Creating a Supportive Learning Environment for Students with Tourette Syndrome and Related Disorders
Marla W. Deibler, Psy.D.
Originially published in the Spring 2020 issue of The New Jersey School Psychologist newsletter. Download PDF version.
Tourette Syndrome (TS; also known as Tourette’s Disorder) is a complex disorder which begins in childhood. It is characterized by both sudden, rapid, repetitive movements (motor tics) and vocalizations (vocal tics). In order to meet criteria for TS, individuals must have experienced at least 2 motor tics and at least 1 vocal tic, not necessarily at the same time, over the course of at least one year.
TS is one of three neurobiologically-based conditions referred to as Tic Disorders. Other Tic Disorders include Persistent (Chronic) Motor or Vocal Tic Disorder (motor or vocal tics which persist for at least one year) and Provisional (formerly, Transient) Tic Disorder (motor and/or vocal tics which are present for less than one year). Tics are largely involuntary in nature, although they can sometimes be suppressed for a period of time.
However, suppression typically requires a great deal of effort and is accompanied by increasing distress or sense of tension; this tension may be relieved by performing the tic. Tics are common in youth, occurring in as many as 1 in 5 school-aged children; approximately 1.2% of children meet the criteria for Tic Disorders, and 0.6% of children meet the criteria for TS. TS is more common in males than it is in females. It typically first appears at approximately 4 – 6 years of age, intensifying/peaking between 10 – 12 years of age, and typically diminishing to some degree by late adolescence/early adulthood.
Tics vary widely in appearance, frequency, intensity, and severity; they can be simple (involving one muscle group) or complex (involving multiple muscle groups). Some of the most common simple motor tics are eye blinking, mouth movements, shoulder shrugging, arm or neck movements, and hand or foot tapping. Some of the more complex motor tics 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 