1. A Teachers guide to dealing with Tourettes Syndrome in the classroom

2. Research Question How can I support a student with Tourettes syndrome in the classroom? HBO video clip on tourettes

3. What is Tourettes Syndrome? Tourettes is a childhood- onset developmental neurological disorder that is characterized by numerous motor and vocal tics. This disorder is often present with symptoms of obsessiveness and/or compulsiveness, anxiety, and behavioral impulsivity. Tourettes can be treated if it causes the child severe social or emotional impairment and pain New tic’s may transpire at any given time and cannot be controlled by the child If a child happens to see another child with a tic he or she might start to develop a similar tic

4. Special Facts Tourette's is six times more common in males than females The developmental progression of Tourette’s follows a similar course: - first present from the ages of 5-7 - tic’s are most severe from ages 12-13 A tic may be present for several months and then disappear overtime A small portion of patients will use inappropriate tics such as uttering obscure words or making vulgar gestures

5. How to identify a child with Tourettes Syndrome Both physical and vocal tics have been present at some time during the course of symptoms Tics are constantly present throughout the day, almost every day or intermittently throughout a period of more than 1 year, and during this period there has never been a tic-free period of more than 3 consecutive months These signs and symptoms have occurred before the age of 18

6. How to address Tourettes Syndrome in the Classroom Prior to discussion communicate with parents Speak to the student before you decide to address the topic to see if he/she is comfortable with answering questions or being present in the room talk to the class as a whole about respect and differences Bring in a specialist who can be present during discussion Create a safe and comforting environment

7. Ways to support a student with Tourettes Syndrome Set clear and consistent limits as increased anxiety with enhance symptoms Daily communication with parents, students and support staff is essential Encourage good work and appropriate school behavior Assign the student a capable peer who will assist him/her Encourage the student to be physically active in addition to PE as this can help to release symptoms Provide the student with a safe place to go when the tics become severe as this can be physically and mentally exhausting for the student Do not suggest that the student suppress his/her tics as this will divert attention away from learning

8. Classroom Modifications Don’t’ require eye contact from student as this can be over stimulating to the visually defensive student and produces academic and behavioral problems Provide student with instructions prior to telling the class Present verbal information slowly and concisely Restate directions so that the student is clear on the task Assign work at appropriate instructional level Provide learning activities so that the student can experience success Break assignments into 10 minute segments

9. Assessment Strategies Test in a low stimuli environment Asses verbally Use a variety of assessment strategies Allow student to extra time Prepare an alternate test that has a lower volume of questions Identify if the student should be on an IEP

10. Treatment Tourette's syndrome is often present with both ADHD and Obsessive compulsive disorder therefore treatment must include working with parents, patient and other support staff medication- serotonin reuptake inhibitors (SRI) Decrease anxiety Self monitoring- have the subject record tics in a small notebook

11. Impact of Neurological Disorder on Learning LearningTS symptoms disrupts learning process. Energy to suppress tics can slow down learning. MemoryPieces of information missing in cognitive file due to TS symptoms interfering with learning by disrupting ability to store information in memory. StrategiesUnderstands strategies, able to use strategies except when TS symptoms interfere with ability to use strategies. SequencingAble to sequence except when TS symptoms cause impulsivity which interferes with the ability to sequence. Problem SolvingAble to problem solve except when TS symptoms interfere with the ability to problem solve. socialSocial interaction affect ignorance of others embarrassment from TS symptoms, teasing, withdrawal.

12. Implications for teaching Parental support Funding Objection to medication use Further questions? What is the likelihood of Tourettes syndrome affecting children after childhood ?

13. Resources http://www.springerlink.com/content/b7n4jkj1h212p077/fulltext.pdf Jackson.M.Gerogina. Biology: Tourette's Syndrome. Volume 16, Issue 12. Pg.R443-R444. (June 2006). The University of Nottingham. Dornbush.P.Marilyn.Teaching the Tiger. (April 1996). Hope press. Leckman.F.James and Cohen.J.Donald. Tic’s, Obsessions and Compulsions: Tourette's Syndrome.(1999).John Wiley and Sons, INC. Tourettes syndrome associated conditions and the complexities of treatment: http//brain.oxfordjournal.org/content/123/3/425.full.pdf+html http://www.bced.gov.bc.ca/speacial_ed_policy_manual.pdf#page=5 Video retrieved from youtube: http://www.youtube.com/watch?v=HPmpIY7XJVE Photos retrieved from google images without permission