Classroom Strategies and Techniques for Students with Tourette Syndrome

Managing Tics in the Classroom

Knowledge and understanding are key elements to creating an accepting and supportive educational environment. When school personnel have information about Tourette Syndrome (TS), students have greater opportunities for success. This resource, while not all-inclusive, provides strategies that will help you develop compassionate and effective supports.

For Tic Symptoms

• Provide a separate test location with time limits waived or extended.
• Educate other students who come into contact with a classmate with TS. Contact your local chapter to see if a Youth Ambassador is available to provide a peer in-service. If not, a video of a Youth Ambassador presenting to a class is available on the Association website.
• Provide a safe place– Some students benefit from a specific place (as well as a back-up in case this is not available), where a student may release symptoms.
• Give breaks out of the classroom, as it can be helpful to have a change in settings; e.g., the bathroom, the drinking fountain, a real or made up errand.
• Brainstorm possible solutions with the student– if tics are socially inappropriate (spitting, swearing, touching people inappropriately), and unless the child is very young, help the student think of different ways that they can express his or her tic (e.g., a student may suggest or agree to spit into a tissue as a solution).
• In certain instances, students may be receiving specific clinical therapies outside of the school such as Comprehensive Behavioral Intervention for Tics (CBIT) or other types of therapies. Such treatments may require very different classroom approaches. In these cases, the child, family, or practitioner would engage the teacher and school directly.
  Written Language Deficits
  The use of a tablet, computer, and/or scribe is often provided as an accommodation.
• Do not penalize students for poor handwriting. Provide alternatives for doing tests, assignments, etc. (orally, taped, typed, or use of highlighters to “indicate” answers).
• Do not penalize for spelling errors. Encourage the use of spell check.
• Provide a copy of class notes rather than having the student copy from the board or overhead.
• Waive time limits on tests to reduce stress/anxiety.
• Condense or reduce assignments when feasible.
• Verify all homework assignments to make sure they were copied accurately.
• Provide graph paper to help line up math problems or turn paper sideways to calculate “columns” using wide-ruled paper.

For Obsessive Compulsive Symptoms

Obsessions and compulsions can take so many forms that it is difficult to provide general strategies. It is important to first assess the nature of these symptoms. Learning strategies may require a team effort. Brainstorm possible solutions with the student, the family, and/or other professional personnel. Here are some examples. It may take some creativity to come up with the best learning style:

• A student with an obsession to count words in every line can be provided audiobooks.
• A student with a germ obsession can be encouraged to carry a hand sanitizer in his pocket to wash his hands when needed.
• A student who needs to have a perfectly sharpened pencil to write can be given a mechanical pencil.
• A student with writing obsessions who either erases frequently or begins work numerous times can be allowed to use a computer for his work and may help to alleviate the problem.
• A student with organizational difficulties may be helped by using a graphic organizer .
• Anxiety Difficulties & Transition

Many students with TS have sensory issues, and/or OCD symptoms, which can be overwhelming and result in increased stress, anxiety and sometimes anger. Encourage a student’s self-advocacy by establishing a trust with the student that his or her needs will be supported with respect.

• Allow transition time between activities for students with TS.
• Allow the student to leave the classroom two to three minutes early to avoid crowded hallways.
• Have a teacher aide nearby in the cafeteria to prevent confrontations. An alternative eating site with a friend may be ideal.
• Assign a seat in front on the school bus and educate the bus driver.
• Develop and support strategies that diminish anxiety through self-help techniques and seeking environments supportive of these strategies.

ADHD & Executive Deficits

• Offer or provide preferential seating in the classroom; up front on the side may be ideal where the teacher can assist the student to stay on task. The center front may be embarrassing for someone with obvious tics.
• Allow for freedom of movement, such as quick trip to the bathroom or water fountain.
• Provide a quiet place to work in the classroom. A headset with music or semi-permeable earplugs might help block out distractions. Establish a hand gesture or signal as a reminder to re-focus and get back on task or to communicate a need.
• Break down all long range assignments and projects into shorter more manageable parts; for instance, part 1 may be due in two days rather than the entire project in three weeks.
• If possible, assign one assignment at a time rather than several.
• Provide a daily assignment sheet to be filled out by the student and verified by the teacher or another student/partner for accuracy. The parent could then check to make sure that all the work is accomplished.
• Assist with homework prioritizing and management.
• Establish a communication journal between an adult at home and yourself for needs-based strategies.
• Reduce the length of homework assignments whenever possible by eliminating repetitive tasks once a concept is grasped.
  A resource or consultant teacher should be considered, as a part of the team, to assist with workload management and to assist other teachers regarding reasonable expectations for the student. This person teaches life-long strategies for organization and time management.

Occupational Therapy & Sensory Integration Dysfunction

• Many students have particular sensory needs and an individualized sensory plan can be critical to the student’s success. Overstimulation, crowded hallways, cafeteria, school bus, playground and other unstructured settings are frequently areas of difficulty.
• Students with TS often have difficulty transitioning from one activity to another because of sudden and unexpected stimulation of the senses. Loudness, brightness, smells, touch and general sensations can seem amplified to someone with sensory hypersensitivity. Alternatively, hyposensitivity can make a student crave sensory stimulation. A low sensitivity to stimulation could lead to the need for loud and even harsh behavior and physical actions and reactions.
• If you observe that a student reacts intensely (either way) to sensory stimuli, use strategies that help the student to cope in the short term and encourage student participation in a long-term plan with a specialist.
  Successful strategies involve a process to accommodate needs that evolve over time.
• Periodically reassess the current accommodations in place to determine their effectiveness.

Mutual respect, communication and trust will facilitate effective strategies and techniques, as well as play a positive role in the student’s learning.
REMEMBER that students with TS do not want to be out of control and may have difficulty using appropriate strategies “in the moment”.