Gaming her brain

Mike Schiller's young daughter has a problem, and video games may be her best hope for recovery.

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In my home, 2008 was the year of Guitar Hero 3. It was my primary means of relaxation, and my kids, being kids, always wanted to watch me play. It wasn't long before watching turned into wanting to do it themselves. They wanted to be rock stars like the guy on TV with the spikes coming out of his head. So my 4-year-old son and 4-year-old daughter played. They took pleasure in small victories, but oh, how they wanted to get through a whole song. I heard the first minute of "Slow Ride" more times that year than any person should have to. My 6-year-old daughter was particularly determined. At first, she simply didn't have the hand-eye coordination to match the movements of her two separate hands with the colors floating across the screen, even on the game's easiest mode. Still, constant failure didn't stop her. She wanted to play it, and she wanted to win.

The first time she got through a song, I heard it from the next room:

"DADDY! DADDY! I DID IT! I BEAT IT!"

What kind of proud daddy would I be if I didn't go and see for myself?

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A quick look at the post-song stats made it obvious that she spent much of her time on the brink of failure. While I wanted to see her demonstrate her success, asking her to do it again would be risky. As I considered the pros and cons of such a request, however, she removed the choice with a quick "watch this!," and off she went.

She'd been practicing. My daughter should have been able to breeze through that song. She pushed all the right buttons and she knew exactly when she was supposed to strum. Still, I kept waiting for the streaks to arrive, for that consecutive notes counter to go up, for a multiplier that accurately reflected her skill. Those things never came. Instead, every 10 or 15 notes or so, she would scrunch her shoulder to her ear and twist her neck. It was as if she had an itch that she just couldn't scratch.

I watched this phenomenon a few more times over the course of the next week. I asked questions: "Are you OK?" "Are you comfortable?" "Do you have an itch?"

"I'm fine," "Yes," and "No," she'd reply. As far as she was concerned, there was nothing at all wrong. The only reason she wasn't progressing, in her mind, was that she needed more practice. I wasn't ready to let it go. I would talk to friends, family, anyone who would listen about her inability to hold still, and every response boiled down to the idea that I was worrying too much:

"Nothing to worry about," they said. "Maybe it's growing pains?" "Kids squirm."

"Relax. She'll grow out of it."

She didn't.

Instead, it got worse. We noticed little quirks, things like humming that was so high-pitched it sounded like squeaking, constant adjusting of her clothes to make them more comfortable, and for a couple weeks, an inexplicable tendency to speak with a British accent. None of this alarmed us, really. Kids will be kids, and while her behavior was odd at times, it never really seemed like anything out of the ordinary.

And then there was the cough. The doctor said it was a cold, "the flu, maybe. It will pass." It didn't.

The coughing got worse, slowly evolving into an ugly, loud, throat-shredding hack that would come from somewhere in the back of my daughter's throat every 30 seconds or so. All day, every day, that cough was the soundtrack to our lives. One night as the clock approached midnight, unable to sleep or find a reprieve from that guttural sound, we found ourselves with no choice but to pack her a small bag's worth of entertainment, including a Nintendo DS, and bring her to the emergency room.

Even in the waiting area, I tried to convince myself that we didn't belong there. I wanted to leave, to take my daughter home and tell her she'd feel better in the morning, to tuck her in and tell her, "It's just a cough, honey. It won't last forever." My soothing words were troublingly half-hearted. I didn't believe the words coming out of my own mouth anymore.

We spent two hours at the hospital that night. Doctors ran tests, bombarded my daughter and me with questions, came up with theories. Two doctors met with us, and both left us alone for upwards of a half-hour while they went to look for answers. The hospital room got smaller with every passing minute. I paced. My daughter was shockingly patient. We left the hospital that night with an inhaler that may as well have been a sugar pill for all the good it did.

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In a place of desperation, my wife and I began to catalog every bit of respite she was able to get. We soon saw a pattern and devised a theory of our own: Every time she turned on the DS, whether at home or in the cold confines of that emergency room, the cough went away. It felt like a footnote at the time, either an odd coincidence or a tribute to an activity so engrossing that it inspired her to stifle the cough. Little did we know that it was another symptom — the one that led to her diagnosis.

Planet Puzzle League was her game of choice, and for 10, 15, 20 minutes at a time, it was as though she was magically cured. I didn't notice it at first. You don't typically notice silence unless you are trying to, but when she played, the house was oddly quiet.

This little girl had spent the last three months coughing incessantly. She coughed so constantly and violently that the bones in her chest took the distress as a cue to grow out of proportion to the rest of her body. Yet somehow, she didn't cough while she played. At the time, it almost felt as if we had found a "cure," however short-term it happened to be.

Still, she couldn't play it all the time. She kept coughing. She coughed so hard and so often that she broke her own rib. This, of course, sent us back to the doctor. The DS came up when the doctor asked if my daughter was getting any relief at all. It was at that point that he nodded and told us that her need to cough might not be caused by something in her throat or her chest, but by something in her brain. He sent us to one more doctor. The neurologist confirmed his suspicions.

MY DAUGHTER DOES NOT HAVE MOVIE TOURETTE'S — SHE DOES NOT RANDOMLY SHOUT PROFANITIES.

My daughter has Tourette's syndrome. For about six months, the persistent cough was her dominant tic. Eventually, a neurologist would explain to us that Planet Puzzle League occupied her brain enough to relieve that tic for as long as she played.

Tourette's syndrome is a disorder of the brain characterized by involuntary vocalizations and movements called tics. Tourette's is also a spectrum disorder, which means that somebody diagnosed with Tourette's is also at risk for symptoms related to obsessive-compulsive disorder, anxiety, depression, attention-deficit hyperactivity disorder and autism.

My daughter does not have movie Tourette's — that is, she does not randomly shout profanities. That's a rare symptom of Tourette's called coprolalia. Rather, her time with Tourette's syndrome has included coughing, neck stretching, humming, head bobbing, handstands and counting.

Most persistent and pervasive, however, was that coughing tic. At its worst, it regularly kept my daughter up past midnight. Thanks to that little bit of emergency waiting room experience, it wasn't long before our treatment for those difficult nights was a half-hour with a DS. Rarely would the coughing stop completely, but it would certainly slow. A little relief and relaxation went a long way.

Video games allow her to engage her brain in a way that forces her to process and respond to audiovisual stimuli, without the pressure to be evaluated that comes with so many of her other activities. For someone with Tourette's syndrome, engagement involves actively "doing" an activity rather than just taking it in; a conscious motor skill must also be involved, or else the brain will provide one — a tic. Games, through their audiovisual stimulation and the requirement of user input, offer stretches of relaxation that her brain wouldn't allow for her if she were to simply lie in bed, listen to music or watch TV.

Video games are a huge part of what helped us learn her diagnosis, and just as huge a part of what helped her become comfortable with it.

In a journal article titled "Tourette Syndrome and Tic Disorders: Overview and Practical Guide to Diagnosis and Treatment" (Swain, James E. and Leckman, James F., Psychiatry, 2005 July, p26-36), the authors discuss the power of engagement with those suffering with Tourette syndrome:

...activities that require focused attention and fine motor control, such as reading aloud, playing a musical instrument, engaging in certain sports and even performing surgery, are associated with transient improvements in tics.

One can easily see how this could extend to video games. Video games require a great deal of attention and fine motor control. Planet Puzzle League offered needed relief in that doctor's office, and when we pointed out to her the reduction in her tics that happened while she was playing, it immediately became her go-to method of relaxation. What exactly defines the "right" and "wrong" game for someone with a Tourette's diagnosis will certainly change from person to person.

In my daughter's case, the distraction of the weighty Guitar Hero guitar peripheral combined with a long wait from note to note on the "Easy" difficulty level may have meant that she couldn't engage with the game on a consistent enough basis. By comparison, the fast action and easy stylus controls of Planet Puzzle League allowed her to put all of her concentration into what exactly she was going to do next. Finding the "right" game for a given person can be an effective way to provide a little bit of calm to a brain that can't figure out how to settle itself down.

In a time where pharmaceutical solutions often take the predominant role of treatment, video games are a welcome supplement. My daughter's favorite games have become some of her most effective coping strategies. While I would never suggest that video games replace doctor-prescribed treatment, understanding the disorder and what engages her in meaningful cognitive activity has allowed my wife and me to give her one more tool in her set of coping strategies.

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My daughter is 10 years old now, and her game of choice is Minecraft. She would play for days if we let her. It's something she can get lost in, something that doesn't require immediate action at every turn, but always offers something new to do. There is no pressure to perform here, only the act of creation. She hates watching me play, though, because I'm careless. Zombies and spiders always seem to be able to find me, and if I had just listened to her, I wouldn't have been killed. Playing on her own relieves her tics; watching me flail around with a wooden sword only exacerbates them.
HER GAMES HAVE BECOME HER COPING STRATEGIES.

For now, her tics are relatively dormant. We don't know if or when the handstands, or the squealing, or, God forbid, that horrible cough will return. We don't know if our future is filled with emergency room visits, or meetings with school officials, or tics we never could have imagined.

What we do know, however, is that games have been there for her, and will continue to be there for her. They give her one more avenue to connect with other children who may only have seen her as "the kid with Tourette's." They give her the sort of relief that is hard to come by. They give her joy, a venue through which to celebrate her successes and laugh at the idiosyncrasies of herself and her friends.

She's a great kid. She deserves every bit of joy that she can get.