cs include knuckle cracking, clapping, holding facial expressions, touching/tapping/hitting, echopraxia (echoing another’s movements) and copropraxia (obscene gestures). Complex motor tics may also appear as multiple motor tics strung together, such as touching the tip of the nose, then touching the tongue, then copropraxia (obscene gestures). Complex motor tics may also appear as multiple motor tics strung together, such as touching the tip of the nose, then touching the tongue, then clenching the fist.
Examples of simple vocal tics include throat-clearing, coughing, sniffing, spitting, barking, yelling, grunting, and humming. Complex vocal tics may present as the repetition of specific words or phrases, changes in speech patterns (rhythm, tone, accent, or intensity), palilalia (repeating oneself), and echolalia (repeating others). Although less common, occurring in approximately 10% of individuals with TS, coprolalia (inappropriate or socially taboo speech) may also occur.
TS is a complex disorder which often co-occurs with other neuropsychiatric disorders; in fact, approximately 86% of those diagnosed with TS have at least one co-occurring condition. Among the most common co-occurring difficulties are Attention Deficit/Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD), Learning Disorders, anxiety, behavioral struggles, sensory sensitivities, social skills deficits, and disturbed sleep.
As accompanied by the aforementioned challenges, some tics may be difficult to distinguish from these co-occurring struggles; thus, for example, tics can be mistaken for impulsive, compulsive, or oppositional behaviors. For this reason, careful assessment and analysis of the observed behavior is essential, if it is to be responded to in a helpful manner.
For example, calling out in class/speaking out of turn, running across a room, jumping in place, fidgeting hand movements or what appears to be an inability to remain in one’s seat in the classroom may be indicative of hyperactivity and/or impulsivity, or these behaviors may be tics (vocal or motor).
Tapping, touching, or repeating a behavior may be related to obsessions and compulsions in the context of OCD, but in the absence of OCD, these behaviors may be more tic-like in nature. Hitting or touching another child, doing something immediately after being asked to stop a behavior or refrain from a behavior, making a sighing noise, rolling one’s eyes, or obscene gestures all have the potential to be interpreted as intentionally oppositional in nature. Or, they may be tics.
Behavioral intervention planning might look very different in these scenarios, based upon the perception of the behavior. So the ability to be effective in behavioral intervention rests on the accurate understanding of the behavior and its function. This is often of particular significance in school or social settings, as not only may the symptoms impact the student, they may also be disruptive or have an otherwise significant impact on others.
Thus, it is vital for educators and school-based service providers to understand TS in order to provide a supportive learning environment in which these students may thrive.
It is important that educators understand:
● Tics can be exhausting, uncomfortable, or even painful.
● The suppression of tics can require a great deal of mental effort and can significantly detract from a student’s availability to attend to learning.
● Tic suppression is not always possible, as tension can build and become unbearable.
● In some cases, students may not be aware of the occurrence of a tic.
● Tics are not intentional and are not “nervous habits.”
● The occurrence of tics can be modulated by emotions or physiological states (e.g., excitement, anxiety, fatigue, hunger, illness).
● Difficulty inhibiting thoughts and behaviors (applying the “mental breaks”)is very common, resulting in what may appear to be impulsive or intentionally defiant behaviors.
● Commonly co-occurring difficulties, such as handwriting and learning difficulties may result in anger, frustration, rage, or opp