Tourette Syndrome TS

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Tourette Syndrome (TS)

• Dana Barvinchak
• An Overview of Tourette Syndrome for Teachers

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Learner Objectives

• Participants who complete this seminar will be
  able to
• Define symptoms and characteristics of Tourettes
• List positive ways to address behaviors related
  to Tourette Syndrome in the classroom
• List necessary supports that a student with
  Tourettes may need in the classroom

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Glossary

• Attention deficit disorder (ADD) characterized
  by short attention span and impulsivity
• Attention deficit hyperactivity disorder (ADHD)
  similar to ADD but with a hyperactive component
• Co-morbidity Two or more diagnoses occurring
  simultaneously
• DSM IV-TR Diagnostic and Statistical Manual
  of Mental Disorders (4th edition)
• Provides categories and diagnostic criteria for
  various disorders or mental health diagnoses

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Glossary Continued

• Tic involuntary body movements and/or
  vocalizations
• Coproialia use of obscene words or phrases
• Copropraxia use of unacceptable gestures
• Obsessive Compulsive Disorder characterized by
  persistent thoughts or compulsions to perform
  certain actsfeelings that you MUST complete a
  certain routine in a certain way or a set number
  of times
• Health A to Z (2006). Tourette syndrome.
  Retrieved September 13, 2007, from
  http//www.healthatoz.com/healthatoz/Atoz/common/s
  tandard/transform.jsp?requestURI/healthatoz/Atoz/
  ency/tourette_syndrome.jsp.

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History

• Gilles de la Tourette was a French neurologist .
• Provided the first formal description of
  Tourettes Syndrome in 1885
• Defined it as an inherited neurological disorder
  characterized by the presence of vocal and motor
  tics
• Prior to this, people with tics were believed to
  have been possessed by the devil.
• Health A to Z (2006). Tourette syndrome.
  Retrieved September 13, 2007, from
  http//www.healthatoz.com/healthatoz/Atoz/common/s
  tandard/transform.jsp?requestURI/healthatoz/Atoz/
  ency/tourette_syndrome.jsp.

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Definition

• Diagnostic criteria includes
• presence of multiple motor AND one or more vocal
  tics
• symptoms occur nearly every day or intermittently
  for a period of one year
• impairs functioning
• childhood onset
• symptoms not related to medications or another
  medical condition
• Bagheri, M.M., Kerbeshian, J., Burd, L. (1999).
  Recognition and management of tourettes syndrome
  and tic disorders. America Family Physician.
  Retrieved September 13, 2007, from
  http//www.aafp.org/afp/990415ap/2263.html.

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Examples of tics

• Simple Tics

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• Complex Tics

Bagheri, M.M., Kerbeshian, J., Burd, L.
(1999). Recognition and management of tourettes
syndrome and tic disorders. American Family
Physician. Retrieved September 13, 2007, from
http//www.aafp.org/afp/990415ap/2263.html.
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Prevalence

• Occurs 3 to 4 more times in boys than girls
• Affects 1 in 1,000 or .10 of the population of
  the United States
• Symptoms first noticed in childhood
• Occurs in all populations and all ethnic groups
• Health A to Z (2006). Tourette syndrome.
  Retrieved September 13, 2007, from
  http//www.healthatoz.com/healthatoz/Atoz/common/s
  tandard/transform.jsp?requestURI/healthatoz/Atoz/
  ency/tourette_syndrome.jsp.

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How we identify/diagnose the problem

• Diagnosis is made through observations and
  interviews with the patient and caregiver(s),
  examination of family history, and ruling out
  other secondary causes of tics.

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Factors Complicating Diagnosis

• People with Tourettes often present with an
  extreme range of symptoms often misdiagnosed or
  under-diagnosed
• People with Tourettes may also be diagnosed with
  or have symptoms of
• ADD/ADHD (approx. 50)
• Anxiety
• Depression
• Learning Disabilities (approx. 25-30)
• OCD (approx. 25-40)
• Examples of co-morbid diagnosis
• Bagheri, M.M., Kerbeshian, J., Burd, L. (1999).
  Recognition and management of tourettes syndrome
  and tic disorders. American Family Physician.
  Retrieved September 13, 2007, from
  http//www.aafp.org/afp/990415ap/2263.html.

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Biological factors

• Research has shown a genetic predisposition in
  relation to Tourettes
• Specific gene is not known presently
• Not everyone that inherits the genetic
  vulnerability will show symptoms
• Inherited neurological disorder
• Neurotransmitter, dopamine, found in excess
• Bagheri, M.M., Kerbeshian, J., Burd, L. (1999).
  Recognition and management of tourettes syndrome
  and tic disorders. American Family Physician.
  Retrieved September 13, 2007, from
  http//www.aafp.org/afp/990415ap/2263.html.

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Family factors

• Parenting style will impact the frequency in
  which the tic occurs.
• Family support tremendously important!!
• Families must also be their childs advocate.

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School factors

• Are there school factors that may cause the tic
  to intensify?
• YES!
• Anxiety, Stress, and Fatigue

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School Factors

• How should a teacher properly discipline the
  behavior?
• DONT DO IT!
• Disciplining the behavior is NOT going to reduce
  the frequency of the tic!

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School Factors

• Teasing and bullying occurtic behavior
  increasesteasing and bullying increases
  Vicious cycle!
• BREAK THE CYCLE!

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How the problem affects school life

• Depends on the specific child and his/her
  specific strengths and weaknesses
• Most children with Tourettes will need some type
  of academic accommodation or necessary support.
• Accommodation for visual-motor integration
  problems Assign a buddy as a note taker or
  homework partner, allow extra time for test
  taking, allow use of a calculator for rote
  calculations, etc.
• Accommodation for language problems provide
  visual input as well as auditory whenever
  possible, repeat directions and then have student
  repeat them again, when reading give the child a
  card with a cut out window so that they are
  only viewing one word at a time, etc.

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How the problem affects school life

• Accommodation for attention problems seat the
  child in front of the teacher, seat the child
  away from windows and doors, short assignments
  with frequent checks, etc.
• Knoblauch, B. (1998). Teaching children with
  tourette syndrome. ERIC Digest. Retrieved
  September 13, 2007, from http//www.ericdigests.or
  g/1999-4/tourette.htm.

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Legal safeguards in Pennsylvania

• Students with Tourette Syndrome would be covered
  under Section 504 of the Rehabilitation Act of
  1973.
• The school district must provide necessary
  supports for the child to participate in the
  educational programs at the school
• Equal access to all extracurricular school
  programs and activities
• Students with more severe tic behaviors may need
  further supports through the use of an
  Individualized Education Plan.
• Education Law Center. A comparison of the rights
  of a child with a disability who needs special
  education and a child who is a protected
  handicapped student.

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What YOU can do to help

• Remember People with Tourettes are not all
  alike!
• Learn more about how Tourettes impacts your
  student.
• Talk to the students family about positive ways
  to handle school stress and what works for the
  particular student.

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What YOU can do to help

• TOLERANCE!
• Ignore the tics
• Allow the student to have a permanent pass to
  leave the classroom as needed so that he/she may
  get the tics out if/when they become too
  overwhelming
• Provide a private place where the student can go
  to relax and/or release tics
• Allow things to be completed through a different
  medium ---presentations that are videotaped at
  home if oral recitation is problematic for the
  student

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What YOU can do to help

• Provide the student with extra time on certain
  activities and/or the option to take a test in a
  different location
• Provide a peer education program (with permission
  from student and family) to reduce any bullying
  of teasing. If this continues, provide
  additional adult supervision during the less
  structured times of the day
• Alternatives/reasonable accommodations
• MODEL ACCEPTANCE

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What to avoid

• Losing your patience
• Punishing the child for his/her tic
• Punishment will not make the tic go away. You
  are ultimately punishing the child for something
  that he/she cannot control.
• Knoblauch, B. (1998). Teaching children with
  tourette syndrome. ERIC Digest. Retrieved
  September 13, 2007, from http//www.ericdigests.or
  g/1999-4/tourette.htm.
• Tourette Syndrome PLUS (2005). Tips on dealing
  with tics in the classroom. Retrieved September
  13, 2007, from http//www.schoolbehavior.com/Files
  /tips_tourette.pdf.

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Prognosis

• Approximately 30 of people with Tourettes will
  have a decrease in the frequency and/or severity
  of the tic.
• Approximately 30 to 40 will completely lose all
  symptoms during late adolescence.
• Majority of those diagnosed with Tourettes
  retain full time employment and pursue higher
  education
• Health A to Z (2006). Tourette syndrome.
  Retrieved September 13, 2007, from
  http//www.healthatoz.com/healthatoz/Atoz/common/s
  tandard/transform.jsp?requestURI/healthatoz/Atoz/
  ency/tourette_syndrome.jsp.
• Wikipedia. Tourette syndrome. Retrieved October
  31, 2007, from http//en.wikipedia.org/wiki/Touret
  te_syndrome.

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Info for parents

• REMEMBER You are NOT alone!
• Learn about Tourettes and openly explain the
  diagnosis to others involved in the childs life.
• Remember that the behaviors are not intentional
  Punishing the behavior will not make the behavior
  go away!

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Where you can get more help

• http//www.mimh.nih.gov - tells you about
  federally funded research projects and findings
  on Tourettes
• http//www.tsa-usa.org Tourette Syndrome
  Association, Inc. offers many resources
  (publications, videos, training sessions, etc.
  that are aimed at helping students, parents,
  families, and especially educators understand
  Tourettes as well as tips to properly handle the
  symptoms EXCELLENT resource
• http//www.tourettesyndrome.net Tourette
  Syndrome PLUS

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Additional Resources

• I Have Tourettes, but Tourettes Doesnt Have Me
• a documentary that appeared on HBO that focused
  on children with Tourettes as they go about
  their daily lives
• Gives a personal account of what their life is
  like
• Video clip may be seen at http//www.tsa-usa.org/n
  ews/HBO_Release_apr06_update.htm - may also
  purchase entire DVD through this site
• EXCELLENT resource!!!!

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Scenario

• Imagine that you are in a room with 20-30 of your
  peers and you are all silently reading a passage
  that you are about to be quizzed on. All of a
  sudden, you begin to feel a slight tickle in your
  throat and you feel that you need to cough. A few
  seconds pass and it goes away and you are able to
  stay on task to finish the assigned reading.
  Before you know it, that tickle is back and even
  worse this time around. You NEED to cough, to
  let it out, in the worst way. Your body
  naturally and involuntarily responds to the
  tickle in your throat by coughing. NO! you
  tell yourself. You are supposed to be paying
  attention to the reading. Everyone else is going
  to be done and ready to move on and you will
  still be reading. Then everyone is going to
  tease you for being a slow reader. BUT YOU NEED
  TO COUGH!! The more you think about and tell
  yourself to pay attention and finish reading, the
  worse and more severe the tickle gets in the back
  of your throat. You begin to fidget in your seat
  and tap your pencil off of your desk. Dont do
  it, dont cough, you tell yourself. The more
  you tell yourself this the worse the tickle is
  getting. It is getting worse.and worseand
  worse!!

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Scenario

• Did you cough?
• Imagine that you did cough and everyone around
  you starts to laugh. The teacher sends you to
  the principals office for coughing in class
  AGAIN.
• How do you feel now?

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Case study

• I want you to imagine that you are Samantha.
  How would you react/feel given this scenario?
• If you were the teacher, what could you have
  done differently? What could you do to change
  the vicious cycle of bullying?
• From what you know, was the school compliant
  with Section 504 regulations? If not, what
  should be done?

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Contact information

• Dana Barvinchak
• E-mail dmb0901_at_gmail.com
• Telephone [phone]