Dear Tanya

We have two sons aged 14 and 11 at a local independent school. Both boys are rather shy and quiet and the youngest has a dysfluency speech problem, which he is growing out of. However, he is a bright child and popular with his friends. He has also always had considerable respect for authority.

Last week, while I was in an adjoining room at a parents' tea, he was on the school computers by himself. It turned out that he had signed in to a friend's e-mail account (which is strictly against the rules) and within a minute had sent three e-mails to his male class teacher, with whom he has always got on very well, containing the words “Have sex”, “F***” and “Shit”. We have never even heard him use this language and we don't use these words at home.

He cannot provide any explanation for his behaviour. He had no grudge against the teacher, or his friend, and has confirmed that he would never have dreamt of using such language directly to the teacher. He seems remarkably unfazed by the experience, but did not enjoy getting into trouble for it. We too are mystified, but are particularly concerned because when he was about 8 he was assessed for possible Tourette syndrome because of speech and nervous tics (eye-rolling and adjusting clothes). Given that he could be stopped from “tic-ing” by bribery with sweets and was not making any noises as such, both a paediatrician and speech therapists felt there was no diagnosis to be made. Should we be concerned again?

Harriet, 30, London

Your question has many layers that need to be evaluated as there are many possible explanations. From an assessment perspective, a differential diagnosis would be required - we need to evaluate the possibilities within the story you tell and work out what best helps us to understand your son's behaviour.

Clearly, he has had anxiety problems in the past and has been assessed for his tics (involuntary, rapid, sudden movements, sound or words that occur repeatedly). You describe him as shy and quiet and that may be in part related to some social anxieties he has.

However, you raise the possibility of Tourette syndrome (TS) so we should consider that first.

TS is a neurological disorder seen before the age of 18 and the result of an abnormal metabolism of the neurotransmitters dopamine and serotonin (chemicals in the neural networks of the brain that stabilise mood). It is genetically transmitted and characterised by multiple motor and vocal tics that may be present most of the time, or may occur in bouts.

The tics can be “controlled” by the individual, but eventually the urge to perform them will be overwhelming. A feature of TS is coprolalia - where socially inappropriate or unacceptable words or phrases will be expressed almost against the person's will and their moral beliefs, such as the urge to utter racist comments or swear loudly. Often, like the motor tics, the compulsion to say such things is overwhelming. People with TS are more likely to have any combination of these problems: Attention-Deficit/Hyperactivity disorder (ADHD); Difficulties with Impulse Control (disinhibition); Obsessive-Compulsive Disorder (OCD); learning disabilities (such as dyslexia); sleep disorders.

If you have concerns about TS, I suggest that you contact the Tourette Syndrome Association: 0845 4581252; www.tsa.org.uk and speak to your GP about a referral to a Child and Adolescent Mental Health Team for an assessment. I would be surprised if TS explains the behaviour, given that it has been so long since you had cause to be concerned about this.

You also mention dysfluency - a disorder of communication. Children aged between 2 to 5 tend to have periods of “normal” dysfluency when they stutter - usually because they are thinking faster than the muscles move and so jumbling their words.

However, if this has gone on for more than four months and the child appears stuck with some sounds or words, an assessment is advisable. For your son, the dysfluency may have caused a self-consciousness and anxiety about language that may, in part, explain his recent behaviour.

Sometimes we feel compelled to behave out of character given our levels of stress and anxiety. Anxiety - the fight-or-flight response - is an in-built response to a threat that includes the build up of stress and pressure. When we are very anxious we become almost totally physiological in our functioning as our body prepares to run or hide - this means that oxygenated blood predominantly goes to the parts of the body that are needed for survival (our muscles, our lungs, areas of the brain associated with motor behaviour). The rational parts of our brain become less efficient, thinking becomes black and white and behaviour disinhibited.

Your son is at a time of life where he will be experiencing many pressures and stresses - biologically, psychologically, emotionally and socially. Although there are no profanities in your home there are, undoubtedly, in the school and he will be drawn to the language and behaviour of his peers.

As a pubertal boy he will be experiencing many new feelings and he will be experimenting with thought and behaviour new and exciting to him - sometimes because they are forbidden. His identity-formation behaviour will shift from family to peers. This is normal. We know that young people using technology for communication don't always appreciate the seductive power of the anonymity of the medium, which often leads to things being typed and sent that, if face to face, would never be said. The excitement of breaking rules and writing swear words to a teacher exists in the fantasies of many teens - the impulsive action is a combination of a lack of rational thought and a state of disinhibition when aroused.

I think this is a better explanation, particularly in a boy who has had impulsive behaviour associated with anxiety before. However, it is worth considering that his behaviour could have been an anxiety-related “fight” response and a “cry for help” - check whether all is well with this teacher or his peers. Your son's behaviour is not uncommon in children of his age and may be nothing more than the normal “acting out” behaviour of adolescence. I also wonder whether he feels he can explore and discuss his feelings and behaviour at home? It is important that adolescents have non-judgmental space to explore their identities with us as well as with their peers and to draw boundaries at this confusing time for them.

I advise against pathologising this behaviour, which is all too easy to do nowadays. It's normal to be odd and quirky sometimes, especially when one is hitting puberty.

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