Education and Schools
What is Tourette Syndrome?
Tourette Syndrome (TS) is a paediatric neurological disorder characterised by both motor and vocal tics. It is a genetic disorder and approximately one in a 100 children are born with the TS gene.
However it is very rare for the tics to develop to such a degree that a diagnosis of Tourette’s is made.
Tics are involuntary, repetitive noises and movements. Sometimes the child may not even be aware that he/she is having tics as they are often part of the child’s everyday life.
More than 85 per cent of those diagnosed with Tourette Syndrome will also have a co-morbid mental health disorder like ADHD, OCD or anxiety. In some cases children may also have sensory processing disorders or a learning disability like dyslexia or dyspraxia.
In most instances children with Tourette Syndrome and related comorbidities are of normal intelligence.
Tics in the classroom
Very little is known about Tourette Syndrome in New Zealand and in most instances teachers and schools have never knowingly encountered a student with Tourette’s.
In the past tics have often been misinterpreted as bad behaviour; or a child who has struggled with schoolwork because of the impact of his/her tics, for example illegible handwriting, has been mistakenly thought to have a learning disorder.
What do tics look like?
Much like a fingerprint, each child with Tourette’s will have tics that are unique to them and these can change overnight in frequency, severity and how they present.
The more common motor tics are facial twitches, constant blinking, jaw movements, shoulder shrugging or repetitive movements like tapping a pencil or fidgeting.
Vocal tics can sometimes be harder to differentiate as they can be as simple as a sniff or a cough. These tics may then change over time into stuttering or having to repeat one’s own words or someone else’s.
Please download the attached sheet of the range of tics and the more complex disorders that are related to Tourette’s.
The impact of Tics on learning
Tics will affect each child differently and sometimes it can be hard to differentiate between a tic and an impairment.
In a classroom situation anxiety and stress tend to exacerbate tics and a child with Tourette’s may appear to have problems with speech for example.
This might be a direct result of a stuttering tic or even a tic that requires the person to hold their breath. It may even be embarrassment or anxiety at having to vocalise in front of other people due to feeling ashamed.
If you may notice that a child’s speech issues come and go – this may be the tic waxing and waning; testing a child in another environment may provide very different results depending on the child’s level of anxiety and stress.
Written school work may appear messy as a result of a twitch or of a symptom of another comorbidity like ADHD or OCD.
TS is not a learning disability, but much like vocal implications, the ability to learn in a classroom situation can be compromised by tics or comorbidities.
Other types of tics might involve:
- Movement tics of the eyes that can make reading or concentrating difficult
- Hand tics may cause items such as pens being repeatedly banged down on a desk
- Impulsive traits can manifest as calling out or speaking out of turn in class
- Those with vocal tics like stuttering may also be reluctant to read aloud, ask questions or stand in front of the class.
A child with Tourette Syndrome may try to avoid embarrassment or disturbing those around them by hiding or suppressing their tics. This requires a lot of energy and concentration and as a result the child may miss instructions or not be able to complete their work on time.
Managing TS in school
Older children can sometimes develop successful strategies to disguise their tics, very similar to techniques used in cognitive behavioural therapy. An eye tic may be concealed by looking around the classroom; a vocal tic by coughing or laughing; a twitching tic by moving or by appearing to be ‘messing about’.
Others may manage to suppression their tics for a long period of time however this is often not ideal as when they can no longer control the tics it results in an explosion of sounds and movements -much like holding your breath and the overwhelming messages to breathe. Eventually you need to let go.
Controlling tics in this manner requires a huge amount of concentration and energy.
How you can help
Providing support and awareness of Tourette Syndrome to those interacting with a child with TS can significantly reduce the amount of stress or anxiety on the student.
If the child has the confidence to speak about Tourette Syndrome to their classmates this often results in greater tolerance and understanding and reduces the risk of bullying.
THINGS YOU CAN DO IN THE CLASSROOM:
- Pair students with understanding and supportive ‘buddies’.
- Have open communication between the school and home.
- Try not to ask a student to ‘stop’ or ‘not do’ something. This will become a focus for them and only increase that urge to do that behaviour.
- Try not to respond too much to the tics. Classmates tend to accept and then not even notice the tics. However tics can sometimes be humourous and it would be un-natural not to recognise this.
- Provide time out when the tics are particularly frequent. Allowing the tics to be released will lessen the tension on the child. This may be time away from their desk – often sitting in a beanbag or in a safe zone can help; or a quick time-out from the classroom.
- Giving the child a card, like the Tourette’s Association of New Zealand ID card, to hold up when they feel the need to tic is a great way to reduce their anxiety and allow you to respond – perhaps by giving the child an excuse to leave the classroom like running an errand.
- Do not exclude the child from activities events if their tics put them at-risk. Perhaps designate a job so that they feel included and responsible.
- Plan seating arrangements to minimise disruption to others — at the end of a row and in the back row rather than the front.
- Modify tasks or instructions when possible. Perhaps distribute instructions rather than have the child write out lists.
- If a child has had a particularly stressful day or frequent tics they may be too tired to complete homework. Projects done at home may require an extended timeframe.
- Poor handwriting may be a result of tics. Allowing a student to use a device in the classroom can be beneficial in this situation.
- The stress of exams often triggers tics and severe panic attacks. A Tourette Syndrome child may require a separate room or extra time to complete their tests or exams.
- Inform substitute teachers that the child has Tourette’s as often a change in routine will increase stress and anxiety levels, in turn increasing the need to tic.
Things to keep in mind about Tourette’s
- Neither rewards nor punishment will enable a student to control their tics.
- Children with Tourette Syndrome are not misbehaving when they tic.
- Children with Tourette’s are not the result of bad parenting.
- The onset of puberty and the chemical changes in the brain cause tics to worsen, often until mid-teenage years.
- The transitions between primary, intermediate and high school are particularly difficult times for children with Tourette Syndrome. They may require additional planning and support.