Tourette Syndrome An Overview of Tourette Syndrome for Teachers.
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Transcript of Tourette Syndrome An Overview of Tourette Syndrome for Teachers.
Tourette Tourette SyndromeSyndrome
An Overview of Tourette Syndrome for An Overview of Tourette Syndrome for TeachersTeachers
Learner ObjectivesLearner Objectives
Participants who complete this seminar will Participants who complete this seminar will be able to:be able to:
Define symptoms and characteristics of Define symptoms and characteristics of Tourette’sTourette’s
List positive ways to address behaviors List positive ways to address behaviors related to Tourette Syndrome in the related to Tourette Syndrome in the classroomclassroom
List necessary supports that a student List necessary supports that a student with Tourette’s may need in the classroomwith Tourette’s may need in the classroom
GlossaryGlossary ““Tic”Tic” –– involuntaryinvoluntary body movements and/or body movements and/or
vocalizationsvocalizations
CoproialiaCoproialia – use of obscene words or phrases – use of obscene words or phrases
CopropraxiaCopropraxia – use of unacceptable gestures – use of unacceptable gestures
HistoryHistory Gilles de la Tourette was a French neurologist .Gilles de la Tourette was a French neurologist .
Provided the first formal description of Provided the first formal description of Tourette’s Syndrome in 1885Tourette’s Syndrome in 1885
Defined it as an inherited neurological Defined it as an inherited neurological disorder characterized by the presence of disorder characterized by the presence of vocal and motor ticsvocal and motor tics
Prior to this, people with tics were believed to Prior to this, people with tics were believed to have been possessed by the devil.have been possessed by the devil.
DefinitionDefinition
Diagnostic criteria includes:Diagnostic criteria includes: presence of multiple motor AND one or more presence of multiple motor AND one or more
vocal ticsvocal tics symptoms occur nearly every day or symptoms occur nearly every day or
intermittently for a period of one yearintermittently for a period of one year impairs functioningimpairs functioning childhood onsetchildhood onset symptoms not related to medications or another symptoms not related to medications or another
medical conditionmedical condition
Examples of ticsExamples of tics
Simple TicsSimple Tics
VocalVocal-Throat clearing-Throat clearing
-Sniffing-Sniffing
-Barking-Barking
-Coughing-Coughing
-Yelling-Yelling
-Hiccupping-Hiccupping
-Belching-Belching
-Animal sounds-Animal sounds
MotorMotor-Eye blinking-Eye blinking
-Sticking tongue out-Sticking tongue out
-Head turning-Head turning
-Muscle tensing-Muscle tensing
-Flexing fingers-Flexing fingers
-Kicking-Kicking
Complex TicsComplex Tics
Vocal Vocal -Repeating parts of -Repeating parts of words or phraseswords or phrases
-Talking to self-Talking to self
-Different intonations-Different intonations
-Obscene word usage-Obscene word usage
Motor Motor -Flapping arms-Flapping arms
-Facial grimacing-Facial grimacing
-Adjusting or picking -Adjusting or picking at clothingat clothing
-Jumping-Jumping
-Shaking feet-Shaking feet
-Pinching-Pinching
-Poking-Poking
-Kissing-Kissing
-Spitting-Spitting
PrevalencePrevalence
Occurs 3 to 4 more times in boys Occurs 3 to 4 more times in boys than girls than girls
Affects 1 in 1,000 or .10% of the Affects 1 in 1,000 or .10% of the population of the United Statespopulation of the United States
Symptoms first noticed in childhoodSymptoms first noticed in childhood Occurs in all populations and all Occurs in all populations and all
ethnic groupsethnic groups
How is Tourette’s diagnosed?How is Tourette’s diagnosed?
Diagnosis is made through observations Diagnosis is made through observations and interviews with the patient and and interviews with the patient and caregiver(s), examination of family caregiver(s), examination of family history, and ruling out other secondary history, and ruling out other secondary causes of tics.causes of tics.
Factors Complicating Factors Complicating DiagnosisDiagnosis People with Tourette’s often present with an People with Tourette’s often present with an
extreme range of symptoms – often misdiagnosed extreme range of symptoms – often misdiagnosed or under-diagnosedor under-diagnosed
People with Tourette’s may also be diagnosed People with Tourette’s may also be diagnosed with or have symptoms of :with or have symptoms of :
ADD/ADHD (approx. 50%)ADD/ADHD (approx. 50%) AnxietyAnxiety DepressionDepression Learning Disabilities (approx. 25-30%)Learning Disabilities (approx. 25-30%) OCD (approx. 25-40%)OCD (approx. 25-40%)
Biological factorsBiological factors
Inherited neurological disorderInherited neurological disorder Not everyone that inherits the genetic vulnerability will Not everyone that inherits the genetic vulnerability will
show symptomsshow symptoms
Neurotransmitter, dopamine, found in Neurotransmitter, dopamine, found in excessexcess
Family factorsFamily factors
Parenting style will impact the Parenting style will impact the frequency in which the tic occurs.frequency in which the tic occurs.
Family support tremendously Family support tremendously important!important!
Families must also be their child’s Families must also be their child’s advocate.advocate.
School factorsSchool factors
Are there school factors that may Are there school factors that may cause the tic to intensify?cause the tic to intensify?
YES!YES!Anxiety, Stress, and FatigueAnxiety, Stress, and Fatigue
School FactorsSchool Factors
How should a teacher properly How should a teacher properly discipline the behavior?discipline the behavior?
DON’T DO IT!DON’T DO IT!Disciplining the behavior is Disciplining the behavior is NOT going to reduce the NOT going to reduce the frequency of the tic!frequency of the tic!
School FactorsSchool Factors
Teasing and bullying occur…tic Teasing and bullying occur…tic behavior increases…teasing and behavior increases…teasing and bullying increases – Vicious cycle!bullying increases – Vicious cycle!
BREAK THE CYCLE!BREAK THE CYCLE!
How the problem affects How the problem affects school lifeschool life
Depends on the specific child and his/her Depends on the specific child and his/her specific strengths and weaknessesspecific strengths and weaknesses
Most children with Tourette’s will need some Most children with Tourette’s will need some type of academic accommodation or type of academic accommodation or necessary support.necessary support.
Accommodation for visual-motor integration Accommodation for visual-motor integration problemsproblems– Assign a buddy as a “note taker” or – Assign a buddy as a “note taker” or “homework partner,” allow extra time for test taking, “homework partner,” allow extra time for test taking, allow use of a calculator for rote calculations, etc.allow use of a calculator for rote calculations, etc.
Accommodation for language problemsAccommodation for language problems – provide – provide visual input as well as auditory whenever possible, visual input as well as auditory whenever possible, repeat directions and then have student repeat them repeat directions and then have student repeat them again, when reading give the child a card with a cut out again, when reading give the child a card with a cut out “window” so that they are only viewing one word at a “window” so that they are only viewing one word at a time, etc.time, etc.
How the problem affects How the problem affects school lifeschool life
Accommodation for attention problemsAccommodation for attention problems – seat the child in front of the teacher, seat – seat the child in front of the teacher, seat the child away from windows and doors, the child away from windows and doors, short assignments with frequent checks, short assignments with frequent checks, etc.etc.
Additional Additional AccommodationAccommodation
Students with more severe tic Students with more severe tic behaviors may need further behaviors may need further support through the use of an support through the use of an Individualized Education Plan.Individualized Education Plan.
What YOU can do to What YOU can do to helphelp
Remember: People with Tourette’s Remember: People with Tourette’s are not all alike!are not all alike!
Learn more about how Learn more about how Tourette’s impacts your Tourette’s impacts your student.student.
Talk to the student’s family about positive Talk to the student’s family about positive ways to handle school stress and what works ways to handle school stress and what works for the particular student.for the particular student.
What YOU can do to helpWhat YOU can do to help TOLERANCE!TOLERANCE! Ignore the ticsIgnore the tics Allow the student to have a permanent pass to Allow the student to have a permanent pass to
leave the classroom as needed so that he/she leave the classroom as needed so that he/she may “get the tics out” if/when they become may “get the tics out” if/when they become too overwhelmingtoo overwhelming
Provide a private place where the student can Provide a private place where the student can go to relax and/or release ticsgo to relax and/or release tics
Allow things to be completed through a Allow things to be completed through a different medium ---presentations that are different medium ---presentations that are videotaped at home if oral recitation is videotaped at home if oral recitation is problematic for the studentproblematic for the student
What YOU can do to helpWhat YOU can do to help
Provide the student with extra time on certain Provide the student with extra time on certain activities and/or the option to take a test in a activities and/or the option to take a test in a different locationdifferent location
Provide a peer education program (with Provide a peer education program (with permission from student and family) to reduce permission from student and family) to reduce any bullying of teasing. If this continues, any bullying of teasing. If this continues, provide additional adult supervision during provide additional adult supervision during the less structured times of the daythe less structured times of the day
Alternatives/reasonable accommodationsAlternatives/reasonable accommodations MODEL ACCEPTANCEMODEL ACCEPTANCE
What to avoidWhat to avoid Losing your patienceLosing your patience
Punishing the child for his/her ticPunishing the child for his/her ticPunishment will not make the tic Punishment will not make the tic go away. You are ultimately go away. You are ultimately punishing the child for punishing the child for something that he/she cannot something that he/she cannot control.control.
PrognosisPrognosis Approximately 30% of people with Approximately 30% of people with
Tourette’s will have a decrease in the Tourette’s will have a decrease in the frequency and/or severity of the tic.frequency and/or severity of the tic.
Approximately 30 to 40% will completely Approximately 30 to 40% will completely lose all symptoms during late lose all symptoms during late adolescence.adolescence.
Majority of those diagnosed with Majority of those diagnosed with Tourette’s retain full time employment Tourette’s retain full time employment and pursue higher educationand pursue higher education
Where you can get Where you can get more helpmore helphttp://tourette.ca is the only national voluntary non-profit is the only national voluntary non-profit
organization in Canada assisting individuals affected by Tourette organization in Canada assisting individuals affected by Tourette Syndrome (TS) and its associated disorders.Syndrome (TS) and its associated disorders.
http://www.mimh.nih.gov - tells you about (US) federally funded http://www.mimh.nih.gov - tells you about (US) federally funded research projects and findings on Tourette’sresearch projects and findings on Tourette’s
http://www.tsa-usa.org – Tourette Syndrome Association, Inc. offers – Tourette Syndrome Association, Inc. offers many resources (publications, videos, training sessions, etc. that are many resources (publications, videos, training sessions, etc. that are aimed at helping students, parents, families, and especially aimed at helping students, parents, families, and especially educators understand Tourette’s as well as tips to properly handle educators understand Tourette’s as well as tips to properly handle the symptoms – EXCELLENT resourcethe symptoms – EXCELLENT resource
http://www.tourettesyndrome.net – Tourette Syndrome “PLUS” – Tourette Syndrome “PLUS”
Additional ResourcesAdditional Resources
I Have Tourette’s, but Tourette’s Doesn’t I Have Tourette’s, but Tourette’s Doesn’t Have MeHave Me a documentary that appeared on HBO that a documentary that appeared on HBO that
focused on children with Tourette’s as they go focused on children with Tourette’s as they go about their daily livesabout their daily lives
Gives a personal account of what their life is likeGives a personal account of what their life is like Video clip may be seen at Video clip may be seen at http://www.tsa-usa.org/news/HBO_Release_apr06_update.htm
- may also purchase entire DVD through this site- may also purchase entire DVD through this site EXCELLENT resource!!!!EXCELLENT resource!!!!
ScenarioScenario Imagine that you are in a room with 20-30 of your peers and Imagine that you are in a room with 20-30 of your peers and
you are all silently reading a passage that you are about to be you are all silently reading a passage that you are about to be quizzed on. All of a sudden, you begin to feel a slight tickle in quizzed on. All of a sudden, you begin to feel a slight tickle in your throat and you feel that you need to cough. A few seconds your throat and you feel that you need to cough. A few seconds pass and it goes away and you are able to stay on task to finish pass and it goes away and you are able to stay on task to finish the assigned reading. Before you know it, that tickle is back the assigned reading. Before you know it, that tickle is back and even worse this time around. You NEED to cough, to let it and even worse this time around. You NEED to cough, to let it out, in the worst way. Your body naturally and involuntarily out, in the worst way. Your body naturally and involuntarily responds to the tickle in your throat by coughing. “NO!” you responds to the tickle in your throat by coughing. “NO!” you tell yourself. You are supposed to be paying attention to the tell yourself. You are supposed to be paying attention to the reading. Everyone else is going to be done and ready to move reading. Everyone else is going to be done and ready to move on and you will still be reading. Then everyone is going to on and you will still be reading. Then everyone is going to tease you for being a slow reader. BUT YOU NEED TO tease you for being a slow reader. BUT YOU NEED TO COUGH!! The more you think about and tell yourself to pay COUGH!! The more you think about and tell yourself to pay attention and finish reading, the worse and more severe the attention and finish reading, the worse and more severe the tickle gets in the back of your throat. You begin to fidget in tickle gets in the back of your throat. You begin to fidget in your seat and tap your pencil off of your desk. “Don’t do it, your seat and tap your pencil off of your desk. “Don’t do it, don’t cough,” you tell yourself. The more you tell yourself this don’t cough,” you tell yourself. The more you tell yourself this the worse the tickle is getting. It is getting worse….and the worse the tickle is getting. It is getting worse….and worse…and worse!!worse…and worse!!
ScenarioScenario
Did you cough?Did you cough? Imagine that you did cough and Imagine that you did cough and
everyone around you starts to laugh. everyone around you starts to laugh. The teacher sends you to the The teacher sends you to the principal’s office for coughing in principal’s office for coughing in class AGAIN.class AGAIN.
How do you feel now?How do you feel now?
Case studyCase study■ ■ I want you to imagine that you are Samantha. I want you to imagine that you are Samantha. How would you react/feel given this scenario?How would you react/feel given this scenario?
■■If you were the teacher, what could you have done If you were the teacher, what could you have done differently? What could you do to change the differently? What could you do to change the vicious cycle of bullying?vicious cycle of bullying?
■■From what you know, was the school compliant From what you know, was the school compliant with Section 504 regulations? If not, what should with Section 504 regulations? If not, what should be done?be done?
Contact informationContact information
Dana BarvinchakDana Barvinchak E-mail – E-mail – [email protected] Telephone – 412-480-4924Telephone – 412-480-4924