Cognitive · Tourette Syndrome

What is it?

Tourette Syndrome (TS) is a neurological disorder characterised by repetitive and involuntary movements and vocalisations or ‘tics’.

What causes it?

The cause is not yet known although differences in the neurotransmitters in the brain have been reported.

Incidence

It is most commonly recognised between the ages of 2 and 21. Tourette’s affects males to females at a rate of 4 or 5:1. Mild symptoms are evident in about 1% of the population.

Medical Considerations

Tics, either simple or complex, are brief, repetitive movements eg. blinking or repetitive throat clearing. Tics can occur over a short or long term and may be mild, moderate or severe. The occurrence and presentation of tics may change over a period of months with one tic seemingly replacing another. Tourette’s can be diagnosed after symptoms have been present for around a year.

Characteristics

While repetitive movements are termed ‘involuntary’, most people with TS have some level of control over symptoms, often just preceding tics. Tics are felt as an increase of tension. They are irresistible and eventually must be performed. Students may display more tics with stress and fewer when absorbed in an enjoyable activity. Tics may be ‘simple’ and include motor or vocal tics such as blinking, jerky movements or grunting. More complex tics may include repetitive limb movements, jumping or biting oneself.

Vocal tics include:

• coprolalia – the involuntary utterance of offensive language
• echoalia – echoing sounds or words just heard
• palilalia – echoing words or sounds the student themselves has just uttered

Tourette Syndrome may occur with comorbid diagnoses such as:

• OCD: repetitive actions, rituals and preoccupations
• ADHD: concentration difficulties, easily distracted, impulsive, self-control issues
• Learning Difficulties: dyslexia, arithmetic difficulties, handwriting problems.
• Psychosocial problems: depression and anxiety.

Support

Some medications may help to suppress symptoms but no medication treats all aspects. Behavioural programs can also be effective. Students may work effectively in the mainstream with only minor accommodations. Understanding the profile of a student with TS will assist in classroom management strategies.

Further Information

Tourette Syndrome Association of Australia

Lesson Preparation & Materials

• Provide explicit instructions and examples to reduce anxiety.
• Adopt a familiar layout to handouts to provide structure and routine.
• Offer materials prior to the lesson so that students can feel more settled by knowing what is expected.
• Incorporate space for students to actively engage with the text eg. highlighting.
• Identify all materials student will need in a lesson rather than leaving them to work it out.
• Create short tasks and offer immediate feedback.
• Use novelty to gain attention.

Teaching Strategies

• Begin each lesson with a review of previous material.
• Teach in a variety of formats, with and without technology.
• Always gain student attention before giving instructions.
• Break assignments and activities into smaller, manageable chunks.
• Maintain the lesson pace and try not to get side-tracked.
• Consider informal assessment or time tasks to coincide with the student’s most productive time of day.
• Incorporate visuals and lists.
• Alternate preferred and non-preferred activities.
• Use low-key cues to signal the student to think about what he/she is doing without drawing unwarranted attention.
• Avoid time restrictions on the achievement of goals if possible. Time pressure may increase stress.
• Provide sensory breaks following listening demands.

Feedback & Assessment

• Students may need separate supervision to reduce distraction.
• Ensure that teachers across the school are familiar with behavioural management to ensure consistency.
• Ensure that casual teachers are notified of the student’s condition prior to relief teaching.
• Discuss strategies with other teachers to achieve consistency across KLAs.
• Refer to the student’s IEP or Behaviour Plan for further information.
• Avoid timed tests.

Classroom Management

• Provide a predictable environment. Give the student advance notice when there will be a change in schedule or routine.
• Watch for behavioural cues that indicate the student may be getting anxious. Track these behaviours to look for patterns.
• Develop private signals to let the student know you will be soon asking them to respond.
• Questions students individually to frequently monitor understanding.
• Try to reduce extraneous classroom noise.
• Provide clear expectations, consistency, structure and routine for the entire class. If rules are broken, remain calm and speak in a neutral, matter-of-fact voice.
• Ensure a quiet space is available for working in small groups. This provides a distraction-free zone.
• Consider preferential seating arrangements.

Peers & SLSOs

• Allocate students to group to prevent exclusion.
• Unstructured times may induce anxiety. Consider additional supervision.
• Consider pairing the student with selected peers during group activities.
• Be aware of peer relationships and provide support when necessary.
• Seat student away from peers if ritualised behaviours may be distracting or embarrassing.

Have I...

• Arranged for special provisions in assessment tasks – separate supervision?

• Considered preferential seating near teacher or peer role model?

• Displayed rules and expectations on classroom noticeboards?

• Established a reward system and method for students to self-monitor progress?

• Incorporated frequent revision activities and study notes?