What do we need to know ? Nydia Guzman Katherine Honadle Jenifer Logan Heidi Zissman

What is it? “Tourette Syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The disorder is named for Dr. Georges Gilles de la Tourette, a French neurologist.” (National Institute of Neurological Disorders, 2006)

Characteristics: * Involuntary motor and vocal movements and sounds, called tics. Difficulty attending to and completing work and social isolation Common motor/vocal tics: eye blinking, head or arm jerking, throat clearing, or sniffing. Tics may become more complex, may appear in facial gestures or movements that imitate others, or completely different tics may appear. Tics may also seem to “disappear” during a brief remission period. Difficulties in emotional regulation, obsessive compulsions, and rituals. Little or no control over the indicators, a ‘’monster within”. Tics, thoughts, and compulsions have a habit of occurring when they are least wanted, and purposely trying to repress them can make the urge become stronger and stronger until a release becomes inevitable.

Types of Tics: Coprolalia: the spontaneous utterance of socially objectionable or taboo words or phrases is the publicized symptom of Tourette’s, but it is not required for a diagnosis of Tourette’s and only about 10% of Tourette’s patient exhibit coprolalia.Echolalia: repeating the words of othersPalilalia: repeating one’s own words

Some Facts About Tourette Syndrome The early symptoms of Tourette syndrome are almost always noticed first in childhood, with the average onset between the ages of 7 and 10 years. Tourette syndrome occurs in people from all ethnic groups. Males are affected about three to four times more often than females (3:1 or 4:1). Their cognitive development is normal. People with Tourette syndrome have average or high average intelligence.

Impact on the Child: Feelings of guilt, shame, and embarrassment. Self-consciousness & low self-esteem. Teasing can lead to feelings of rejection & socially isolation. Severe tics can interfere with learning activities in the classroom. Avoidance of group activities and class participation. The stigma of TS may lead to strained family relationships. Side effects of medications may impact on the learning process. Certain side effects (drooling/tremors) can be the target of ridicule by peers. The child with TS may follow a complex medication regimen. Dangerous drug interactions and poor compliance with complex medication regimens are possible.

Impact on Language Acquisition: Language and communication disorders have not been commonly recognized by clinicians as an associated feature of TS. The time lapse between thought and verbal expression may be attributed to cognitive delay, mutism, extreme shyness, or stuttering, which results in difficulty in a student’s ability to express language. In many languages the order in which words are placed in a sentence will further impact the completion of thoughts. Palilalia, manifested by repetition of the last syllable, word, or phrase directly affects a student’s ability to properly produce sounds and words affecting their ability to communicate effectively. A variety of disabling speech and voice abnormalities effect both first and second language acquisition.

The Impact of Tics on School Performance: Tics can impact learning and performance in different ways. The most commonly reported problems are that eye tics and head/neck tics directly interfere with reading and can be very frustrating for the student. Eye, head/neck, and arm tics also directly interfere with handwritten work for a number of students with tics.

Strategies: Break down student’s assignments into manageable “chunks” or sections. Base homework on student’s rate of task completions, especially if the student requires more time to finish assignments. Use grid paper for writing and mathematics assignments if handwriting is a problem. Provide oral or computerized assignments if the handwriting problem is severe. Provide the student with seating near the teacher’s desk so the student can be quickly and quietly redirected. Minimize distractions in the classroom. Provide student with a workstation in a quiet area if possible. Create a comfortable, daily routine in your classroom. Provide visual aides, written instructions, and demonstrations. Set reasonable time limits for assignments. Avoid “timed” tests. Allow students to test in a quiet area away from others. Avoid stress!!

Educational Needs: All students with TS need a tolerant and compassionate setting that both encourages them to work to their full potential and is flexible enough to accommodate their special needs. (Child Development Institute) Although students with TS often function well in the regular classroom, it is estimated that many may have some kind of learning disability. When attention deficit disorder, obsessive compulsive disorder, and frequent tics greatly interfere with academic performance or social adjustment, students should be placed in an educational setting that meets their individual needs. These students may require tutoring, smaller or special classes, and in some cases special schools.

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