Understanding Tics and a Child with Tourette Syndrome
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 change, and can wax and wane, more so in children than in adults with TS. For example, a student may have a sniffing tic for a time; then, a squealing tic develops, which may be in addition to the sniffing tic, or replace it. Tic frequency and intensity may change depending on the environment: tics may be less frequent and/or less intense early in the day but become more noticeable and disruptive as the day progresses; they may be quieter in one specific class and louder in another; tics may increase prior to lunch and decrease after eating; they may also be worse when the student is tired, angry or stressed. Often, if a person with TS is engrossed in an enjoyable activity, like playing a musical instrument, 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 often described as urges that must be completed. Even when they seem to be expressed in reaction to a current situation, they are not within the control of the student with TS.
- 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 this tic. The added stress to control the tic may increase anxiety and exacerbate 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 to suppress the urge can distract from concentration on the subject at hand.
- Stress can increase Tics. Stress almost always increases tics. Helping the student with TS to avoid classroom stress may include assistance in not calling on the student unless he volunteers or offering testing in a separate location.
SUGGESTED CLASSROOM STRATEGIES
- Ignore tics. Disruption and distraction are subjective judgments – consider the dripping faucet – incredibly distracting to someone, while another person may not even notice it. In the classroom, announcements for teachers become background noise to some, while for others it is impossible to concentrate during an announcement. So many noises during a school day could be considered distracting: coughs, sneezes, overhead airplanes, people in the hall, and more. Usually they don’t succeed in being distracting because we recognize them, and our brain classifies them as background noise. The same can be true of tics. A clearing throat tic becomes background noise when we know that the student can’t help it; we know that it’s an involuntary symptom of a complex neurological disorder. The teacher can role model ‘planned ignoring’.
- 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.
- 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/she generally will put a great deal of energy and focus on suppressing his tics because he/she doesn’t want to cause disruption or embarrassment. This often results in negatively impacting his/her academic performance.
- Using some of the above strategies may alleviate many classroom situations and make tics a routine occurrence in the classroom, rather than a disruption because:
Tics become less disruptive when everyone knows that they are going to occur and why they occur.
- The students learn general tolerance and compassion for differences, understanding that everyone has unique attributes and difficulties.
- The student with TS has reduced anxiety and an increased ability to attend to academics.
- Educate the class about Tourette Syndrome.
MANAGING EXTREME TICS IN CLASS
In some rare instances, tics in the classroom may be frequent and intense. Include a person knowledgeable about TS when conducting a Functional Behavioral Assessment. This will assist the team to determine if there is a pattern and if a positive and proactive support, accommodation and/or modification would reduce tics.
- Use technology – although it’s usually not desirable to exclude the student with TS from his classmates, he can be assigned to a separate room where Skype or other electronic means enable him to participate in his class on a ‘real time’ basis.
- Tutoring in a separate location – may be necessary under extreme situations for as brief a time as possible until the tics become less disruptive. Isolating the child from his peers is the least desirable alternative. 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. 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.
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