Tourette's Syndrome is a rare, psychiatric condition that has the potential to negatively impact one's social, emotional, and academic domains (American Psychiatric Association, 2000). Those individuals most at risk from suffering from harmful effects are children and young adolescents, who are at a particularly vulnerable point in their lives as they progress through the stages of maturation and development in a variety of realms. Recent research has been conducted examining Tourette's Syndrome's neurological pathways, etiology, characteristics, and limitations of the disease (Freeman, Fast, Burd, Kerbeshian, Robertson & Sandor, 2000). However, limited research exists focusing on the lived, personal experiences of individuals living with this rare and unique syndrome. This study focused on the lives of three participants living with Tourette's Syndrome.<p> Conducted from a narrative inquiry approach, each participant shared their private and unique stories living with Tourette's. Stories were shared through a semi-structured interview design, where each interview was audio recorded and fully transcribed. Each individual's transcript was then analyzed and compared to each participant in efforts to identify common patterns and themes which emerged or notable differences which set each apart. The resulting findings identify an understanding of lives lived with Tourette's Syndrome, and the ultimate strength and courage that is required to overcome obstacles that the syndrome and society have placed on each individual. The findings also provide valuable information for educators and counsellors to assist in their professional practices.

Tourette's Syndrome is a rare, psychiatric condition that has the potential to negatively impact one's social, emotional, and academic domains (American Psychiatric Association, 2000). Those individuals most at risk from suffering from harmful effects are children and young adolescents, who are at a particularly vulnerable point in their lives as they progress through the stages of maturation and development in a variety of realms. Recent research has been conducted examining Tourette's Syndrome's neurological pathways, etiology, characteristics, and limitations of the disease (Freeman, Fast, Burd, Kerbeshian, Robertson & Sandor, 2000). However, limited research exists focusing on the lived, personal experiences of individuals living with this rare and unique syndrome. This study focused on the lives of three participants living with Tourette's Syndrome.<p> Conducted from a narrative inquiry approach, each participant shared their private and unique stories living with Tourette's. Stories were shared through a semi-structured interview design, where each interview was audio recorded and fully transcribed. Each individual's transcript was then analyzed and compared to each participant in efforts to identify common patterns and themes which emerged or notable differences which set each apart. The resulting findings identify an understanding of lives lived with Tourette's Syndrome, and the ultimate strength and courage that is required to overcome obstacles that the syndrome and society have placed on each individual. The findings also provide valuable information for educators and counsellors to assist in their professional practices.

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The thesis deals with the communication of children with Tourette's syndrome. The first part of the thesis, the theoretical part, defines the basic terms concerning specifically the manifestations of Tourette's syndrome. An integral part of Touret-te's syndrome are psychiatric diseases, behavioral disorders and learning disor-ders that children suffer from. The theoretical part of the text is mainly from the study of literature. The second part, the analytical part, is composed of semi-structured interviews, with mothers who are willing to share their experiences with children having Tou-rette's syndrome. All mothers agreed with to beeing recorded and and anonymous proccesing of results for the purpose of the thesis. Keywords Tourette's syndrome, communication, vocal tics, children communication

L'impulsivité, un trait multidimensionnel, détermine la sévérité d'affections comportant des désordres compulsifs (syndrome de Gilles de la Tourette, maladie de Parkinson, troubles obsessionnels compulsifs), mais la nature de la relation impulsivité / compulsivité reste méconnue. L'intérêt du présent travail est d'identifier les substrats neurobiologiques de la balance impulsivité / compulsivité, dans une approche transnosographique, en s'aidant au plan préclinique, de manipulations causales et au plan clinique, d'une approche corrélationnelle. Ainsi, nous démontrons pour la première fois en dehors du champ de l'addiction, non seulement que l'impulsivité motrice, endophénotype de vulnérabilité à la compulsivité, prédit, sous l'influence de la transmission noradrénergique, la transition vers la compulsivité, mais aussi que (dans le modèle de la maladie de Parkinson) la dénervation de la voie nigrostriée et les traitements substitutifs dopaminergiques amplifient l'état impulsif. D'où l'interaction complexe entre le trait impulsif, les traitements et le processus dégénératif. Enfin, nous démontrons le bénéfice thérapeutique de la stimulation de la portion antérieure du pallidum interne dans les formes sévères de tics et suggérons dans un modèle préclinique d'une grande valeur heuristique, que le trait impulsif prédit l'efficacité de la stimulation du core du noyau accumbens. Nos résultats démontrent l'intérêt de mieux caractériser le trait impulsif des patients présentant des désordres compulsifs (syndrome de Gilles de la Tourette, maladie de Parkinson) et ouvrent ainsi de nouvelles perspectives thérapeutiques, tant pour la prévention de la transition de l'impulsivité à la compulsivité, que dans le traitement de ceux-ci. / Impulsivity, a multidimensional trait, determines the severity of compulsive disorders (Tourette's syndrome, Parkinson's disease, obsessive compulsive disorders), but the impulsive / compulsive relation remains unclear. The aim of this work is to identify the neurobiological substrates of impulsive / compulsive balance, using causal manipulations in rats and correlational studies in patients. The results demonstrate - for the first time beside the field of addiction - that, not only high impulsive trait is a transnosological endophenotype of increased vulnerability to develop compulsive disorders, but also that the transition from impulsivity toward compulsivity depends upon the noradrenergic transmission. Furthermore, we also show that, in a Parkinson's disease preclinical model, both the nigrostriatal denervation and dopaminergic treatments increase impulsive state, thereby indicating the contribution of a complex interaction between impulsive trait, medications and neurodegenerative process to the impulsive/compulsive balance. Finally, we show the therapeutic benefit of anterior globus pallidus interna in severe forms of tics and suggest in a preclinical model, with great heuristic value, that impulsive trait predicts the efficacy of nucleus accumbens core stimulation. Together, our results demonstrate the need to address the impulsive/compulsive balance in compulsive disorders and show promise for developing new pathophysiological-based therapeutic strategies that will treat both impulsivity and compulsivity.

Contexte : Les fonctions exécutives (FE) du syndrome de Gilles de la Tourette (SGT) demeurent à ce jour un sujet complexe. Les études tentent d’élucider l’implication des tics sur le fonctionnement cognitif, mais notent des résultats contradictoires. Ceux-ci seraient occasionnés par plusieurs facteurs, mais principalement par les comorbidités, incluant la dépression. Les risques de développer des symptômes dépressifs sont de 76 % dans la population du SGT. Toutefois, les études qui mettent en évidence un profil des fonctions exécutives à l’aide d’un questionnaire auto administré, tout en considérant les effets de la dépression, demeurent pratiquement absentes pour cette population. Ainsi, il est pertinent d’étudier ce sujet à l’aide d’un outil sensible aux atteintes exécutives afin de considérer ce besoin et d’édifier un portrait global du trouble. Objectifs : Le premier objectif sera de valider les relations entre les symptômes SGT, les symptômes dépressifs sous-cliniques (SDSC) et les sous-facteurs du BRIEF. Le deuxième objectif consiste à confirmer la nature des liens entre les évaluations du BRIEF-A et les différences entre les groupes atteints du SGT ou de tics chroniques (TC) avec ou sans SDSC et un groupe contrôle. Le troisième objectif vise à extraire un profil typique pour discriminer les groupes avec le BRIEF-A. Participants : Un groupe de 28 contrôles, 15 SGT ou TC et 16 SGT ou TC avec SDSC ont été recrutés. Ceux-ci ont été appariés selon l’âge et le sexe. Procédure : Le questionnaire auto-évalué et rapporté par les proches du BRIEF-A, l’inventaire de dépression de Beck (BDI), l’inventaire d’anxiété de Beck (BAI) et le YGTSS (Yale Global Tic Severity Score) ont été administrés. Résultats : Les résultats de l’ANOVA et des tests Welch, ainsi que les analyses de la fonction discriminante effectuées, révèlent un domaine caractérisant le SGT ou TC-SDSC soit l’inhibition. Conclusion : Le BRIEF-A permet de distinguer un profil exécutif propre aux personnes SGT ou TC avec SDSC. Les atteintes associées à l’inhibition seraient, en majeure partie, reliées aux SDSC et refléteraient une catégorie d’individu parmi la population SGT ayant développé une prédisposition à une dépression présentant une agitation psychomotrice. / Background: The executive functions (EF) of Gilles de la Tourette’s syndrome (TS) remain a complex subject to this day. Indeed, studies attempt to elucidate the implication of tics on cognitive functioning note mixed results. Several factors could influence these results, including significant comorbidities like depression. The chances of developing depressive symptoms in the TS population is as high as 76%. However, studies that highlight a profile of executive functions with a self-administered questionnaire and consider the effects of depression remain practically absent for this population. Thus, it is relevant to study this question using a tool sensitive to executive impairment to address this need and build a global portrait of the disorder. Objectives: The first objective will validate the relationships between TS symptoms, subclinical depressive symptoms (SCDS) and BRIEF sub-factors. The second objective is to confirm the nature of the BRIEF-A assessments and the differences between groups with TS or chronic tic (CT), TS or TC with SCDS and a control group based on BRIEF subfactors, TS symptoms and SCDS. The third objective is to extract a general profile to discriminate groups with the BRIEF-A. Participants: A group of 28 controls, 15 SGT or TC and 16 SGT or TC- SCDS, were recruited. They were matched by age and sex. Procedure: The BRIEF-A, a self-report version as well as the informant version, Beck’s Depression Inventory (BDI), Beck’s Anxiety Inventory (BAI) and the YGTSS (Yale Global Tic Severity Score) were administered. Results: The results of the ANOVA and the Welch, as well as the discriminant function analysis performed in the two versions of the BRIEF-A, reveal a domain that may characterize SGT or TC- SCDS: inhibition. Conclusion: The BRIEF-A makes it possible to distinguish a specific executive profile highlighting SGT or TC people with SCDS. The impairments measured in the executive function related to inhibition are mainly due to SCDS and could reflect a category of individuals among the SGT population with a predisposition to depression and psychomotor agitation.

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