When educators demonstrate acceptance of differences and provide support for academic success, students with TS will more likely be respected and accepted by their peers. Vocal tics (for example, sniffing, throat-clearing, or yelling out a word or phrase) and multiple motor tics (for example, blinking or shrugging the shoulders) must both be present for a diagnosis of Tourette Syndrome (TS), although they might not always happen at the same time.
Tics can be simple or quite complex. They can include relevant, seemingly purposeful utterances, or be totally inappropriate to the current situation. Coprolalia, a vocal tic that manifests as a curse word or socially inappropriate phrase and Copropraxia, a motor tic that involves obscene gestures, occur in a minority of people with TS.
- Tics wax and wane, may change, and intensity can vary inconsistently from day to day and even moment to moment. Tic frequency and intensity may change depending on the environmental factors. Tics may be less frequent and/or less intense early in the day but become more noticeable and disruptive as the day progresses.
- Stress will almost always increase tics. They may be quieter in one specific class and louder in another. Hunger and thirst can stress the body so tics may increase prior to lunch. They may also be worse when the student is tired, angry or frustrated. Often, if a person with TS is engrossed in an enjoyable activity, like playing a musical instrument or drawing, tics may dissipate or disappear entirely. The only truly consistent nature of TS is the inconsistency.
- Tics may appear to be purposeful. However, tics are neurological in nature. They are physiological urges that need to be completed. Even when they seem to be expressed appropriately in reaction to a current situation, it is important to remember they are not purposeful.
- Tics can be suggestible. Reminding the student not to tic may be counterproductive. For instance, if someone tells you not to blink for the next two minutes, you might be able to resist the urge, but being reminded will make it more difficult. Similarly, reminding a child not to tic will often increase the urge to complete a tic. The added stress to control the tic may increase anxiety exacerbating the urge to tic.
- Suppressing tics can affect academic performance. Just as we are sometimes able to suppress the urge to scratch an itch, students with TS are sometimes able to suppress tics…for a time. However, the mental concentration and energy to suppress the urge can be distracting to academics.
- Stress almost always increases tics. Helping the student with TS to avoid stress may include privately letting a student know when you will call on them. It also may be helpful to offer testing in a separate location with extended time or reduced workload.
Suggested Classroom Strategies
- Ignore tics when possible. Disruption and distraction are subjective judgments. Typically, when people are knowledgeable regarding the source of noise/movement, the amount of distraction is reduced. Consider the dripping faucet which can be incredibly distracting to some, while another person may not even notice it. Similarly, announcements for teachers become background noise to some, while for others it is impossible to concentrate during them. Many noises during a school day could be considered distracting: coughs, sneezes, overhead airplanes, people in the hall, and more. They aren’t distracting because we recognize them, and they become background noise. The same can be true of tics. A clearing throat tic becomes background noise when we recognize it as involuntary symptom of a complex neurological disorder. When teachers model ‘planned ignorance’, bullying is reduced.
- Do not ostracize the child. In the past, students with TS were given permission to leave the room in order to express tics. This may be a helpful accommodation for some students; however, for others it may be perceived as a form of punishment for a symptom the child can’t control. Being asked or encouraged to leave may result in the student perceiving tics as ‘bad’ and may lead shame rather than accepting them as being a small part of who they are and their disability.
- Use accommodations as needed. For some circumstances, like test taking, making a separate location available may help the student to excel academically. When a student with TS is in a quiet classroom with other students for a test or quiz, he generally will put a great deal of energy and focus on suppressing his tics because he doesn’t want to cause disruption or embarrassment. This often results in negatively impacting his academic performance.
- Tics become less disruptive when everyone knows that they are going to occur and why they occur. The students learn tolerance and compassion for differences recognizing that everyone has unique attributes and difficulties.
- Educate the class and school staff about Tourette Syndrome. Contact firstname.lastname@example.org for suggestions and materials.
Managing Extreme Tics In Class
In some rare instances, tics in the classroom may be frequent, intense and truly disruptive or dangerous. Include a person knowledgeable about TS when conducting a Functional Behavioral Assessment and when developing a positive and proactive plan regarding tics.
- Use technology – it’s usually not desirable to exclude the student with TS from his classmates. However, during extreme symptoms, the student may benefit from the availability of a separate room where technology is available to enable him to participate in his class on a ‘real time’ basis.
- Tutoring in a separate location –Again, isolating the child from his peers is the least desirable alternative. This may be necessary under extreme situations for as brief a time as possible until the tics become less disruptive. Also, returning the student to the general education setting after a period of isolation may provoke anxiety and result in the return of increased tics.Depending on the student, it may be more effective to slowly return the student into the general education setting beginning with subjects or times of day when tics are less frequent, and anxiety is at its lowest.
The Following Are Some Key Take-Aways To Keep In Mind:
- Tics are not intentional attempts at gaining attention or to be disruptive.
- Tics are not the student’s fault (or the fault of parents).
- Tics should not be taken personally.
- Tics are not simple habits that can easily be replaced or stopped.
- There is no one-size-fits-all “cure” for tics.
- All children want to be successful.
- Tics can be difficult on others but is most difficult for the student with TS.