Teaching and Educational Resources for Tourette Syndrome

Books: 

• Concise and well-written introductory text to TS | 'Tourette Syndrome: The Facts' Mary Robertson & Simon Baron-Cohen | ISBN 0-19-852398-X
• 'Teaching the Tiger' M. Dornbush The best practical reference book for educators working with students who have Tourette Syndrome, ADD, and/or OCD/OCB | ISBN 978-1878267344

Links:

• Tourette Syndrome Association of Australia TSAA have produced an excellent video podcast on how to approach  TS in a school or classroom setting (available in several formats): http://www.tourette.org.au/tsaa%20podcast.html

• Tourette Syndrome is 'more than tics' a very informative guide from the TSA by specialist educator, Kathy Giordano: Available online: http://www.tsa-usa.org/aeduc_advoc/morethantics.htm TSA also provide a wealth of other resources, materials and valuable information for teaching students with TS: http://www.tsa-usa.org/aProfessionals/ProfEducators/educators.html

• The US National Tourette Syndrome Association, TSA initiated a "Youth Ambassador" Programme which trains young people to talk about TS and gives them the preparation they need to "speak about TS before their peers...." Youth Ambassadors frequently give presentations in schools to help improve understanding of TS and the educational needs of those who have TS. TSA provides a video (download) and online materials: http://www.tsa-usa.org/aPeople/Youth/YouthAm.htm

• Words from a teacher of a child with TS (6 video clips): http://video.tourette.ca/index.php?entry_id=5890 (Tourette Syndrome Foundation of Canada)

• Brad Cohen, an award-winning teacher with Tourette Syndrome travels to a British school to help raise TS awareness. Video: http://bit.ly/xoj0ke

• 'An Education in Education' - Dr B. Duncan McKinlay (An Educational Psychologist with TS) http://www.tourette.ca/resources-newsletters-tgl.php?entry_id=6873

• Educational approaches and difficulties - talk by Kathy Giordano (educational specialist and mother of a son with TS) - makes reference to US 504/IEP plans but still mostly relevant to UK educational provision and statementing /IEPs and the needs of students with Tourette Syndrome. Video: http://www.tsa-usa.org/ZEdDVD/2_01_504andIEPs/504_and_IEP_2_01.html

Advice: Some bullet points!

• Recognise any difficulties the student may have by educating yourself about TS and being aware of the challenges TS can pose to the learning process
• Don't continually admonish a student for having 'tics' - it is pointless and, more importantly, very stressful for the student and sets a very bad example to classmates
• Recognise that a student may need to leave the classroom when their tics are troubling them or they are becoming stressed due to suppressing/hiding their symptoms. If necessary have a pre-arranged signal for the student so they can leave without asking
• Some individuals with TS have polyuria and need to make frequent bathroom (toilet) visits. They should be permitted to do so when required
• Invite the student to give a presentation to the class (see the TS ambassador section above) if they feel comfortable or confident in doing so. If not ask their permission for the class to devote time to learning about TS (similar disorders can be included here too) or give a lesson or show a video presentation
• Always be aware that a student with TS may have difficulties in following teaching given through certain media or in a busy environment. They may experience NLD which slow their 'non-verbal' abilities
• Many will require additional time during assessments or benefit greatly by being able to sit apart (e.g. in a separate room) so they are not continually worrying about their tics disturbing other students. Imagine what it is like to have TS and have to sit for an extended period, still and quiet in a room/hall filled with students concentrating hard where the slightest disturbance is heard or detected by all.
• Where a child or student sits in the classroom can be extremely important. This should involve determining their specific needs. Many people with TS are very unsettled and become anxious when they have other people sitting behind them and tend to prefer being at the back or to the side or in a corner position. Sensory issues must be considered also and a student may need to sit where they are best able to follow the lesson and hear the teacher/lecturer clearly. Some students may, additionally, need to be able to lip read in order to better understand what is said especially when other ambient background noise levels or visual stimuli are high. They may not be able to read and take notes effectively when you are talking. Seating is especially important in written examinations and may affect their performance and stress levels.
• Children (and older students) with obsessive compulsive behaviours (OCB is very common as a part of TS) may need more time in completing tasks and 'real-time' assignments. This may include taking longer to organise themselves, getting from one class to another, getting ready for sports activities and in initiating new activities and assignments.
• Students with TS need somewhere to study. It may not occur to you but most cannot just go and work in the library as other students do. Libraries can be a nightmare for students with TS as noise, movements and disturbance are not tolerated unless your library has particularly lax rules. The availability of a separate study room/area is the solution, preferably without flourescent lighting.
• Unlike the approach usually taken for students with dyslexia or ASD, not all students with Tourette Syndrome will benefit from using computers for academic assignments, many are better at writing by hand and reading from paper media. Another important consideration with keyboard use is the challenge presented by obsessive and compulsive behaviours and sensory processing issues in TS. Keyboards may provoke unique difficulties for some individuals. Some students with TS will be placed at a significant disadvantage if there is an insistence that they may only use information technology rather than traditional paper-based methods of fulfilling academic assignments.
• Many children with TS have 'untidy' writing - which for some is eventually resolved as their skills and development progress but may persist. Some students with TS may additionally, have dyslexia or dysgraphia which can influence reading and/or writing abilities. Dysgraphia will also cause difficulties with producing both text and drawing on paper. Both conditions may affect IT skills.
• Do not humiliate a student in front of their peers with respect to their 'disorder' - show sensitivity by avoiding stereotypical comments and generalisations about their disability (or any other disability that may affect other students). Individuals with TS often lack self-confidence and are acutely sensitive to criticism. They do not choose to be born with a lifelong condition and must be allowed to feel comfortable in the classroom and in the presence of teachers and staff who have authority over them.  Do not refer to TS as a 'mental illness' - this is a common misconception that often prevails among teaching staff at schools and universities (and a frequent cause of stigmatisation and bullying). It is a neurodevelopmental disorder, as is cerebral palsy, not an illness and does not have a psychological origin. 
• Evidence shows that those with TS respond strongly to positive feedback. When an opportunity for acknowledgment of a student's efforts and good work arises, take it, it will help increase self-confidence and self-belief more than you can imagine
• Although, like everyone, individuals with TS can be intentionally disobedient, disruptive and obstinate, be very aware that most with TS try very hard to 'follow the rules' but are not well-equipped for doing so and much of their behaviour is 'unintentional', embarrassing to them and not a true reflection of the way they are inside
• Children with TS should not be automatically excluded from class and other school activities because they have a disability or may be inconvenient to have around. Although the needs of all pupils must be considered, there is usually a work-around that will help the child with TS to be included in class activities.
• As a teacher you are in a unique position to influence the quality of the learning experience for a student with TS and to help encourage awareness and acceptance among other class members. Try to avoid initiating a 'bullying' or adversarial environment. Others will take your cue and follow suit. Although we like to believe this unthinkable, students have reported 'bullying' by teachers (all too frequently). For some this has proved to be one of the worst and most debilitating experiences in their development and much more difficult to rationalise about than that carried out by peers. It goes without saying that peer-to-peer bullying is one of the greatest challenges a child with TS will face (almost all are bullied at school) and must be identified and stopped when it occurs.
• All these issues are not always unique to TS. They can be equally relevant to many other neuro-developmental disorders such as autism, cerebral palsy, LD, SPD etc., physical disabilities and also conditions such as depression and anxiety. Also bear in mind that some of this advice is not just a matter of doing the best for your students, it can be a matter of law and any actions you take may require subsequent explanation and justification within the frame-work of the relevant National Disability Discrimination/Equalities Acts which all contain strict guidelines on educational provision and describe implicit obligations to ensure equality and reduce disadvantage.