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Managing Tourette Syndrome in the Classroom Haim Ginott If I Had But

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Managing Tourette Syndrome in the Classroom Haim Ginott If I Had But Slide ___________________________________ 1 Managing Tourette ___________________________________ Syndrome in the Classroom ___________________________________ ___________________________________ Susan Conners, M. Ed. ___________________________________ Author President, TSA of ___________________________________ Greater NY State ___________________________________ Slide ___________________________________ 2 Haim Ginott ___________________________________ I’ve come to the conclusion that I am the ___________________________________ decisive element in the classroom. It’s my personal approach that creates the climate. It’s my daily mood that makes the weather. ___________________________________ As a teacher, I possess a tremendous power to make a child’s life miserable or joyous. I ___________________________________ can be a tool of torture or an instrument of inspiration. I can humiliate or honor, hurt or heal. In all situations, it is my response that ___________________________________ decides whether a crisis will be escalated or de-escalated and a child humanized or de- humanized ___________________________________ Slide ___________________________________ 3 If I had but one life to give for my country, it would be ___________________________________ Billy in the third row. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide ___________________________________ 4 Tics ___________________________________ An Involuntary, repetitive ___________________________________ motor movement or vocalization ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide ___________________________________ 5 Multiple Motor Tics Simple Motor Tics ___________________________________ Eye blinking, grimacing, nose twitching, leg movements, shoulder ___________________________________ shrugs, arm and head jerks, etc. Complex Motor Tics ___________________________________ Hopping, clapping, throwing, touching (self, others, objects), ___________________________________ funny expressions, sticking out the tongue, kissing, pinching, tearing paper or books, echopraxia ___________________________________ (repeating actions), copropraxia (obscene gestures) ___________________________________ Slide ___________________________________ 6 Vocal Tics Simple Vocal Tics ___________________________________ Whistling, coughing, sniffling, screeching, animal noises, grunting, throat clearing ___________________________________ Complex Vocal Tics Linguistically meaningful utterances: “I’ve got it.” ___________________________________ “Oh boy.” “Now you’ve seen it.” ___________________________________ Speech Atypicalities Unusual rhythms, tone, accents, ___________________________________ intensity of speech, stuttering ___________________________________ Slide ___________________________________ OTHER UNUSUAL TYPES OF 7 VOCAL TICS ___________________________________ Echolalia - involuntary repetition of someone ___________________________________ else’s words Palilalia - involuntary repetition of one’s own ___________________________________ words Coprolalia - involuntary utterance of curse words ___________________________________ or other socially inappropriate phrases or sentences ___________________________________ NOTE: Coprolalia is NOT necessary for a diagnosis of TS ___________________________________ Slide ___________________________________ 8 Waxing and Waning ___________________________________ Tics naturally wax and wane, change in ___________________________________ nature and in severity Tics change much more frequently in ___________________________________ childhood than adulthood Tics typically seem to worsen during pre- ___________________________________ puberty and puberty Many people with TS experience a lessening of tics in adulthood ___________________________________ ___________________________________ Slide ___________________________________ 9 Environmental Factors That Can Worsen TS Symptoms ___________________________________ Stress ___________________________________ Anxiety ___________________________________ Excitement Fatigue ___________________________________ Illness ___________________________________ ___________________________________ Slide ___________________________________ 10 SUPPRESSION OF ___________________________________ SYMPTOMS Results in: ___________________________________ . Worsening of symptoms . Inability to concentrate on task at hand ___________________________________ . Shutting down . Fatigue and/or worsening of symptoms at end of day ___________________________________ . Often explosion of symptoms at home ___________________________________ ___________________________________ Slide ___________________________________ 11 CLASSROOM SUGGESTIONS ___________________________________ Even tics which appear to the onlooker to be very mild can be very interfering (e.g. eye rolling, head shaking). Vocal and motor tics can create tremendous social stresses for the student ___________________________________ Frequent breaks ___________________________________ Preferential seating Assessing interference of individual tics for accommodations ___________________________________ Educate classroom about TS SKYPE ___________________________________ ___________________________________ Slide ___________________________________ 12 ASSOCIATED DISORDERS ___________________________________ TS is a Neurobiological spectrum ___________________________________ disorder - almost always accompanied by other neurological ___________________________________ conditions ___________________________________ ___________________________________ ___________________________________ Slide ___________________________________ MOST COMMON ASSOCIATED 13 DISORDERS ___________________________________ An extremely large number of people with TS are also diagnosed with the ___________________________________ following: ___________________________________ Obsessive-Compulsive Disorder Attention Deficit Hyperactivity ___________________________________ Disorder ___________________________________ Learning Disabilities ___________________________________ Slide OTHER FREQUENTLY OCCURRING ___________________________________ 14 ASSOCIATED ISSUES ___________________________________ In addition, students may exhibit other ___________________________________ neurobiological symptoms, including: Executive dysfunction Depression ___________________________________ Anxiety disorders Sleep disorders ___________________________________ Fine-motor difficulties (Dysgraphia) Aggressive and/or explosive behavior ___________________________________ Sensory defensiveness Social Skills Deficits ___________________________________ Slide ___________________________________ 15 ___________________________________ OCD “Tics of the Mind” ___________________________________ ___________________________________ Your body tics and ___________________________________ your mind tics QuickTime™ and a decompressor are needed to see this picture. ___________________________________ ___________________________________ Slide COMMON OBSESSIONS ___________________________________ 16 AND COMPULSIONS ___________________________________ Need for symmetry and perfectionism ___________________________________ Neatness Counting ___________________________________ Checking things over and over Constant doubt or worrying ___________________________________ Germ obsessions 1 Transition Difficulties 3 ___________________________________ Ritualistic behavior Obsessive Sense of Justice 2 ___________________________________ Slide ___________________________________ 17 MANAGING OCD IN THE CLASSROOM ___________________________________ An obsession with erasing words slows down writing. May need writing accommodations. ___________________________________ Counting compulsion - May need books on tape or a scribe. Time limits waived and extended time on tests. ___________________________________ Advanced warning for any changes Distraction and humor ___________________________________ Look for red flags for OCD and……. ___________________________________ ___________________________________ Slide ___________________________________ 18 Red Flags for OCD ___________________________________ ___________________________________ Writing and erasing Continually sharpening pencil Difficulty with transitions ___________________________________ Unable to tolerate any changes Repeated hand washing ___________________________________ Perfectionism Not able to turn in papers/tests for fear of mistakes ___________________________________ Repeated checking Asking constant questions ___________________________________ Slide ___________________________________ 19 OBSESSIVE-COMPULSIVE ___________________________________ DISORDER (OCD) ___________________________________ Neurological Disorder Driven, Perfectionistic, ___________________________________ Need to complete ___________________________________ Difficulty transitioning Mental brakes get stuck ___________________________________ ___________________________________ Slide ___________________________________ 20 ATTENTION ___________________________________ DEFICIT ___________________________________ HYPERACTIVITY ___________________________________ DISORDER ___________________________________ (ADHD)
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