Transcript Title

Tourette Syndrome
(TS)
Dana Barvinchak
“An Overview of Tourette Syndrome for Teachers”
Learner Objectives
Participants who complete this seminar will be able to:

Define symptoms and characteristics of Tourette’s

List positive ways to address behaviors related to
Tourette Syndrome in the classroom

List necessary supports that a student with Tourette’s
may need in the classroom
Glossary

Attention deficit disorder (ADD) – characterized by short
attention span and impulsivity

Attention deficit hyperactivity disorder (ADHD) – similar to
ADD but with a hyperactive component

Co-morbidity – Two or more diagnoses occurring
simultaneously

DSM – IV-TR – Diagnostic and Statistical Manual of Mental
Disorders (4th edition)
 Provides categories and diagnostic criteria for various
disorders or mental health diagnoses
Glossary Continued

“Tic” – involuntary body movements and/or vocalizations

Coproialia – use of obscene words or phrases

Copropraxia – use of unacceptable gestures

Obsessive Compulsive Disorder – characterized by persistent
thoughts or compulsions to perform certain acts…feelings that
you MUST complete a certain routine in a certain way or a set
number of times
Health A to Z (2006). Tourette syndrome. Retrieved September 13, 2007, from
http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/At
oz/ency/tourette_syndrome.jsp
.
History

Gilles de la Tourette was a French neurologist .

Provided the first formal description of Tourette’s Syndrome in
1885
 Defined it as an inherited neurological disorder
characterized by the presence of vocal and motor tics

Prior to this, people with tics were believed to have been
possessed by the devil.
Health A to Z (2006). Tourette syndrome. Retrieved September 13, 2007, from
http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/At
oz/ency/tourette_syndrome.jsp.
Definition
Diagnostic criteria includes:
 presence of multiple motor AND one or more vocal tics
 symptoms occur nearly every day or intermittently for a period
of one year
 impairs functioning
 childhood onset
 symptoms not related to medications or another medical
condition
Bagheri, M.M., Kerbeshian, J., & Burd, L. (1999). Recognition and management of tourette’s syndrome and tic
disorders. America Family Physician. Retrieved September 13, 2007, from
http://www.aafp.org/afp/990415ap/2263.html.
Examples of tics
Simple Tics
Vocal
-Throat clearing
-Sniffing
-Barking
-Coughing
-Yelling
-Hiccupping
-Belching
-Animal sounds
Motor
-Eye blinking
-Sticking tongue out
-Head turning
-Muscle tensing
-Flexing fingers
-Kicking
Complex Tics
Vocal
-Repeating parts of words or
phrases
-Talking to self
-Different intonations
-Obscene word usage
Motor
-Flapping arms
-Facial grimacing
-Adjusting or picking at
clothing
-Jumping
-Shaking feet
-Pinching
-Poking
-Kissing
-Spitting
Bagheri, M.M., Kerbeshian, J., & Burd, L. (1999). Recognition and management of tourette’s syndrome and tic disorders.
American Family Physician. Retrieved September 13, 2007, from http://www.aafp.org/afp/990415ap/2263.html.
Prevalence




Occurs 3 to 4 more times in boys than girls
Affects 1 in 1,000 or .10% of the population of
the United States
Symptoms first noticed in childhood
Occurs in all populations and all ethnic groups
Health A to Z (2006). Tourette syndrome. Retrieved September 13, 2007, from
http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/At
oz/ency/tourette_syndrome.jsp.
How we identify/diagnose the problem

Diagnosis is made through observations and interviews
with the patient and caregiver(s), examination of family
history, and ruling out other secondary causes of tics.
Wikipedia. Tourette syndrome. Retrieved October 31, 2007, from http://en.wikipedia.org/wiki/Tourette_syndrome.
Factors Complicating Diagnosis


People with Tourette’s often present with an extreme range of
symptoms – often misdiagnosed or under-diagnosed
People with Tourette’s may also be diagnosed with or have
symptoms of :
 ADD/ADHD (approx. 50%)
 Anxiety
 Depression
 Learning Disabilities (approx. 25-30%)
 OCD (approx. 25-40%)
 *Examples of co-morbid diagnosis
Bagheri, M.M., Kerbeshian, J., & Burd, L. (1999). Recognition and management of tourette’s syndrome
and tic disorders. American Family Physician. Retrieved September 13, 2007, from
http://www.aafp.org/afp/990415ap/2263.html.
Biological factors

Research has shown a genetic predisposition in relation
to Tourette’s




Specific gene is not known presently
Not everyone that inherits the genetic vulnerability will show
symptoms
Inherited neurological disorder
Neurotransmitter, dopamine, found in excess
Bagheri, M.M., Kerbeshian, J., & Burd, L. (1999). Recognition and management of tourette’s syndrome and tic
disorders. American Family Physician. Retrieved September 13, 2007, from
http://www.aafp.org/afp/990415ap/2263.html.
Family factors


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Parenting style will impact the frequency in
which the tic occurs.
Family support tremendously important!!
Families must also be their child’s advocate.
School factors

Are there school factors that may cause the tic to
intensify?
YES!
Anxiety,
Stress, and Fatigue
School Factors

How should a teacher properly discipline
the behavior?
 DON’T
DO IT!
 Disciplining the behavior is NOT going
to reduce the frequency of the tic!
School Factors

Teasing and bullying occur…tic behavior
increases…teasing and bullying increases –
Vicious cycle!

BREAK THE CYCLE!
How the problem affects school life


Depends on the specific child and his/her specific
strengths and weaknesses
Most children with Tourette’s will need some type of
academic accommodation or necessary support.

Accommodation for visual-motor integration problems–
Assign a buddy as a “note taker” or “homework partner,” allow
extra time for test taking, allow use of a calculator for rote
calculations, etc.

Accommodation for language problems – provide visual input
as well as auditory whenever possible, repeat directions and then
have student repeat them again, when reading give the child a card
with a cut out “window” so that they are only viewing one word at
a time, etc.
How the problem affects school life

Accommodation for attention problems – seat the
child in front of the teacher, seat the child away from
windows and doors, short assignments with frequent
checks, etc.
Knoblauch, B. (1998). Teaching children with tourette syndrome. ERIC Digest. Retrieved September
13, 2007, from http://www.ericdigests.org/1999-4/tourette.htm.
Legal safeguards in
Pennsylvania
Students with Tourette Syndrome would be covered
under Section 504 of the Rehabilitation Act of 1973.
■The school district must provide “necessary supports” for the child to
participate in the educational programs at the school
■Equal access to all extracurricular school programs and activities
*Students with more severe tic behaviors may need further supports through
the use of an Individualized Education Plan.
Education Law Center. A comparison of the rights of a child with a disability who needs “special
education” and a child who is a “protected handicapped student.”
What YOU can do to help
Remember: People with Tourette’s are not all
alike!

Learn
more about how
Tourette’s impacts your
student.
Talk
to the student’s family about positive ways to handle
school stress and what works for the particular student.
What YOU can do to help



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TOLERANCE!
Ignore the tics
Allow the student to have a permanent pass to leave the
classroom as needed so that he/she may “get the tics
out” if/when they become too overwhelming
Provide a private place where the student can go to
relax and/or release tics
Allow things to be completed through a different
medium ---presentations that are videotaped at home if
oral recitation is problematic for the student
What YOU can do to help



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Provide the student with extra time on certain activities
and/or the option to take a test in a different location
Provide a peer education program (with permission
from student and family) to reduce any bullying of
teasing. If this continues, provide additional adult
supervision during the less structured times of the day
Alternatives/reasonable accommodations
MODEL ACCEPTANCE
What to avoid

Losing your patience

Punishing the child for his/her tic
 Punishment will not make the tic go away. You are ultimately
punishing the child for something that he/she cannot control.
Knoblauch, B. (1998). Teaching children with tourette syndrome. ERIC Digest. Retrieved September 13, 2007, from http://www.ericdigests.org/19994/tourette.htm.
Tourette Syndrome “PLUS” (2005). Tips on dealing with tics in the classroom. Retrieved September 13, 2007, from
http://www.schoolbehavior.com/Files/tips_tourette.pdf.
Prognosis


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Approximately 30% of people with Tourette’s will have
a decrease in the frequency and/or severity of the tic.
Approximately 30 to 40% will completely lose all
symptoms during late adolescence.
Majority of those diagnosed with Tourette’s retain full
time employment and pursue higher education
Health A to Z (2006). Tourette syndrome. Retrieved September 13, 2007, from
http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/At
oz/ency/tourette_syndrome.jsp.
Wikipedia. Tourette syndrome. Retrieved October 31, 2007, from
http://en.wikipedia.org/wiki/Tourette_syndrome.
Info for parents


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REMEMBER: You are NOT alone!
Learn about Tourette’s and openly explain the
diagnosis to others involved in the child’s life.
Remember that the behaviors are not intentional
– Punishing the behavior will not make the
behavior go away!
Where you can get more help
http://www.mimh.nih.gov - tells you about federally funded
research projects and findings on Tourette’s
http://www.tsa-usa.org – Tourette Syndrome Association,
Inc. offers many resources (publications, videos, training
sessions, etc. that are aimed at helping students, parents,
families, and especially educators understand Tourette’s as well
as tips to properly handle the symptoms – EXCELLENT
resource
http://www.tourettesyndrome.net – Tourette Syndrome
“PLUS”
Additional Resources

I Have Tourette’s, but Tourette’s Doesn’t Have Me




a documentary that appeared on HBO that focused on children
with Tourette’s as they go about their daily lives
Gives a personal account of what their life is like
Video clip may be seen at http://www.tsausa.org/news/HBO_Release_apr06_update.htm - may also
purchase entire DVD through this site
EXCELLENT resource!!!!
Scenario

Imagine that you are in a room with 20-30 of your peers and you are all
silently reading a passage that you are about to be quizzed on. All of a sudden,
you begin to feel a slight tickle in your throat and you feel that you need to
cough. A few seconds pass and it goes away and you are able to stay on task
to finish the assigned reading. Before you know it, that tickle is back and even
worse this time around. You NEED to cough, to let it out, in the worst way.
Your body naturally and involuntarily responds to the tickle in your throat by
coughing. “NO!” you tell yourself. You are supposed to be paying attention
to the reading. Everyone else is going to be done and ready to move on and
you will still be reading. Then everyone is going to tease you for being a slow
reader. BUT YOU NEED TO COUGH!! The more you think about and tell
yourself to pay attention and finish reading, the worse and more severe the
tickle gets in the back of your throat. You begin to fidget in your seat and tap
your pencil off of your desk. “Don’t do it, don’t cough,” you tell yourself.
The more you tell yourself this the worse the tickle is getting. It is getting
worse….and worse…and worse!!
Scenario


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Did you cough?
Imagine that you did cough and everyone
around you starts to laugh. The teacher sends
you to the principal’s office for coughing in class
AGAIN.
How do you feel now?
Case study
■ I want you to imagine that you are Samantha. How would you
react/feel given this scenario?
■If you were the teacher, what could you have done differently?
What could you do to change the vicious cycle of bullying?
■From what you know, was the school compliant with Section 504
regulations? If not, what should be done?
Contact information



Dana Barvinchak
E-mail – [email protected]
Telephone – 412-480-4924