4 minute read
Classroom support for Tourette’s
Nancy Doyle explains how schools can be made more productive and manageable for pupils with Tourette’s
Tourette’s syndrome is a much misunderstood condition. It attracts a lot of sensationalist press coverage, without receiving the same level of understanding that is often accorded to other conditions such as autism or dyslexia. It is thought that roughly one per cent of the UK population has Tourette’s syndrome (TS), which is about the same as autism, although far fewer people understand what TS is and how it affects individuals.
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Having TS means that both physical and verbal tics are present, these being movements or sounds that the person cannot control. Most people with TS have simple tics, such as eye blinking, throat clearing or cracking their knuckles. These are common in childhood, with as many as 10 to 20 per cent of children developing some isolated tics, typically around Key Stage 1 and 2, which they then grow out of in adolescence. Educators are therefore likely to encounter children with minor tics, a few of whom will go on to develop TS. Complex tics occur in around 0.25 per cent of the population, with even fewer developing coprolalia, which refers to tics that are rude or insulting in nature, such as swearing or making obscene hand gestures.
Suppressing tics
TS most frequently co-occurs with autism, attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD) and anxiety. Children are likely to appear anxious and jumpy, and may be self-conscious about their tics, not knowing why they occur. Trying to stop a tic has been likened to attempting to prevent a sneeze; it requires an enormous amount of effort and is often impossible. Suppression of tics can lead to exhaustion, stress and lack of focus on the task at hand. Eventually, the tic will need to be released.
distracting other pupils and not staying still. This can lead to them having feelings of self-reproach, shame and frustration. Other conditions may or may not be diagnosed, and if they are untreated into adolescence they can be a major cause of mental health issues in the teenage years. Stress itself exacerbates TS, making tics more frequent and harder to control. Some tics can lead to repetitive strain injuries or, with complex tics, actual physical injuries to person and property which can be extremely frightening for the child.
What helps pupils with Tourette’s syndrome?
There is a legal imperative for schools to make adjustments for children with TS. I typically recommend providing pupils with a breakout space where they can go to “tic out”, letting all their tics loose without worrying about what others will think. Additionally, you may need to encourage open conversation with peers and teachers so that tics aren’t surprising and stigmatising. If their tics are really obvious, it can help the individual to have an alert card explaining that they have TS, and to develop some stock phrases to inform people on first meeting that they have TS. Reducing anxiety and ensuring physical comfort is key. Pupils may need permission to move during assembly or take exams in quiet spaces. Reducing unnecessary distractions and preventing sensory overload are also important. So it’s crucial to think, for example, about the impact of busy corridors during transitions, whether the child can be seated in a quieter corner of the classroom, and whether potential issues with lighting, acoustics or smells at school can be addressed to help children with TS and other conditions.
Positive qualities
TS is often associated with higher levels of creativity and innovative thinking than the general population. People with TS tend to develop good observational skills and cognitive control, in order to avoid sensory triggers and thoughts which would then lead to tics. People with TS are also thought to display high levels of empathy and consideration for others. Co-occurring conditions like autism and ADHD often come with strengths in visual processing or mechanical thinking, and these can overlap into TS. The key to educating children with TS, as for most children, is to find their passion – the activity or interest that takes them into a state of hyper-focus. Individuals with more severe TS and coprolalia have been known to significantly reduce tic-ing when engaged in photography, climbing, art or music. For example, the pop singer Billie Eilish has TS yet doesn’t tic when she is singing.
About the author
Dr Nancy Doyle is a registered occupational psychologist with 15 years’ experience of assessing and coaching neurodiversity at work. She campaigns with the British Psychological Society and is a Research Fellow at Birkbeck College, University of London. Nancy is the founder and CEO of Genius Within.
geniuswithin.co.uk @NancyDoylePsych @geniuswithinCIC
■ Encourage open conversation.
to the best of their abilities, these children need supporting in the activities they enjoy and are inspired by, and the right encouragement to think broadly about how they can turn their interests into skills for life. People with TS need our understanding and empathy. In return, they can contribute their creative souls to our school communities.
