Teachers frequently have difficulties understanding the needs of children with Tourette Syndrome. Despite the free availability of detailed information and advice in the literature and in the the form of printed educational material, videos and presentations by the Tourette Syndrome Association (TSA, Tourette's Action) there still remains much uncertainty among teaching staff about the disorder and the accommodations and provisions that should be considered.
I suggest that the following issues should be a principle concern for teaching staff who have a child with TS in the class:
Always remember that children with TS are often very bright and quick-thinking but their abilities may be overlooked and less obvious due to the difficulties they may experience. Most fall within the normal IQ range but many are towards the upper end.
Reading speed may be slow despite the fact that children with TS are very often 'early readers' and are very quick at picking up a large vocabulary and are frequently good at spelling. Also be aware that some children with TS may also have dyslexia. A large part of TS involves problems with central processing which may cause a child to have sensory processing difficulties and a poor ability to understand information and concentrate in a busy or noisy classroom. An important aspect of TS is reduced inhibition which may have the consequence of apparantly poor impulse control and may also affect sensory input resulting in hypersensitivity to sound and visual stimuli or other 'disturbances'. They may also have difficulties with using keyboards and in interacting with screen-based text and information.
Written asignments and homework may take the TS child much longer to do than for other children.
In written tests / examinations, additional time or untimed assessments should be considered if there is any indication that they are unable to keep up with the performance speed of other children.
If necessary provide separate accomodation for the child when taking written or other tests / examinations as they may otherwise focus most of their concentration and attention on suppressing their tics and trying to still quietly and trying to remain still for an extended time rather than focusing on the task at hand
Children with TS may suffer from polyuria (frequent need to pass urine) due to neurohormonal imbalances which affect the production of urine in the kidney and reducing water resorption. They should be permitted to leave the classroom to visit the bathroom/toilet whenever they need to and NOT have to ask. Many children are painfully embarrassed by having to constantly ask the teacher in class. The same goes for long examinations and is an additional reason for exams being untimed.
Importantly, if a child, as part of their Tourette Syndrome, calls out or makes inappropriate comments or in rare cases, may curse or make 'socially unacceptable' gestures, do not constantly admonish them. These behaviours are tics and are mostly involuntary. Some children are able to intercept them or suppress them but many cannot and have little control over them. The worst response is to tell them off each time and especially to embarrass them or ridicule them in front of their classmates. Children with TS are often less able to respond to tics and have a low awareness of them. Although they may have little ability to suppress or hide them, doing so increases the stress that 'builds up' inside and can exacerbate their difficulties. Don't fall into the trap of assuming that children with TS will be shouting obscenities and expletives, this does occur but is a rare aspect of TS and ridiculously over-emphasised by an ill-informed media.
If children with 'special needs' are to be integrated into mainstream classes then teaching staff must excercise an appropriate level of tolerance for children with TS. It is unacceptable, and akin to institutional bullying, to tell a child to 'stop doing that' every time they exhibit symptoms of their disorder. Would you tell a child with cerebral palsy to stop talking in an manner or walking strangely, or a child with autism to stop 'obssessing' or 'look into my eyes when I'm speaking to you' or a child with epilepsy to stop having seizures. Chidren with TS have so much to contend with and are often painfully self-conscious about their disorder. They have few enough opportunities to form close friendships at school and therefore need empathy and compassion not condemnation and negativity which other pupils pick up on and which further isolate the child and further enhance their reputation of 'being different'.
Most adults with TS report that although other children did bully them at school and elsewhere, it was the 'bullying' by teachers and authority figures that was the most traumatic and the hardest to forgive in hindsight (and to most incomprehensible). Rest-assured this does happen frequently and research shows that children with TS are often treated in a very different way to children with other disabilities. The way in which many were treated by teachers is seen as unprofessional and a breach of the trust that society places in such professionals and is not behaviour that suggests as acceptable level of integrity. I have heard first hand accounts of the most appalling actions or verbal abuse by teachers (and latterly by college and university lecturers and more worryingly doctors). Some teachers have even encouraged mocking of a Tourette's child by other pupils during class and have joined in.
It is also absolutely vital that as a teacher, you talk to pupils in an informed way (assuming the child and it's parents have given permission) and let them know what to expect, what TS is and how they can help their fellow pupil negotiate their difficulties at school. Above all teach acceptance and tolerance but also set a good example for your pupils to follow.
