cifically 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 management and behavior therapy. Psychopharmacological agents most often prescribed for tics include atypical antipsychotics or antihypertensives. Cognitive behavioral intervention for tics (CBIT) is a structured therapy based on functional analysis. Utilizing the information gathered in the assessment, clinicians help individuals to increase their awareness of tics and urges to tic, develop and implement specific competing responses when an urge to tic is noticed, and make changes to daily routines and activities which may be helpful in reducing tics. To learn more about CBIT and training opportunities to learn CBIT, visit Tourette.org on the web.
Quality resources for schools, families, and communities to raise awareness and provide comprehensive and reliable information about TS and related disorders is fundamental.
The New Jersey Center for Tourette Syndrome and Associated Disorders (NJCTS) (njcts.org), a not-for-profit organization dedicated to the advocacy of children, adolescents, adults and families affected by Tourette Syndrome and its associated disorders, is such a resource. NJCTS provides programs and services to support families, public outreach and awareness campaigns, education for schools and healthcare professionals, and referrals for specialized treatment providers across the state of New Jersey. Additional programming, such as educational webinars, virtual support groups, youth advocacy programs, the NJCTS Tim Howard Leadership Academy, the NJCTS Family Retreat Weekend, and research collaborations also provide impactful means of supporting the TS community. To learn more about TS and resources in New Jersey, visit njcts.org.
Marla W. Deibler, Psy.D.is a Licensed Psychologist and the Executive Director of The Center for Emotional Health of Greater Philadelphia, Cherry Hill & Princeton, NJ