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

Our New Normal: Parenting Our Child with Tourette Syndrome, ADHD, OCD,ODD

retro clock Neurologically Gifted

Transitions

I have an weekday mid-afternoon alarm.  It goes off everyday signalling the end of school.  It is the sound of my son’s blood curdling shriek the moment he is “home”.  Home to Nate is the place in his world that he is free of scrutiny of others and he can let his guard down.  The garage door opens, then shuts and it is as if the whole outside world disappears and he is transported magically to “home.”

Click, (the garage door), screech, “F**k” (in the loudest voice you can imagine), bang, bang, “F**k”, screech, bang then “Mom?  Hi!

This is my alarm.  My signal that it is my turn.  Nate’s turn is over and he has likely done an outstanding job.  I no longer worry that his screaming and swearing will be heard by the neighbours.  I no longer worry about the noise or the coprolalia.

He comes in to to the kitchen.  “Hi Mom.”  His backpack bumps the counter and he says, “F**k”, screeches and throws his backpack into the corner.  He screeches again.  Then, “Sorry Mom”.

At this point I make a decision about whether I should ask him how his day was or if he has homework or if I should give him a hug and a kiss.  I really want to do all of these things but I play it by ear.

I had a rough day.”  He tells me.  He struggles to get his lunch bag out of his knapsack and ends up smashing it down on the counter in frustration at this simple task. Screech then a colossal “AHHHHHH!”, screech.

I wait for him to finish throwing his agenda and homework on the counter and move away from this aggravating task.  I go in for the hug and kiss.  I gently ask if the “situation” at school ended ok.

Nate generously offers a kiss.  The hug he endures because he knows he should.  I remove the force of my hug immediately after giving it to let him direct the duration of contact.  He tells me in 10 words or less what “I had a rough day” means.  He has usually sorted it out at school with the excellent support of his team. He throws the next test at me.  “Can I have a pop?” or “Can we go out for dinner?” or “Can we get a pony?”  Whatever the question is, it doesn’t matter.  He needs to ask me a question that he is sure I will have to say no to.  He puts on his puppy dog eyes and stares at me with the look that if he could only have one wish ever this is what it would be.

I say, “No”.  I don’t launch into an explanation of why I am saying no or ask questions or otherwise engage in the question.  “Where would we keep a pony?” isn’t going to help.  Just “No” and I move on.

 

Nate is now irate.  He goes about his business yelling, “Why?” and “But…” and “B**ch” and “A**hole” and the screeching and banging ramps up to full force.

Depending on his day he will continue for a period of time attempting to engage me in the fight, banging, shrieking and throwing out profanities.

I wait.

Sorry, Mom.”

Okay.”

Mom!  I’m sorry!

Okay Nate.”

This may sound like a good ending but it is often not the end but the beginning.  If Nate doesn’t get the “feels just right” apology acceptance from me he can quickly ramp up to being irate again.  We start all over.  Only the second time he is feeling even more sorry and distressed, and the “feels just right” apology acceptance from me is even more elusive.  At some point I am able to convince him that I heard his apology, I accept it and I love him unconditionally forever and ever.

Then one more drill.  “Can I have a snack?

Sure Nate.

Thanks, Mom.”

Nate grabs his computer and enters his Minecraft world.  I go about making him and bringing him a snack with a smile.  The alarm has been reset.

Every day is difficult but really, it is so much better than it was -for both of us.  I would have never thought that I could see so many positives from this situation, nor be able to brag about all the successes that occur during this short period of time, day after day.

If you missed them, here are some of the successes:

 

  • Nathan is back in regular school, with support, staying a full day and managing his school world successfully almost every day!
  • I understand that Nathan has been self regulating all day long and when he gets home it will almost always fall apart at least for a short time.  I get it and it is ok.
  • Nathan acknowledges and apologizes for all of his verbal or physical threats almost immediately.  He has learned his actions and words can have an impact on others, (me in this case) and he appropriately takes responsibility.
  • Nathan recognizes that events that happen at school need to be resolved and he does resolve most of them before the end of the day.  Again, this is with adult support at school but he is successful at it!
  • Nathan is actively doing his after school must do jobs.  Book bag in its place, contents unpacked, no nagging or reminders required.  That is responsible.
  • Nathan hugs me because he knows it is important to me.  He knows it is how you show love and affection.  He is looking outside himself and to the welfare of others.
  • Nate and I manage an extremely disruptive daily transition and we both know we are loved.

Mom and Son Neurologically GiftedI would have never predicted that this would be our new normal after school routine or that this new normal would actually feel good!

 

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!