Teaching Children With Tourette Syndrome

Tourette Syndrome (TS) is a neurological disorder characterized by repeated, involuntary body movements (tics) such as blinking, twitching, shoulder shrugging, or leg jerking and vocal sounds such as throat clearing or sniffing. Symptoms typically appear before the age of 18 and the condition occurs in all ethnic groups with males affected 3 to 4 times more often than females.

Associated conditions can include obsessivity, attentional problems, and impulsiveness. Since many people with TS have yet to be diagnosed, there are no absolute figures, but the official estimate by the National Institutes of Health is that 100,000 Americans have full-blown TS. Symptoms include: 

• Multiple motor and one or more vocal tics at some time during the illness, although not necessarily simultaneously
• The occurrence of tics many times a day (usually in bouts) nearly every day or intermittently throughout a span of more than one year
• Periodic changes in the number, frequency, type, location, and severity of the tics; for example, symptoms may disappear for weeks or months at a time
• Onset before the age of 18. Associated Behaviors Additional problems may include:
• Obsessions, which consist of repetitive unwanted or bothersome thoughts
• Compulsions and ritualistic behaviors. Examples include touching an object with one hand after touching it with the other hand to "even things up," repeatedly checking to see that the flame on the stove is turned off, or repeating a sentence many times until it "sounds right."
• Attention Deficit Disorder (ADD) with or without Hyperactivity (or ADHD). Indications of ADHD may include:
• difficulty with concentration; failing to finish what is started not listening; being easily distracted; often acting before thinking; shifting constantly from one activity to another; needing a great deal of supervision; and general fidgeting. ADD without hyperactivity includes all of the above symptoms except for the high level of activity.
• Learning disabilities, including reading and writing difficulties, arithmetic disorders, and perceptual problems.
• Difficulties with impulse control, which may occasionally result in overly aggressive behaviors or socially inappropriate acts. Defiant and angry behaviors can also occur.

In many cases, medication can help control the symptoms, but there may be side effects, some of which interfere with cognitive processes. Stimulants such as Ritalin, Cylert, and Dexedrine that are prescribed for ADHD may increase tics, and their use is controversial. Other types of therapy may also be helpful, including psychotherapy, behavior modification therapy that can teach the substitution of one tic for another that is more acceptable, and the use of relaxation techniques, biofeedback, and excercise to reduce the stress that often exacerbates tics.

Establishing the Proper Learning Environment

While school children with TS as a group have the same IQ range as the general population, many may have some kind of learning problem. That condition, combined with attention deficits and the problems of dealing with frequent tics, often call for special educational assistance. The use of tape recorders, typewriters, or computers for reading and writing problems, untimed exams (in a private room if vocal tics are a problem), and permission to leave the classroom when tics become overwhelming are often helpful.