorders may interact with each other and may perpetuate coprolalia.  The obsession with performing, (or not performing), the inappropriate behaviour provokes the urge to follow through with it, and vice versa. (see Post:  Where Tics and Compulsions Meet:  TS Plus OCD for how these two disorders may interact)

Coprolalia is a particularly distressing symptom for people with Tourette Syndrome.  The nature of coprolalia, being socially inappropriate, makes everyone involved uncomfortable, that is, until everyone understands what coprolalia is and why it occurs.  Education about coprolalia being an involuntary symptom of a neurochemical disorder is essential to bring about acceptance and understanding.  Coprolalia can be a lifelong struggle and the individual deserves understanding and acceptance.  Coprolalia must be accepted by the family first, to provide the individual with a support system.

Coprolalia 2 Neurologically GiftedPeople with coprolalia may feel embarrassed and ashamed of their symptoms.  There is no will or want to the expression of coprolalia.  Often, the response to coprolalia and the lack of understanding and acceptance from other people amplifies the individual’s shame and embarrassment, leading to isolation. Fear of performing the tic in public and being constantly scrutinized and judged may also lead to isolation and depression.  In addition, it drives the individual to constantly think about their coprolalia symptoms -What will I tic? -How will I handle it? -How can I suppress it -Who will laugh or stare? -Who will run away?  In turn, the stress and hyper focusing will make the coprolalia occur more frequently and intensely.  In this way, benign symptoms of coprolalia become malignant due to the stigmatization and judgment of the onlookers.

3 Common Difficulties in Understanding Coprolalia

Coprolalia is usually expressed in complex and variable ways, further leading to the misunderstanding of the involuntary nature of the behaviour.  It rarely presents itself as a cut and dry symptom which always challenges everyone’s understanding and acceptance.  The three examples below demonstrate how, by the complex nature of the symptom, parents, teachers, the individuals themselves, and onlookers can be constantly challenged to consistently accept coprolalia as a unwanted and uncontrollable symptom of Tourette Syndrome.

A Misunderstanding of Provocation

Coprolalia, like other tics, is prompted by a premonitory urge.  For example, racial slurs may be prompted by seeing a person of a particular race; sexual comments may be prompted by seeing a member of the opposite sex.  Seeing these people reminds the brain of forbidden/unacceptable words.  Coprolalia co-exists alongside the faulty auto-inhibitory functions within the brain.  When faced, for example, with a person of the opposite sex, the person may quickly think “I’d better not say “_______”.  By thinking this thought, the individual has put the offensive phrase into their own mind.  He/she will then be stuck with the phrase in their head.  Coupled with poor impulsivity control, it can appear as if the person is willingly thinking the thought and then saying it without concern for the other person’s feelings.  In truth, coprolalia has no relationship or meaning to the observed person and is not a personal attack.  There just happened to be something within the environment that prompted that particular urge.  For the person with coprolalia, they struggle to prevent themselves from saying or doing the worst possible thing in the particular situation.  Imagine having to sit in a church or other place of worship.  The mere sight of religious icons evokes meaning in our brains.  This meaning cues the brain and conjures words (good and bad).  A sufferer of coprolalia will focus on restraining himself or herself from shouting offensive words.  This focus will bring these words to the tip of his/her tongue, and eventually out of the mouth.  The struggle is internal and far more painful for the individual than those who may overhear the utterance.  Coprolalia is not directed at other people nor intended to cause harm or fear in others.  Oddly enough, the more a sufferer wants to STOP saying an offensive word, the more likely they are to say it – because of their focus.

Incorporation into Speech

Another confusing aspect about the expression of coprolalia involves the incorporation of coprolalia into regular speech and actions.  This phenomenon is more common in children.  The urge to say the word may be strong enough that it will occur within the context of speech.  The tic is somewhat satisfied for the child, however; it very much appears as being a voluntary addition.  Consider the F_ word as a vocal tic that is coprolalia.  The child may voluntarily slip it into speech in a fluent way, satisfying the tic but being unaware of how voluntary the tic appears to be to others.  For example, “That f_ing dog just f_ing barked at me”.  This is very difficult for others (especially parents and teachers) to understand.  I remember telling my child, when coprolalia began for him, to just pick one or two of the words and say them out of a sentence so people would more easily identify it as coprolalia!  This strategy didn’t work because he doesn’t have the option to choose which tics he says, and because he never really understood why it would make a difference how or when it was expressed.  To him, slipping it into speech was more “normal” than randomly shouting a bad word.  And doing it my way didn’t satisfy his urge, of course.

Intensity and Frequency Changes

Another difficult characteristic of coprolalia that further impedes understanding is that stress increases tic frequency and intensity.   Parents of children with Tourette Syndrome are very familiar with this phenomena.   Both negative and positive stress occupy significant mental attention.  In these situations, a child has less mental energy to suppress his/her tic symptoms.  As a result, more tics are expressed, to conserve mental energy for all the other things that are consuming the child’s mental resources.  Consider that anger, disappointment and frustration are major stresses.  When a child attends to these negative emotions, they do not expend energy on suppressing their tics or coprolalia.  In a situation that provokes strong feelings of anger in the child, tics and coprolalia escalate.  In this type of situation, you will have a child who is angry, using inappropriate language, and louder because you have asked them to do something like “Come do your homework now, please.”  What looks like a child reacting disrespectfully and aggressively may simply be a child reacting to a strong emotion, increasing tic expression due to the displacement of mental focus to the emotion.  This situation is extremely difficult to manage and creates intense stress on families living with neurological disorders.

Education about the disorders, symptoms, and their expressions lay the groundwork to understanding, managing and accepting coprolalia.

Video for Coprolalia Part 1:  The Nature of Coprolalia