ositional behaviors in the classroom.
● Immature behaviors and social deficits are not uncommon; those with TS are vulnerable to being taunted or bullied by peers.
● Cognitive rigidity, psychological inflexibility, perfectionism, difficulty initiating and/or completing schoolwork, and with transitions are not uncommon in students with TS.
Education is critical to creating a supportive learning environment for students with TS. Teaching the educational team to accurately identify, understand, and appropriately respond to tics and related symptoms is vital to a student’s success in the classroom. For example, if a student has an eye-rolling tic, sighing tic, or echolalia, an educator may misperceive these behaviors as rude or disrespectful and may, in turn, respond by reprimanding, disciplining, or sending the student out of the classroom. This may negatively impact the student psychologically and socially. Moreover, drawing attention to the tics and the tension this may create, has the potential to increase the tics and other related behaviors. If the educator perceives the student as problematic, rather than as having a neurobiological disorder with which he or she struggles, the educator is more likely to unintentionally perpetuate the difficulties in the classroom. Essentially, it is important to understand that the student is not giving the educator a hard time, the student is having a hard time. When the student is not misperceived as intentionally causing a problem, educators are more likely to consider what they can do for a student, rather than to a student, paving the way for supportive, empathic, proactive, and creative strategies which more effectively address the behaviors in the classroom.
Strategies to successfully create a supportive learning environment should be individualized and flexible. Strategies can be varied and many. In addition to accommodations or strategies which may be used to support a student with the commonly co-occurring struggles, a few of the most common and useful strategies specifically targeting tics, include:
● Create a “tic-neutral environment.” That is, ignore tics, whenever possible, and avoid drawing attention to or criticizing the student for tic behavior.
● Educate other students about TS and tics so that they better understand the behaviors and how to most appropriately respond to them.
● Arrange an in-service for educators or a peer presentation on TS via the New Jersey Center for Tourette Syndrome and Associated Disorders.
● Provide access to a space wherein students with TS can calm themselves and release tics, but use caution to avoid sending them to an office that may be perceived as a punishment.
● Give the student a set of passes to use for the day (3-4 minutes per pass, with restrictions) so that he or she may less disruptively engage in bouts of tics.
● Test in a separate location with time limits waived/extended.
● Seat the student with TS in an area where tics will be less noticeable, disruptive, and/or embarrassing.
● Whenever possible, reduce stressful situations.
● Consider conducting a functional analysis of the behavior (or request consultation from the school’s behavior analyst) to generate a targeted plan for a specific problematic tic.
Based on an analysis of the behavior, generating stimulus control strategies (manipulating the environmental cues) and competing response strategies (engaging in alternative behaviors that are incompatible with, or cannot be carried out at the same time as the tic) may be very effective means of decreasing tics. For example, a student who hums during tests and other periods of quiet work may benefit from sitting in the front row where he may be less distracting to other students. Or the student may experience a decreased urge to hum during quiet work, if given the opportunity to chew gum during these times. Or teaching the student to focus on a slow,rhythmic breath, with his lips slightly parted during these quiet periods, may result in a decrease in humming behavior.
Evidence-based treatment for TS includes medication managem