What is Tourette’s syndrome?
Tourette’s Syndrome is a complex tic disorder affecting 0.5 to 1.85 per cent of children in school based studies. A tic is defined as an involuntary, rapid, recurrent, non-rhythmic motor or vocal action. The tic is sudden and purposeless and can be divided into simple or complex tics. Simple motor tics are fast and meaningless and can include eye blinking, grimacing and shoulder shrugging. Complex motor tics tend to be slower and may appear purposeful, for example hopping, kissing, touching objects, echopraxia (imitating movements of other people) and copropraxia (obscene gestures). Simple vocal tics include coughing, clearing one’s throat and whistling. Complex vocal tics include repeating certain words or phrases such as “oh boy” or “all right” or repeating a phrase until it sounds “just right”.
Complex vocal tics can also include differences in articulation of speech, including variation in rhythm, tone and rate as well as coprolalia (repetitive use of obscene or socially unacceptable words or phrases). In fact, tics are common and are reported to occur in four to eighteen per cent of children. When there are multiple motor tics and one or more vocal tics this is known as Tourette’s syndrome. To be classed as Tourette’s, the tics must occur many times a day and nearly every day for more than one year, with no period of remission lasting longer than two months.
The exact cause of Tourette’s syndrome is not known, but complex interaction between genetics and brain neurochemistry and structure is believed to be implicated. Theorists have also suggested the involvement of historical infections, perinatal problems and maladaptive learning models.
Though children with Tourette’s exhibit normal intelligence patterns, there is, however, an increased prevalence of Tourette’s in children with learning difficulties or autism. Children with Tourette’s can also suffer from attention deficit disorder, obsessive compulsive disorder, and mood and anxiety disorders
ow can teachers and schools help?
The challenges children with Tourette’s face are best tackled with effective and clear communication between school and home. Psychoeducation, with the help of specialists and SENCOs, can be particularly helpful for individual problems faced by children.
Information on Tourette’s is available from charities and clinical bodies (see below), and SENCOs can put together information packs for teachers. Schools should ensure that individual education plans take full account of a pupil’s Tourette’s. The transition from Year 6 to Year 7 can be particularly challenging and may require additional planning and support.
When there are more pervasive problems with Tourette’s, input from an educational psychologist is appropriate and can be very helpful. Local education authorities can also assist in the consideration of whether a statement of special educational needs should be issued.
Practical classroom support
Specific strategies utilised by experienced teachers are known to be particularly helpful for children with Tourette’s:
seating children with Tourette’s at the front of the classroom. This can enhance attention
the provision of “time-out” passes. Breaks can relieve tension and ensure time for movement
the provision of designated areas where tics are “allowed”. The suppression of tics increases anxiety and sub-optimal educational performance
encouraging teachers to avoid responding to tics. This encourages increased normalisation
breaking down longer assignments into shorter tasks
removing unnecessary objects from desks
permitting students to “fiddle” with specified objects
the use of scribes, rulers, laptops, visual timers, grid paper, calculators, organisers and visual diaries. Such aids can be very supportive
greater emphasis on effort over presentation in written work. This can help relieve anxiety
the use of worksheets that require a minimum of handwriting
pairing students with supportive and understanding “buddies”
work contracts between teachers and student. These can outline particular expectations and provide clearer goals.