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

The Birthday Cake: Lessons from Oppositional Defiant Disorder, ODD

The Birthday Cake Lessons from Oppositional Defiant Disorder NeurologicallyGifted.com

Nathan doesn’t eat birthday cake.

Stop sign-NOHe can’t.  His brain won’t let him.  There is a great big stop sign between him and his birthday cake, parked right between the blowing out the candles and the sweetness of the first bite.  The stop sign says “NO!”  Then a caption underneath says, “This message is brought to you by YOUR ODD.”

Its not hard to pick out a child with Oppositional Defiant Disorder, ODD.  Just ask “ Do you want to go to the park, honey?” or “Do you want some ice-cream?”

ODD Neurologically Gifted“NO!”

“You sure?”

“NOOO!”

“I have your favourite flavour.”

“NOOOO!  I HATE YOU!”

If you think that is bad -try to convince him that he really, really does want ice-cream.  You may start a full blown rage and certainly ruin your day and his day.  What would be even worse?  You end up feeling a need to punish him, send him to his room, ground him from his friends and take away his I-pod.  Yikes!  Things go from bad to worse.  Everyone ends up exhausted and steam-rolled.

And its not like Nathan doesn’t like cake.

(Okay.  He doesn’t like Chocolate cake and that’s a bit weird.)  He likes cake.  He could eat an entire cake all by himself – just not his Birthday cake.

Year after year, Nathan refused his birthday cake.  Chocolate cake, (I know), angel food cake, ice cream cake, any kind of cake…  It didn’t matter.  He loved his birthday and fully participated and listened graciously to our singing “Happy Birthday”, making his wish, posing for photos and blowing out the candles.  And then, “NO!”  to cake.

Sometimes, I would feel ripped off.  Why the heck can’t we just have a happy, normal celebration?  “Let’s eat cake!”  “I got it just for you!” “Just enjoy the damn thing.”  There was something unsatisfying about not ending up with icing and smiles on all our faces.  I admit it – I am pretty sensitive.  Being yelled at by my son hurts my feelings.  Especially if I am really trying to be nice!

Sometimes I felt bad for him.  His challenges are pretty huge and it’s NOT just the cake.  But…his disorder preventing him from being able to participate fully in a normal, happy celebration year after year with his family.  The poor kid!  He likes cake and he can’t even eat his own cake!  Knowing the expectation that “everyone loves birthday cake”, causes his ODD to contradict the expectation.  He can’t help it.  He needs to say “No” to it.  That’s how ODD works:  if he is expected to do something, say something, or even like something (like birthday cake), his internal stop sign pops up and forces him to become non-compliant.

And yes, sometimes it would go from bad to worse.  Someone would naively try to convince him,  “Oh, come on Nathan, you have to havesome of your birthday cake.”  Then his ODD would take over.  Harsh words would go flying, voices would be raised, and feelings would be hurt.  He is already fired up, of course – it’s a party after all.  Not a good way to end a birthday party.

What we have learned from Oppositional Defiant Disorder

  • detour Neurologically GiftedOppositional Defiant Disorder responses are deeply entrenched by repetition.  To circumvent this roadblock, try going around or get off and take another route!  This is one of the general rules in our home.  We know that attempting to crash right through Nathan’s “NO”/Stop sign will cause injuries.  And, who wants to flatten their child?
  • Ignore the “No!”  The automatic “NO!” is exactly that – automatic.  It really doesn’t mean anything.  If we wait it out, the automatic “NO!” may subside, then disappear.
  • Give your child time between their automatic  “NO! and your reaction to it.  Nathan often responds with “NO!” and then physically follows through with a “Sure, Okay!”  The pause before my reaction was the key to that realization.  Over time, the delay between his automatic “No” and “Sure, Okay” became shorter.  Now he often says “No” while he complies with our requests.  It can be funny at times.
  • Pick your battles.  Listen to your child and respect their choices.  Sometimes, “NO!” is really a “NO!” (like the chocolate cake), and not just ODD, (like the “NO!” birthday cake stop sign).  Don’t make a “NO!” into a “You’ll do it because I said so!”
  • Teach your child about their Oppositional Defiant Disorder and what your observations are.  Self insight will help your child immensely to take power over their automatic ODD responses.  We talk about it all the time and encourage Nathan to fight back against his ODD tendencies.
  • We don’t really know when Nathan’s birthday cake stop sign got placed or cemented there but we all know it is there, so we work around it.  This year Nate had a slice of pie.  I made cupcakes and we had two kinds of pie.  He picked lemon meringue.  Candles and everything!

Rage!!!

Rage/Neurologicallygifted.com

As an adult who has Tourette Syndrome and associated disorders, I have an intimate understanding of rage through experience. I understand the frustration of shouldering the burden of getting through every day filled with tremendous and constant challenges due to my disorders and associated symptoms. These demands not only test one’s patience continually, they test one’s ability to be still, to perform routine tasks and even to relax. If unable to calm themselves during times of stress, the sufferer may “boil over” emotionally, and release their frustration through angry outbursts.

(See our post Mental Health Challenges in Neurological Disorders for more about stress – coming soon)

People with neurochemical disorders including Tourette Syndrome and ADHD, often have a low frustration tolerance. They are usually predisposed to poor self-control in the manner of impulsivity and rage. This is especially true in children with neurological disorders. Children are just learning the coping mechanisms and strategies to assist them with daily struggles due to their disorders as well as managing the common unpredictable stress life brings. Dealing with the day to day of managing their symptoms, (which are always waxing and waning), drains away their mental energy to cope with anything else. They can easily become overburdened with stress. Add to this, an under equipped skill set to calm themselves, and outbursts of rage can occur at even the smallest challenges.

At times, the release of this frustration goes beyond the person’s control and the combined behaviours that occur are termed rage. Specific biochemical and hormonal changes occur within the body and brain including the “flight or fight” response. Rational thought, perception and reasoning stop functioning. Learned strategies for calming are no longer useful. The person will often say or do things they would not have ever thought of doing. Often, the person may have no memory or have an altered memory of events that occur during a rage. Shame and depression may also follow rages as the person wonders how they could have acted so poorly and so out of control. It is important for the individual to recognize that the actions that occur during a rage are beyond their control. Feelings of shame post rage will accumulate without this understanding and make the individual more prone to rage. It is also important to understand that despite the involuntary nature of rages, there is help, there are strategies and people manage them effectively. But how?

Referring to my owrage neurologicallygifted.comn experiences with rage and TS+, I have always believed that an adult is ultimately able to control their rage. Developing the ability to do so requires maturity and the ability to take personal inventory (asking yourself, “How am I doing right now? How are people reacting to what I am saying?”). Children can eventually learn to take control, but it requires a great deal of training and understanding. I believed that with coping mechanisms for stress, strategies for relaxation, self awareness and education, rage could be controlled.

Unfortunately it is not quite that simple.

My belief that rage could be controlled was seriously challenged a number of years ago when I was asked to counsel an 11 year old boy who was having up to 20 rages a day at school and home. The child was unable to control himself in any manner. At home, he lived with mom and grandmother. The two women supported each other as they were both of poor health, and endured the constant challenge of rage and violence in their home. The child was quickly growing and was bigger and heavier than they were. His behaviour was unmanageable in both the school and home setting.

Fortunately, I already had a trusting relationship established with this child. When I met with him to counsel him, we reviewed the problem behaviours at home. As his aggression and violent outbursts were becoming increasingly more dangerous, I warned the child that if he continued to be unsafe, he would be taken from his home and would not be able to live with his family. The next two weeks saw a positive change. After that however, he started to re-engage in violent behaviours towards his mother and grandmother. These behaviours continued to become more severe until finally, he attempted to push his grandmother down the stairs. He was immediately removed from his home and spent the next nine months in a residential facility. When he was released and returned home, he was able to control his rage.

So, this eventual success story reinforced my understanding of rage, based on my personal experiences and observations. People who display rage when frustrated are unable to restrain themselves without proper motivation to prevent the rage from occurring in the first place. They will continue to express their frustration with rage until they have “crossed the line”. They will push the limits of others’ tolerance until they surpass those limits. They will “go too far”. That’s what rage is. They will only learn to prevent themselves from rage after they have gone “too far” and suffered the consequences. Dozens of times over the past 20 plus years, I have seen examples that support my observation and belief. The story I have shared is extreme, and yet the boy I described did learn to control himself after he was kept in custody. It has also been the case in my home, although our “limit” wasn’t as serious. Fortunately for us, things didn’t get too far out of control. They easily could have.

As heartbreaking and scary times had been through my stepson Nathan’s rages, an underlying question directed our responses and our final goal.

The question – How can we motivate ourselves, (or our children), to pre-empt the “going to far” and gain control over rage before it happens?

pressuregauge neurologicallygifted.com

Clearly rage triggers a biochemical change in a person which then pre-empts choice, reasoning, rational thinking and self control. On the flip side there are deliberate choices, strategies and coping skills that can be utilized to prevent the onset of a rage. Finding the right timing and the motivation to employ learned skills is an extreme mental challenge requiring practice and tremendous support.

See Part 2, Part 3 and Part 4 of Neurologically Gifted’s Series on Rage