Tourette Syndrome (TS) is a neuropsychiatric disorder characterized by the presence of both motor and verbal tics (American Psychiatric Association, 2000). While many disabilities can either be noted shortly after birth—Down Syndrome, blindness, etc.—or as soon as the child is put into a rigid school environment— attention deficit hyperactivity disorder (ADHD), specific learning disability, etc.—TS does not manifest itself until the ages of 5 to 10 (Felling & Singer, 2011). This can cause confusion between the child and his/her parents when the tics start to manifest themselves. TS is a disorder that does not affect an individual's IQ, but can affect a student’s ability to read, concentrate, and play hide-and-go-seek. To better understand TS and how to help educate those who suffer with it, we will address some of the specifics of the disorder, including tics, co-existing disorders, treatments, known-causes, national occurrence rates, as well as some effective teaching strategies and expectations for difficult transition periods.
The hallmark of TS is the presence of chronic, fluctuating motor and vocal tics. (Rauch, Baer, Cosgrove, & Jenike, 1995). Tics are sudden, repetitive, involuntary movements or vocalizations with differing degrees of intensity and frequency. Simpler physical tics include eye blinking, head jerking, facial grimacing, and/or shoulder shrugging. Simple verbal tics encompass sounds or noises such as throat clearing, sniffing, or grunting (Felling & Singer, 2011). Because TS is a spectrum disorder, there are some people who have very involved and frequent tics, which may include swearing. For example, in the movie Phoebe in Wonderland, Phoebe, an elementary age girl with TS, is pulled into her principal's office for calling her teacher a ‘faggot’ and repeatedly mocking words spoken by the teacher (2008). These are involuntary.
The National Institute of Neurological Disorders and Strokes (NINDS) presents a TS fact sheet that helps us understand what to expect in addition to tics. Children with TS often have a variety of co-existing disorders that can create more problems in life than the tics themselves. These include ADHD, obsessive–compulsive disorder (OCD), learning difficulties, sleep abnormalities, anxiety, etc.
After a child is diagnosed with TS, parents often turn to treatment options. Although there are no cure-all for TS, there are a number of available therapies and treatments that have been explored in the medical, neuroscience, and psychological field. In the official journal of the Society for Neuroscience, Rauch et al. (1995) highlight that operations have been used to treat TS, though research on such treatment is currently limited, and the potential costs and benefits are still unsure.
Another treatment that has been considered is a behavioral treatment called Habit Reversal Training (HRT) used in the field of psychology. Reese, Timpano, Siev, Rowley, and Wilhelm (2012) described this training as a “multicomponent, short-term, behavioral intervention” (p. 19). This treatment focuses on function-based assessment and treatment strategies.
TS has a genetic basis, which implies that individuals with blood related relatives who have TS are more likely to develop the disorder. Current research, from NINDS, points to abnormalities in certain regions of the brain that have interconnected circuits. “Given the often complex presentation of TS, the cause of the disorder is…equally complex” (2012 para. 7).
National Occurrence Rate
Felling and Singer (2011) explain that tics are common in childhood. Epidemiological studies show that “about 20-30% of children exhibit brief, repetitive, involuntary movements or sounds in a classroom setting” (p. 12389). TS has a spectrum of severity, so it is not likely for all of those children to be diagnosed. NINDS estimates about 200,000 Americans have the most severe form of TS. However, those with TS have hope that their symptoms become minimized as they enter into adulthood: “Although TS can be a chronic condition with symptoms lasting a lifetime, most people with the condition experience their worst tic symptoms in their early teens, with improvement occurring in the late teens and continuing into adulthood” (NINDS, 2012, para. 2).
Research-based Teaching Strategies
Students with TS often function well in the regular classroom, but ADHD, learning disabilities, obsessive-compulsive symptoms, and frequent tics can interfere with academic performance and/or social adjustment. Brad Cohen, subject of the film Front of the Class, explained his tics were an itch or a sneeze that he cannot stop altogether even if he wanted to. He explains that he has tics the least when he feels accepted and comfortable (Barnz, 2008). This is one of the best teaching strategies someone can implement in the classroom for a student who has TS. When there is uniform acceptance from the teachers, paraeducators, and classmates the student can focus on learning.
Acceptance is a good first step, but there may need to be more physical strategies to help teach students with TS. Students may require tutoring and smaller or special classes to accommodate their needs. This setting may include a private study area, exams outside the regular classroom, or even oral exams when the child's symptoms interfere with his or her ability to write. (NINDS, 2012, para. 21-22). These strategies are considerate of how comfortable the student is, the noise of their tics in a regular education classroom, and the physical inabilities of some TS students.
Another accommodation is untimed tests to reduce stress for students with TS. In Front of the Class, Brad Cohen was given a room to himself for a standardized licensure test. Though this accommodation was made for him, he was unable to finish in time because of the stress of a timed test (2008). When teaching students with TS, assisted reading and writing—especially on tests—will help the students demonstrate their true spectrum of knowledge on any subject.
Because the behaviors/tics usually do not manifest themselves until later in childhood, there can be great confusion between the child and his/her parents when the tics first appear. As demonstrated in both movies, The Front of the Class (2008) and Phoebe in Wonderland (2008), both the child and the parent must go through a transition period of understanding and acceptance when the tics are first acknowledged.
There is another major transition period in the life of a student who has TS—high school to adulthood (Kochhar-Bryant,& Greene, 2008, pg 3). The best transition service one can have is self-advocacy. It becomes most difficult when students must mange finding a job, creating and maintaining relationships, and begin managing their own health and public affairs (Felling and Singer, 2011). The best way to cope with TS in any social situation is for students to be open about their disability. Brad Cohen encouraging phrase was, “I have Tourette, Tourette doesn’t have me” (Barnz, 2008). This outlook on TS will position blossoming students to advocate for themselves in this world of opportunities.
Brad Cohen’s aspirations to be a schoolteacher were halted time and time again because of his Tourette. But when there is established understanding and acceptance there is no reason to students and adults cannot live fulfilling life (Barnz, 2008). To better understand TS refer to the references below.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
Barnz, D. (Director). (2008). Phoebe in Wonderland [Motion picture]. USA: Distributed by Image Entertainment.
Felling, R. J., and Singer, H. S. (2011) Neurobiology of Tourette syndrome: Current status and need for further investigation. Journal of Neuroscience, 31(35), 12387-12395. Retrieved February 22, 2013 from www.jneurosci.org/content/31/35/12387.full#sec-2.
Kochhar-Bryant, C. A., & Greene, G. (2008). Pathways to successful transition for youth with disabilities, a developmental process. New Jersey: Prentice Hall.
Rauch, S. L., Baer, L., Cosgrove, G. R., and Jenike, M. A. (1995). Neurosurgical treatment of tourette syndrome: A critical review. Comprehensive Psychiatry, 32(2) 141-156. Retrieved February 20, 2013 from www.sciencedirect.com/science/article/pii/S0010440X95901094.
Reese, H. E., Timpano K. R., Siev, J., Rowley, T., Wilhelm, S. Behavior therapy for tourette syndrome and chronic tic disorder: A web-based video illustration of treatment components. Cognitive and Behavioral Practice, 17(1), 16-24. Retrieved February 20, 2013 from www.sciencedirect.com/science/article/pii/S1077722909001023.
National institute of neurological disorders and stroke (NINDS): Tourette syndrome fact sheet. (2012, October 19). National Institute of Health. Retrieved February 18, 2013, from www.ninds.nih.gov/disorders/tourette.
Werner, P. (Director). (2008). Front of the class [Motion Picture]. USA: Kansas City: Hallmark Hall of Fame.
National Tourette Syndrome Association http://www.tsa-usa.org/ International and National information available on this site.
Tourette syndrome - Mayo Clinic https://www.mayoclinic.org/.../tourette-syndrome/.../syc-20350465 Mayo Clinic Aug 10, 2012 - Signs and symptoms of Tourette syndrome