by Susan A. Conners

Tourette Syndrome is one of the most misdiagnosed and misunderstood neurological disorders that impacts a child's educational performance and social/emotional well-being. It is my experience that most educators have now at least heard of Tourette Syndrome. This was certainly not the case when I began my work with children with TS some 18 years ago. It all started in 1984 when I was 36 years old and had been teaching French in a middle school in a suburb of Buffalo, NY for 15 years. I had the good fortune of watching an episode of "The Quincy Show" on television one Sunday night. The subject of that episode was Tourette Syndrome. It was the first time I had ever heard the word. It was also a night that changed my life forever. Three months after that episode I was diagnosed with TS. I had had my first symptoms at age 6. To this day, despite the significant media attention that Tourette Syndrome receives and the substantial contributions of the National Tourette Syndrome Association, it is still a disorder that most educators know very little about. And, what they do know is often inaccurate.

The Mystique of TS

There is a mystique about Tourette Syndrome, a perplexity that often aligns it with bad behavior. If it is treated as such in a classroom setting, no one wins, not the teacher, not the administration and, most importantly, not the child. The mystique of TS is easily explained if one simply looks at it as the medical condition that it is, not unlike other medical conditions that teachers deal with every day in their classrooms. One would never think of punishing a child who was exhibiting the confusion and out-of-sorts behavior associated with low blood sugar in diabetes. No teacher would ever think of reprimanding a child who is disrupting the class with an asthma attack. Yet, a student exhibiting the motor and vocal tics associated with TS is often disciplined to his or her extreme embarrassment for symptoms of a medical/neurological disorder. Why would this ever happen? It happens because people understand diabetes. People understand asthma. People misinterpret TS.

Diagnostic Criteria

Tourette Syndrome is a neurological disorder resulting from a chemical imbalance in the brain. There is currently no medical test that will clinically diagnose TS.  It is therefore diagnosed by the presence of four very observable diagnostic criteria which I will list and expand upon in this article.  These diagnostic criteria are as follows:

1. Multiple motor tics
2. Vocal tics
3. Waxing and waning of symptoms
4. Childhood onset of symptoms

Motor tics: Let's look more closely at all four criteria. A motor tic is a rapid, repetitive movement of any voluntary muscular group in your body.  Simple motor tics could include rapid eye-blinking, head jerking, facial grimaces, arm flailing and/or finger tapping, to name a few. These tics can occur in bouts that can sometimes seem purposeful.  Researchers have discovered that the brain chemical dopamine is affected in some way in the brain of persons with TS.  Since dopamine has as one of its main functions the control of body movements, it is easy to understand the presence of such tics.  Many people with TS also exhibit complex motor tics such as hopping, knee bending, whole body bending or a series of what look like simple motor tics.  I, myself, have a complex motor tic where I must tap my finger on the table, touch my chin and then lick my shoulder always in that sequence.  This must look quite ridiculous to someone who does not understand movement disorders.

A vocal tic can be defined as the repeated uttering of a sound, word or phrase.  Vocal tics can be as simple as a constant sniffing or throat clearing.  It could be a squeak, a snort, a howl, a bark or a word or phrase that is repeated over and over.  A boy diagnosed with TS whom I currently teach makes a series of snorts and animal sounds.  He also repeats phrases such as "chickens are fuzzy, chickens are fuzzy" and "I have a chicken in my pants."  Unfortunately, anyone who knows anything about TS knows of the vocal tic that takes the form of inappropriate language.  This is known as coprolalia.  It does exist and can certainly be a part of Tourette, but is not necessary for a diagnosis.  It actually occurs very infrequently with people with TS.  It usually takes the form of curse words, but could be anything inappropriate such as ethnic slurs or comments on a person's appearance, such as "you're bald, you're fat."  My student's "I have a chicken in my pants" could be classified as coprolalia.  In my classroom where we all understand Tourette, it is simply ignored.  In the real world, this certainly would not be the case.

Waxing and waning also means that tics change in severity depending on environmental circumstances.  The most common of these are stress and anxiety, excitement and fatigue.  Tics almost always worsen during times of stress and excitement in all persons with TS.  Testing situations can be very stressful and this is also a time when the classroom is most quiet, which makes vocal tics especially difficult for a child with TS.  Events such as family birthdays, vacations and field trips can be very exciting for a child, which could temporarily cause symptoms to worsen.  Tics almost always tend to worsen at the end of the day because of the level of fatigue.

Childhood onset: This disorder must first manifest itself in childhood anywhere between the ages of 2 and 18.  The most common age of onset of symptoms is 6 or 7.

continue: Classroom Intervention

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Reviewed: 03/2006