Practitioners teaching Practitioners:
Strategies for Teaching Students with Tourette Syndrome

By:
Carolyn Bryant

Submitted to Austin Peay State University
College of Education

Summer 2012
Dr. Moniqueka Gold

An estimated 2% of the population has Tourette syndrome and this disability was added too IDEA in 2004. This syndrome falls under the category listed in IDEA as and other health impairment. Most people mistake Tourette syndrome as a behavioral or emotional condition when actually it is a neurological condition. Students that have Tourette syndrome will not automatically be eligible for related services or special education. There are factors that are looked at, evaluations to be studied, and it depends on whether having Tourette syndrome negatively affects school performance. “Tourette syndrome is a neurobiological disorder characterized by tics (involuntary, rapid, sudden movements) and/or vocal outbursts that occur repeatedly.” (National Dissemination Center for Children with Disabilities, 2009) This syndrome is also inherited and first identified in childhood normally from ages 7 through 10. Tourette syndrome is four times as likely to be diagnosed in boys as in girls. Attention deficit hyperactivity disorder, poor impulse control, behavioral outbursts, and obsessive compulsive disorder also can co-occur with the syndrome, which further complicates the lives of those affected. (Shaw, Woo, & Val, 2007) Normally when people hear the term Tourette syndrome they automatically think about someone swearing randomly. This happens in a small amount of cases of the syndrome. In the majority of the cases with Tourette syndrome people have tics or vocalizations. Tics, are a range of simple movements (e.g., rapid blinking, facial grimacing, shoulder-shrugging) to more complex movements (involving several muscle groups, such as hopping, bending, or twisting); and vocalizations, are a range of simple (throat-clearing, sniffing, grunting) to more complex involving words or phrases. (National Dissemination Center for Children with Disabilities, 2009) Stress or certain triggers can cause these tics to happen. Some students will try to ignore the tics, but then as they are trying to hold it in they are in discomfort and in stress. The best way to help students that have Tourette syndrome is to have an individualized action plan for the student to help reduce tics, reduce the consequences that come with having the tics, and help get rid of the other symptoms of Tourette syndrome. There is not one specific way to help the student with Tourette because there are different needs to be addressed for every individual, but there are a few general strategies that should help the students with Tourette syndrome to be as successful as they can. A student with Tourette syndrome need released free time. It is nearly impossible for students to stop the tics almost as hard as it is to hold in a sneeze. We do not want our students to sit in class all day only focusing on keeping the tics from coming out. A way to help these students is to give them a time where they can go privately to let the tics happen. This strategy will help the student be able get away from their peers to avoid embarrassment. (Shaw et. al, 2007) These students can also use these safe places to go between activities to be able to regroup and calm down, which may reduce the possibly of tics. (Chaturvedi, Gartin & Murdick 2011)
Another option to help students with Tourette syndrome is to exercise regularly. The student should try to do this at home, but the other option could be when the student is in gym or P.E If the teachers knew about it then they could allow the student to run laps or jump rope or do another activity that could help with their Tourette symptoms. (Shaw et. al., 2007) The environment can have a huge effect on a student with Tourette syndrome. Things in the environment like new paint odors, florescent lights, or sugary treats could be triggers. It just depends on the student, so it takes time sometime to identify the triggers. Try to work with parents to figure out the triggers that need to be avoided to reduce triggers. (Shaw et. al., 2007) When it comes to the environment a classroom that is cluttered and that limit the space for the child with TS. Students with TS will need room and space to get their energy out. Also when considering the placement of a student there needs be a consideration of who the student sits by in the classroom. They need to be in proximity of peers who are accepting of differences. (Chaturvedi et. al., 2011) They also are in need a peer buddy be partner to this student and to help the child with Tourette’s to be successful. (Christner & Dieker, 2008) Social skills training can also be a helpful strategy for students with Tourette syndrome. To a large degree, the most obvious symptoms of Tourette are much like those of ADHD. (Shaw et. al., 2007) Along with social skills, students with TS can also benefit from individual or group counseling. Medication is also a big factor for students with TS. It is important for the child’s teachers to report any effects of the medication noticed in school. (Shaw et. al., 2007) Students with Tourette’s syndrome also struggle with starting and finishing activities for class. To help with beginning work without hesitation teachers can create a cue with the student to help give the student to remind them to work on the activity. Assignments, homework and tests can be divided into smaller sections so that they student can be more successful with completing tasks. (Chaturvedi et. al., 2011) With their writing, math, spelling, and language problems there are many strategies that will help these children succeed in these areas. For writing give them more time, allow them to record a report rather than writing, and assign them a note-taking buddy. Their spelling is normally poor so do not penalize them for incorrect spelling, instead focus on proof reading. For math, allow these students to use manipulatives when learning a new concept and a calculator when they are doing rote calculations. When it comes to language issues these students need directions both orally and written out, direction in one or two steps at a time, and when reading they need to only look at one word at a time. (Knoblauch, 1998) Testing should also be done individually for a student with TS, so that they can let their tics happen without the fear of embarrassment. (Knoblauch, 1998) Assistive technology devices can also make a huge impact in the success of a student with Tourette’s within the curriculum. They could use a computer for their writing, have a classroom FM system to amplify the teacher’s voice for the student, and a sensory seat to help with attention issues. (Christner et.al. 2008) Lastly the student may be uncomfortable when answering question posed to the whole class. The teacher and student should come up with a ready signal for the student to show when they are ready to answer the question. Also the teacher can provide any hand-outs or questions prior to teaching the lesson to give the student a chance to think about the material. (Chaturvedi et. al., 2011) According the research out there it has been established that students with Tourette syndrome can be successful in school as long as they have these strategies in place. These strategies can be simple or require some real effort, but they are worth it in the long run. Again it also helps when the teacher is informed. If not then not much can be done for the student. The parents need to notify the school about the diagnosis in order for the plan to be put into place. Also the teacher needs to be willing to work with the student and their parents to come up with the best way to accommodate the student.

Scenario:
TJ is a student in my class with Tourette’s syndrome. Whenever TJ would go to gym class he would get in trouble for his behaviors and removed from the group. The PE teacher only dealt with the situation in class and did not notify the classroom teacher. So TJ would go home and tell his parents about what was happening in gym class. Finally his parents contacted me to have a conference.

What is the solution to this problem?
-Communication
-Safe place to release ticks for this student.
-Positive classroom environment
-Exercise

References:
Chaturvedi, A., Gartin, B., & Murdick, N. (2011). Tourette syndrome: Classroom implications. Physical Disabilities: Education and Related Services, 30(1), 53-66.
Christner, B., & Dieker, L. A. (2008). Tourette syndrome: A collaborative approach focused on empowering students, families and teachers. TEACHING Exceptional Children, 40(5), 44-51. Retrieved from http://ezproxy.lib.apsu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ852658&site=ehost-live&scope=site; http://www.cec.sped.org/Content/NavigationMenu/Publications2/TEACHINGExceptionalChildren/default.htm
Knoblauch, B. (1998). Teaching children with Tourette syndrome. [Teaching Children with Tourette Syndrome], 1.
National Dissemination Center for Children with Disabilities (2009). Tourette Syndrome. Retrieved from http://nichcy.org/disability/specific/ohi-tourette
Shaw, S., Woo, A., & Valo, S. (2007). Tourette's syndrome: A primer for school leaders. Principal Leadership, 7, 12-15.