Helping Students with Tourette Manage Anxiety
A significant percentage of school-aged children with Tourette also have accompanying worry and anxiety. They may worry or feel self-conscious about their peers noticing their tics. They may be concerned about being accepted and fitting in socially. In addition to a diagnosis of Tourette or Tic Disorder, they may also have an Anxiety Disorder diagnosis, such as Social Anxiety, Separation Anxiety or Generalized Anxiety Disorder. Along with monitoring and treatment by medical professionals, teachers and school professionals can offer assistance to the child to help him manage his anxiety over the course of the school day. Helping students to face stressors rather than avoid them altogether, and experience success while taking small, manageable steps, will build their confidence so they can handle stressful situations.
Below are some accommodations that teachers can offer anxious students in the classroom. Additionally, school-based professionals, such as the school psychologist, occupational therapist, or speech and language therapist, can offer instruction in some anxiety management techniques included below.
Teachers can work with the student to try to identify situations that trigger the student’s anxiety.
They can then brainstorm with the child some proactive ways to adapt the situation and make it less stressful. Unstructured social situations and public speaking are common sources of anxiety.
Does getting up and speaking in front of the class create worry? Allow him to record a presentation for the class rather than present it live, or perhaps he can co-present with a fellow student, or have a peer read his work aloud for him
Does going into the lunchroom and needing to negotiate with whom to sit cause anxiety for the student? Is the environment too loud and over-stimulating? Consider assigning the student to a lunch table with a small group of peers, matching the student up with a lunch or recess buddy, or offering him an alternative setting such as a lunchtime social skills group led by the school’s speech and language pathologist.
Preview schedule changes.
Changes to a child’s daily routine can be upsetting. Forewarn him about the change, and consider putting up the revised schedule on the board—the whole class can benefit from this. An additional visual schedule on the student’s desk may help, too.
For example, a student had a rotating scheduling where every six days she had an additional music class. She worried and was preoccupied all day long that she would forget to go to that class. The teacher helped the student set up an alert on both her cell phone and wristwatch so that she would not have interfering anxiety about accidentally missing the music class.
Warn the student about upcoming transitions and add structure to transitions to help him focus.
During the 5 minutes that classmates are lining up to go to the library, the anxious student can be assigned a task such as pushing in all chairs closer to the table.
If a student is worried about an upcoming special assembly, give him a task such as holding the door and directing people to their seats, to keep him occupied during the transition time.
Prompt the student in advance that you will be calling on him to answer a question.
For example “Billy, I’m going to ask you to tell me who won this Civil War battle, but first, I want to discuss…”
Allow extra time on tests and in-class assignments, and consider reduced homework.
Though many children feel stressed in test-taking situations, children with anxiety disorders may experience impaired working memory, reduced processing speed, and difficulty recalling information during testing situations.
Homework may take an inordinate amount of time for the perfectionist student. Allow the student to do the odd-numbered problems only, or provide short answers rather than complete sentences.
Work with the child to select relaxation strategies that work for him. Relaxation strategies that can be taught and practiced in the school setting include:
- Spelling Your Name with Belly Breaths
- Deep Muscle Relaxation
- Guided Imagery
- Mindfulness and Meditation. There are many child-friendly meditation apps.
- A Calming Box in a designated area of the class. This can include items such as Yoga Cards, therapy ball, clay, stuffed animal, headphones, beanbag.
- Taking a break in a quiet corner of the classroom on a beanbag., or going to another designated area (other classroom, library, nurse’s office, etc.)
- Develop positive self-talk scripts with the student.
Introduce positive scripts to practice during anxiety-provoking situations.
The student may even want the scripts written on index cards to keep in his pocket, or taped to the inside of his notebook or desk.
“I’ve done this before, I can do it this time, too.”
“Just start with the first problem on the worksheet, then go on to the next one.”
“I’m not bad at math, I’m just not good at division yet.”
Help the student develop self-awareness of anxiety.
Some students aren’t even aware that their anxiety is building until they feel overwhelmed. There are tools to help them develop their self-awareness, such as periodically “taking their temperature” with a fear thermometer, which is a visual aid on which they can rate their anxiety levels.
Cue the student to use his strategies.
Teachers are often aware of the building tension even before the student is; the teacher may observe signs such as fist-tightening or jaw-clenching, or maybe the student becomes quieter or less attentive, etc. The teacher can verbalize the anxiety for the student, prompt a strategy, and remind him of past successes. “You look tense now. You can do your deep breathing, then finish the worksheet. That really helped you yesterday.”
Schedule self-calming practice time into their day.
It may help some students to have a brief relaxation skills practice session built into their schedule, during a time they are not feeling anxious. Then, when they need to call upon the skill when they are in fact feeling anxious, they are well-practiced and effective. The self-calming practice can take place in the classroom or out of the classroom in a private but supervised area if needed, such as the school psychologist’s or nurse’s office.
Reward the student’s effort and use of a strategy that helped him stay calm and stay on task.
The reward can be as simple as fun, colorful pens and pencils, or extra time on a preferred task, such as a computer game. If the student is in treatment for anxiety with a private therapist, it may be helpful for the school psychologist to collaborate with the practitioner on the child’s treatment plan, so that there can be continuity of treatment in the school setting.