Coprolaliacan be a particularly distressing symptom and a lifelong struggle for an individual with Tourette Syndrome. Stigmatization, shame and isolation must be reduced by the efforts of the individual, their families, their community and society. Strategies to manage coprolalia will target improving the acceptance and understanding of this difficult symptom which will in turn reduce the frequency and the intensity of it’s expression.
Here are some strategies that take action on coprolalia to reduce it’s impact on well-being.
Use positive language
Planned ignoring of coprolalia is not just ignoring the symptom altogether especially if the behaviour is having a negative or harmful impact on the individual or other members of the family. Be sure to define what negative or harmful impact means for your family. An individual can contribute to the family’s well being whilst consistently ticcing “F**k, f**k”. It is not harmful just because you or someone else does not particularly want to hear it. In fact, a tic as harmless as this example may actually be helpful in directing the individual’s attention away from more harmful forms of coprolalia. When helping to redirect behaviours that are harmful or have negative impact, use positive language at all times. (See Neurologically Gifted’s article: Using Positive Language for Success). If coprolalia is loud enough or involves another person you can use positive language to help modify the behaviour or make it less hurtful. For example, “You may say “F**k” but you need to increase the distance from your brother’s ear when you say it”. If coprolalia hurts another person’s feelings you can use positive language to teach responsibility. For example, “You looked at your brother and called him a name. You didn’t mean to, but you hurt your brother’s feelings. You should apologize and ask if he is okay.” Note: this is not apologizing for having Tourette Syndrome and for having tics, it is an apology for having potentially hurt someone’s feelings (a natural consequence).
Use substitution words
Substitution words are words or phrases that can be strategically placed to modify coprolalia. The important aspect of this technique is that the child must be involved in its development and the word or phrase must satisfy the tic. The individual using this technique must also be highly motivated to attempt to modify the behaviour. If they are not invested, this strategy will not work. Always investigate motivation and the ability to invest mental energy into this task. A child who suppresses tics all day and is mentally exhausted will not benefit from mom or dad saying, “Now Johnny, say Fruit Cake, not F***.” Willingness and readiness is essential and it is okay to put this task aside indefinitely if necessary. If there is enough motivation and investment from the individual, involve them with coming up with words that are similar enough to satisfy the tic but may be less offensive. For example, “Shitake” or “Fruit cake”. If the tic is not satisfied the individual is essentially suppressing the tic, causing more focus on the actual tic and increasing stress. Increasing stress on the individual is counter-productive to managing coprolalia.
Here is an example of my son substituting counting from 1-10, (his own idea) to prevent coprolalia from recurring. Caution: Clip contains Coprolalia.