Tourette's Syndrome
By:
Cecilia Fern, Rachel Holtz
and Emilie Miller
What is Tourette’s
Syndrome?
• Tourette’s Syndrome is an inherited,
neurological disorder characterized
by multiple involuntary movements
• Uncontrollable vocalizations called
tics that vary over the years
History
• Dr. Georges Gilles de la Tourette, a
French neurologist, first described
an 86 year old woman with this
condition in 1885.
• The disorder is named after him.
Statistics
• Like mental retardation, the
symptoms of TS manifest before the
age of 18.
• TS can affect any ethnic group
• Males are affected 3 to 4 more
times than females.
• 100,000 Americans have full-blown
TS.
What are the Symptoms?
•
•
First symptoms are usually facial
tics: mostly eye-blinking, but can
include nose twitching and grimaces.
Over time, motor tics can develop:
head-jerking; neck stretching; foot
stamping; body twisting and bending
Symptoms, cont.
• It is not uncommon for a person with
TS to continuously clear his/her
throat, cough, sniff, grunt, yelp, bark
or shout.
Coprolalia
• People with TS may involuntarily
shout obscenities
• They may also utter strange and
unacceptable sounds, words or
phrases.
Echolilia
• Individuals with Tourette’s Syndrome
may also constantly repeat the word
of others.
• They may touch other people
excessively or repeat actions
obsessively.
Rare Behaviors
• Few patients with severe TS
demonstrate self-harming behaviors:
lip and cheek biting and banging head
against hard objects.
• Remember, these behaviors are
extremely rare.
How are Tics Classified?
• There are two types of tics:
• Simple
• Complex
Simple Tics
• Simple tics are sudden, brief
movements that involve a limited
number of muscle groups.
• They occur in a single or isolated
fashion and are often repetitive.
Simple Tic Examples
• Simple tics include:
Eye-blinking; shoulder shrugging; facial
grimacing; head jerking; yelping and
sniffling.
Complex Tics
• Complex tics are distinct,
coordinated patterns of successive
movements involving several muscle
groups.
Complex Tics Examples
• Complex tics include:
Jumping; smelling objects; touching the
nose; touching other people;
Coprolalia; Echolalia; or self-harming
behaviors.
Can People with TS Control
Their Tics?
• People with TS can sometimes
suppress their tics; however, the
effort is much like holding back a
sneeze.
• Eventually tension mounts to the
point where the tic escapes.
Controlling Tics cont.
• Tics worsen in stressful situations
• They improve, however, when a
person is relaxed or absorbed in an
activity.
• Tics decrease in most cases during
sleep.
What Causes Tourette’s
Syndrome?
• The basic cause of Tourette’s
Syndrome is unknown.
Causes of TS, cont.
• However, current research suggests
that there is an abnormality in the
genes affecting the brain’s
metabolism of neurotransmitters,
such as:
Dopamine, serotonin, and
norepinephrine
Disorders Associated with
Tourette’s Syndrome
• There are many other disorders that
can occur concurrently with
Tourette’s Syndrome.
• Some include: Obsessive compulsive
behavior; AD/HD; Learning
Disabilities; sleep disorders.
Disorders, cont.
• In fact, the accompanying disorders
can be more disabling than the tics
themselves.
• Patients, families, and physicians
need to determine which set of
symptoms is most disabling so that
appropriate medications and
therapies can be administered.
Diagnosing TS
• Physicians get descriptions of the
tics and evaluate family history.
• Motor and phonic tics must be
present for 1 year in order for a
diagnosis of TS.
Neuro-imaging Studies
• Neuro-imaging Studies that rule out
other conditions include:
• Magnetic Resonance Imaging (MRI)
• Computerized Tomography (CT)
• Electroencephalogram (EEG)
Diagnosis cont.
• Tourette’s Syndrome is a clinical
diagnosis.
• Therefore, there are no blood tests
or other laboratory tests that
definitively diagnose TS.
How is TS Treated?
• Since the symptoms do not impair
the individuals, the majority of
people with TS do not need
medication.
• Medication is available if symptoms
interfere with functioning.
Treatment, cont.
• There is no one medication to help all
people with TS.
• Also, there is no one medication that
completely eliminates symptoms.
• Most of these medications have side
effects as well.
Treatment, cont.
• The medication is used to reduce the
frequency and intensity of tic
symptoms.
• One kind of drug used is Neuroleptic
drugs, like Haloperidol and Pimozide.
• Though, these medications are given
in very small doses.
Treatment, cont.
• Clonidine is a antihypertensive drug
used in the treatment of tics.
• It is effective in reducing motor tics
rather than reducing vocal tics.
• Although psychological problems do
not cause TS, psychotherapy may
help one cope with the disorder.
Is TS Inherited?
Perhaps.
Inherited, cont.
• Genetic studies suggest that TS is
inherited in a dominant mode,
depending on which genes are
involved.
• A person with TS has a 50-50 chance
of passing on the genes to the
offspring.
Inherited, cont.
• However, that genetic disposition
may not result in full-blown TS.
• Instead, it may be a milder tic
disorder.
• Or, it could result in OCD, or AD/HD
with few or little tics at all.
Inherited, cont.
• Gender is also important in
determining TS gene expression.
• If the gene-carrying TS male has
offspring, the odds are 3 to 4 times
higher of the offspring developing
TS.
Inherited, cont.
• Though, in some cases, TS
inheritance cannot be determined.
• These cases are called sporadic and
their cause is unknown.
What is the Prognosis?
• There is no cure for Tourette’s
Syndrome.
• Though, the condition improves as
the individuals mature.
• The disorder is generally lifelong and
chronic, it is not a degenerative
condition.
Interview with Maureen
Delfeld, B.S.Ed.
• She team teaches a special education
class in a general education school.
• She takes some of her students into
general education classrooms, so she
works directly with general education
teachers and their classrooms.
What to do First…
• Introduce the student with
Tourette’s to the rest of the
students on the first day.
• Make sure the other students
understand that tics will happen
during the school day and it is
something they are going to need to
learn how to cope with.
First, cont.
• Whether or not the student with
Tourette's is in the room at this
point is up to the child and the
parents.
• As instructors, do not encourage the
child to hold tics in; this can make it
much worse.
First, cont.
• Make sure the rest of the class
understands that just because one
child swears, that does not mean
they can swear.
Material Presentation
• Use as few words as necessary when
explaining.
• Check for understanding (have the
child repeat directions for a task
back to you).
• Present a syllabus for the whole
quarter, so the student knows what is
expected of him.
Presentation, cont.
• Use phrases like “This is important”
and “Listen Carefully.”
• Don’t have a lot of visual distractions
in the room, and don’t sit them near
the door or window.
Presentation, cont.
• Have a cue (both you and the student
know) that can be given if he/she needs
to leave the room. And have a certain
spot they are allowed to go.
Medication in the Classroom
• Record students’ behaviors when on
medication (vs. when not on medication)
for doctors.
• One of the major side effects of the
medication is sedation, which can affect
the student’s ability to learn.
Classroom Environment
• Use seating chart to allow for any
movement tics.
• Eliminate all unnecessary items from
the student’s desk to prevent
distractions.
Environment, cont.
• Have a duplicate set of text books
for the child to keep at home.
(Great to use if child misses school,
or is having a hard time
concentrating.)
• Use a study carrel if needed
Transitions
• Give students ample warning that a
transition is coming.
• Have a written schedule on the desk
of the student who has TS.
• When walking through the hall, make
sure the student with TS is at the
front of the line.
Tests and Grading
• Give extra time to finish test or turn
in homework if necessary
• Reduce amount of work (EG: odd
numbers instead of all; sometimes up
to 50%).
• Allow extra time, read the test to
them, oral responses, etc.
Tests and Grading, cont.
• Provide movement breaks during the
test if necessary
• Part of the grade could be based on
individual effort or improvement
• Retake the test (rework problems)
for a passing grade
• Avoid ALL timed tests
Math
• Allow the use of a calculator without
penalty
• Have a table of math facts available
• Break story problems into shorter
segments
• Use graph paper or notebook paper
turned sideways to keep work in
columns.
Classroom Behaviors
• Sit the student with TS next to a
responsible student so it limits the
distractions. (Be careful that this does
not negatively affect the other student)
• Reward forgetful students for
remembering, not punish them for
forgetting.
• Ignore behaviors that are seriously
disruptive.
Behaviors, cont.
• Modifications for any behavior that
is disturbing (foam on desk if they
tap they tap their pencil, tennis balls
on chair legs).
• Have a code for the student when
their behavior is unacceptable.
Reading
• Let the student sit comfortably.
• “Follow along finger” is fine.
• Tapes or reader for textbooks.
Reading, cont.
• Read out loud in a tape recorder to
listen for improvement.
• Read questions first before
reading story.
• Use Headphones to block out noise.
Organization
• Establish a daily routine and stick to
it.
• Have clearly defined rules, and be
consistent enforcing them.
• Write the due date at the top of
worksheets/assignments.
Organization, cont.
• Highlight important stuff so
worksheets aren’t so cluttered.
• Very organized, color coding,
schedule always available, etc.
Handwriting
• Minimize writing on homework.
• Have a computer for that student.
• Copy another student’s notes at
home.
• Printed outline if watching a movie.
• Print out what is written on the
blackboard.
True or False
1) Most cases of Tourette Syndrome
are categorized as mild.
2) Obscene language is typical symptom
of TS.
3) TS is diagnosed by taking blood
samples and other neurological tests.
True and False, cont.
4) Tics involved with TS are classified
as Simple and Complex.
5) It is not that important if TS goes
untreated for a lengthy period of
time.
6) Many students with TS have the
same IQ range as students who do
not have TS.
True and False, cont.
7) TS is inherited.
8) There is a cure for TS.
9) People who have TS often get better
as they get older.
References
• MEDLINEplus Health Information
A service of the National Library of
Medicine and the National Institutes
of Health.
http://www.nlm.nih.gov/medlineplus.
• Interview: Delfeld, Maureen. B.S. Ed.