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2010-2011 Special Education Paraprofessional Training Series
Supporting Students Who Have
Tourette’s Syndrome
January 25, 2011
Dennis Cullen
PaTTAN
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Pennsylvania Training and Technical Assistance Network
PaTTAN’s Mission
The mission of the Pennsylvania
Training and Technical Assistance
Network (PaTTAN) is to support the
efforts and initiatives of the Bureau of
Special Education, and to build the
capacity of local educational agencies
to serve students who receive special
education services.
PDE’s Commitment to Least Restrictive Environment (LRE)
Our goal for each child is to ensure
Individualized Education Program (IEP)
teams begin with the general
education setting with the use of
Supplementary Aids and Services
before considering a
more restrictive environment.
Local Policy
Your local school district, IU, preschool
or employing agency’s policies regarding
paraprofessional job descriptions, duties,
and responsibilities provide the final
word!
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Learner Outcomes
Participants will
• Develop an understanding of Tourette’s
Syndrome
• Identify symptoms and difficulties associated
with Tourette’s Syndrome
• Discuss specific ways to respond to students
with Tourette’s Syndrome
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Agenda
• Introduction
• What is Tourette’s
Syndrome?
• Tic Disorders and
Their Impact
– MotorTics
– Vocal Tics
•
•
Associated Symptoms/
Strategies for:
– Attention-Deficit
Hyperactivity
– Obsessive Compulsive
Disorder
– Learning Disabilities
Recommendations for
paraprofessionals
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Introduction
• Identified by Gilles de la Tourette in 1885
• First reports of a successful drug treatment
for TS in the early 1960s
• Current estimates – some 200,000 in the U.S.
have the most severe form of TS.
– As many as 1 in 100 exhibit milder symptoms
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What is Tourette’s Syndrome?
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What is Tourette’s Syndrome (TS)
Tourette’s Syndrome is a neurological
disorder characterized by repetitive,
stereotyped, involuntary movements, and
vocalizations called tics.
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What is Tourette’s Syndrome (TS)?
• DSM-IV-TR
A. Motor and vocal tics need to be present, not
necessarily at the same time
B. Tics occur nearly daily throughout one year, no
more than a 3 month tic-free period
C. Tics cause distress or significant impairment in
important areas of functioning
D. Onset before age 18
E. Tics cannot be due to effects of a substance or
general medical condition
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What is Tourette’s Syndrome (TS)
• Precise cause of Tourette’s unknown
• Current research points to abnormalities in
certain brain regions including:
– Basal ganglia
– Frontal lobes
– Cortex
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http://tsa-usa.org/index.html
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Tic Disorders and Their Impact
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Tic Disorders and Their Impact
• What is a tic?
– Sudden, rapid, recurrent, involuntary or semivoluntary movement (motor tic) or vocalization
(vocal tic)
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Motor Tics
• Simple tics are fast, purposeless movements such as
eye-blinking, neck-jerking, shoulder-shrugging, or
facial grimacing
• Complex tics may be slower or consist of
stereotyped movements, may appear to have
purpose, and at some point may be characterized as
a “compulsion”
• Echopraxia – involuntary copying of other’s words or
behaviors
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Vocal Tics
• Simple vocal tics are characterized as meaningless
sounds and noises such as sniffing, throat clearing,
snorting, clicking, screeching and barking
• Complex vocal tics are linguistically meaningful
utterances such as words or phrases
– palilalia - repeating one’s own sounds or words
– echolalia –repeating what someone else has said
– coprolalia - obscene, inappropriate & aggressive
words and statements; it is not very common,
occurring in less than 5% of TS patients
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Impact of Tics
• Tend to “wax and wane” in response to
environmental factors
• May change in frequency, type, and location
over time
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Impact of Tics
• May worsen with:
–
–
–
–
–
Stress
Anxiety
Excitement
Fatigue
Illness
• May worsen during
puberty
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Impact of Tics
• Controlling Tics
– Some can suppress,
camouflage, or
manage tics
– May result in
substantial buildup
in tension
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Associated Disorders
Tourette’s Syndrome
Attention
Deficit
Hyperactivity
Disorder
ObsessiveCompulsive
Disorder
Learning Disabilities
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Associated Disorders
• Obsessive-Compulsive Disorder (OCD)
• Attention Deficit Hyperactivity Disorder (ADHD)
• Learning Disability (LD)
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Obsessive-Compulsive Disorder (OCD)
• Often described as “tics of the mind”
• Children rarely discuss for fear of being
thought of as “crazy”
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Common Obsessions and Compulsions
• Need for
symmetry and
perfectionism
• Neatness
• Counting
• Checking things
repeatedly
• Constant doubt
• Germ obsessions
• Ritualistic
behaviors
• Need for things to
be even
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Attention Deficit/Hyperactivity Disorder
• May be the most problematic aspect of TS
• Characterized by
– Disorganization
– Disruptiveness
– Impulsivity
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Attention Deficit/Hyperactivity Disorder
• Likely to have difficulty with the following:
–
–
–
–
Starting a task
Sequencing information
Organizing materials
Regulating the intensity of their emotional
responses to situations
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Attention Deficit/Hyperactivity Disorder
• Dysregulated arousal system
– “Storms” – uncontrollable rages for what appear
to be absolutely no reason
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Learning Disabilities
• May affect all the basic skills
–
–
–
–
Reading
Writing
Spelling
Math
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Working with Students with Tic
Disorders
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Working with Students with Tic Disorder
• Draw no attention to the tic
• Allow child to leave the classroom to let out
the tics
• Explain to substitutes what might happen in
the classroom
• Adjust academic and behavioral expectations
as necessary
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Working with Students with Tic Disorders
• The student must know that you are “On his
side and not on his back.”
– Provide appropriate support
– Is the “Safety Net”
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Working with Students with Tic Disorders
• Consider the tics as “symptoms of the
disability”
• Inappropriate comments may be a
combination of three common symptoms:
– Social skills deficits
– Difficulty inhibiting mental responses
– Vocal tics
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Working with Students with Tic Disorders
• Don’t take behaviors personally
• Recognize the student’s strengths and talents
• Behavior modification techniques & negative
consequences are not usually effective
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Working with Students with Tic Disorders
• Know when to step back
• Remember the role of the paraprofessional is
to provide educational assistance
• Debriefing sessions at the end of the day
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Working with Students with Tic Disorders
• Symptoms and difficulties vary dramatically
from student to student
• Never generalize one student’s difficulties,
symptoms, or successful strategies
– The only thing consistent about TS is the
inconsistencies.
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Resources
Tourette Syndrome Association, Inc.
http://tsa-usa.org
42-40 Bell Blvd.
Bayside, New York 11361
Information from the National Institute of Neurological
Disorders and Strokes (NINDS)
http://www.ninds.nih.gov/
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Contact Information
www.pattan.net
Dennis Cullen
[email protected]
Phone # 610-265-7321
ext. 7232
Commonwealth of Pennsylvania
Thomas W, Corbett, Governor
Pennsylvania Department of Education
Amy C. Morton, Acting Secretary
John J. Tommasini, Director
Bureau of Special Education
Patricia Hozella, Assistant Director
Bureau of Special Education