Family Learning Center

Tic Disorder (Tourette Syndrome)

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                                                               by Dr. Pamela Cooper, M.A., MBA, PhD.

                                                  Educational Diagnostician

Home & School: How to Help the Child with

Tic Disorder (Tourette Syndrome)

Tic Disorder (Tourette Syndrome is a combination of vocal and motor), a condition characterized by repetitive, uncontrolled movements of muscles occurring in any part of the body and vocalizations known as “tics.” Tourette’s is usually noticed in children between the ages of 5 and 10, with symptoms peaking around 10 to 12 years old (middle school age), three to four times more common among males. Types of tic disorders include motor, vocal, and Tourette’s syndrome. Tourette syndrome (TS) is a neurological disorder that affects the brain and nerves. The exact cause of Tourette syndrome (TS) is unknown. Tic disorder tends to run in families, genes play a role. Problems with how the brain metabolizes (breaks down) neurotransmitters contribute to TS. Neurotransmitters, such as dopamine, are chemicals in the brain that regulate behavior and movement. A child born to a mother who smoked or had health complications during pregnancy may be at a higher risk for TS. Low birth weight may also increase the chances of TS.

Types of Tic Disorder (Tourettes Syndrome):

Motor Tics, movements of the limbs and other body parts: facial grimacing, shouting, shoulder shrugging, a jerk of the head, jumping, kicking of the leg when walking, arm jerking, bending at the waist. eye blinking, head jerking or twisting, knocking things over, dropping things, hopping, jaw movement, twisted or distorted facial expressions. When a child that self-abuse, the tic is harmful.

Vocal Tics: Involuntary repetitive sounds, such as grunting, repeating sounds/words, sniffing, rapid eye blinking, shouting, making snorts sounds, barking, laughing, blurting obscenities, humming, sucking sounds, or clearing the throat. A vocal tic called coprolalia leads to swearing or inappropriate language. This type of tic disorder can make someone seem purposefully disruptive or offensive, even though it is an uncontrollable impulse. A child with coprolalia might receive unwarranted punishment at school or at home.

Combined Type Tic, Tourette Syndrome: cases of tics are temporary and resolve within a year. However, people who experience tics develop a chronic disorder termed as Tourette Syndrome. Chronic tics affects about 1 out of 100.

There is not a blood test or imaging exam that can detect Tourette syndrome. Instead, your healthcare provider carefully reviews your medical history and symptoms. They may ask detailed questions: How often do the tics happen, at what age were the tics noticed, what is the tic (simple or complex). Tourette syndrome is not preventable. Early detection and treatment may prevent TS from worsening or lasting into adulthood. People experiencing Tic disorder feel a sensation just before a tic occurs, called a premonitory urge. When working with the child, discuss the urge so that they recognize their tic warning and are better able to manage the tic, getting to a location that allows for dignity when experiencing the tic episode. Excitement or anxiety makes tics worse. Helping the child to stay calm and ways to avoid stress can help to reduce the frequency.

A child with Tic disorder (Tourette’s Symptoms) usually have other health conditions:

• Anxiety disorder, PTSD
• Attention deficit hyperactivity disorder (ADHD)
• Autism spectrum disorder (ASD)
• Depression
• Learning disabilities
• Obsessive-compulsive disorder (OCD)

Children experiencing Tourette syndrome may be frightened or embarrassed by the disruptive nature of their tics while at school. When Tourette’s is not understood by parents, teachers, school staff and/or other students, the child with Tourette’s may face feelings of rejection or ridicule. At home and school, Ignore the symptoms that can be ignored. This demonstrates acceptance and normalizes Tourette Syndrome and other related symptoms. Modeling acceptance can reduce both bullying and stress and may help the child with TS to focus energy on academics rather than tic suppression.

A child with Tourette’s may be embarrassed, have poor self-esteem, difficulty focusing and paying attention at school if they are thinking about their tics. They experience difficulties making friends and worrying about who may be noticing them. Example: while collaborating with a middle school student constantly receiving in-school suspensions and detention for constantly making noise during class, the child was punished for being defiant, disrespectful. When meeting with the student and the parent, it was discovered that the child was diagnosed with obsessive compulsive disorder and the doctor suspected a tic disorder. After the development of a positive Intervention plan, parents sponsored additional medial testing, tic disorder was diagnosed. The behaviors displayed in the classroom were a direct result of an uncontrollable tic disorder. The parents apologized to the child at our intervention meeting.

When noticing repetitive behaviors, parents are encouraged to see the child’s pediatrician or primary care provider to discuss concerns and to get the child a thorough evaluation. Tourette’s syndrome can impact areas of a child’s life: self-esteem, learning abilities, peer relationships.

Children who have Tourette’s syndrome tend to have higher than average rates of other conditions, such as ADHD, dyslexia, dysgraphia, PTSD, and/or OCD. A thorough evaluation of the child will provide information about exactly how Tourette syndrome and any other conditions the child may have impacted their life. These disorders are hereditary.

Recognize that tics are involuntary movements and sounds that can occur unpredictably. A child with TS will attempt to suppress their tics to avoid negative attention from others. While the tic disorder may appear to be within the child’s control and are being done purposefully, they are not. Once they understand the child’s unique needs, family and school personnel working together can find the right strategies to help manage symptoms. The treating doctor will provide a report with specifics that can be shared with the school to help the child’s teachers understand their individualized needs. Parents can support the classroom teacher by learning more and providing information about Tourette’s syndrome and how it affects the child.

Reduce Stress/Anxiety. Stress typically increases symptoms. Therefore, noting what factors increases stress. While the tics associated with Tourette’s are involuntary, treatment options exist. Vocal tics can be lessened with medication. Getting proper treatment for other conditions such as ADHD, OCD or even depression can help reduce tics. Medications may increase tic disorder. There are behavioral-based approaches that may help reduce tic disorder. Behavioral approaches often look for situations that trigger or increase tics so that the child can find new ways to cope with or avoid tic triggers. Behavioral approaches help a child to identify when they will have a tic episode so that they can move to an area where they will not disturb others or harm themselves.

Parents must keep in regular contact with the child’s school and develop a good relationship with the child’s teacher. Identify the skills deficits that may contribute to increased stress/symptoms at home and school. The child’s physician can prepare recommendations to support the child. Example, reduce the amount of information provided at one time, chunk and reduce the amount of work, stress quality over quantity, frequent breaks, homework only for practice not grade, extended time, providing copies of classroom work as needed, educate and control peer reactions to tics, allow the student to leave the room when a break is required without having to make an announcement, and provide an abundance of positive reinforcements. Consider implementation of a Section 504 plan or Intervention and Referral Service Plan or an Individual Educational Plan (IEP) with coping strategies and modifications.

Consider whether accommodation is needed for handwriting issues, they are among the most common difficulties for children with TS. Accommodation for handwriting can include the use of a computer, tablet, a scribe, or having notes provided.

Be aware of co-occurring conditions, such as obsessive-compulsive disorder (OCD) or Attention Deficit/Hyperactivity Disorder (ADHD), which are very common for children with TS. The characteristics of these conditions are often more problematic and harder to manage than the tics themselves. Discuss concerns with the parent, school nurse or child study team.

Be creative with interventions. Teaching life-long strategies and providing support, accommodations, and modifications are typically more effective than relying on consequences. Remember, tics are involuntary.

Involve the child with TS in developing plans and strategies for managing symptoms that can be difficult or impossible to ignore. Provide the child with a permanent pass to be able to leave the classroom at will when tics increase, i.e., when throat clearing becomes excessive due to increased stress of peer reactions. Promote communication with parents or caregivers. Be sure to share achievements and strengths, not just weaknesses.

Use the Child Study Team Professionals for assistance in developing supports and strategies. Remember, we are a support team working together to help the child: parents, school personnel, physicians, community, and agencies. There is no cure for Tourette syndrome. The condition usually improves in early adulthood. Tics may still occur in adulthood, but most adults do not need to continue medication or therapy. People with Tourette syndrome have a normal life expectancy.

Should an individual with Tic Disorder (Tourettes Syndrome) becomes violent, injures themselves, or talk about suicide, contact the Crisis Lifeline at 988 or Emergency, 911, no matter the age of the individual.

For additional information, contact:

Tourette Association of America

tourette.org

Service: Local support for children, families and adults with Tourette Syndrome and other Tic Disorders.