|EDUCATION QUESTION OF THE MONTH
Q. I am a first grade teacher. A student of mine is very bright but can suddenly have explosive behaviors if anyone touches his desk as well as for seemingly no reason. Is it possible that his extreme behaviors which include hitting, pushing, screaming, purposely bumping into things and shoving his desk are due to his having Tourette syndrome? He has either very good days or very disruptive days.
A. Many students with TS have related disorders including sensory processing delays.
Depending on how your student’s brain is receiving the sensory input at that moment, on that day, you may see him withdrawing, hiding, pushing, running, shoving, hitting, or bumping into things or others because his brain is not registering the input as others would. He may hold things too tightly, press too hard on crayons, pencils, toys, etc. He may appear floppy and clumsy, or he may move very fast and seem to be coordinated, but if you make him slow down for accuracy he is unable to perform the task. He may be struggling to perform the visual perceptual, fine and/or gross motor tasks that are expected of him.
Anecdotally, individuals with TS have reported that they sometimes incorporate a sensory component to their tics, needing to repeat a tic or behavior until it sounds, feels, tastes, or looks "just right". This often incorporates an Obsessive Compulsive (OCD) component which may also be observed in classroom behaviors, school work and play situations.
In the case of young students, the child may have a need to have things lined up or organized on his desk in a certain way, or his desk positioned in a certain way. If someone or something should come along and move that order, he can overreact. He may have come to school that day with a plan or map in his head for who he was going to play with, what they were going to do, how his day was going to go. If something doesn't match the map in his head when he gets to school, he is already off to a bad start. Any input to one of his senses (loud noises, smelly markers, gooey snacks) can cause a reaction such as running, screaming, hitting, withdrawing, and refusal to work. I would suggest an educational evaluation that includes an Occupational therapy evaluation to assess visual perceptual, fine motor, gross motor and sensory processing skills by a therapist trained in sensory issues, who can develop a sensory plan (sometimes called sensory diet) to help this student.
As always, if you still have questions, please email our Education Advisory Board (email address directly below), and we will answer.
Ask the Tourette Association Education Advisory Board a question about Education - all questions
will be answered.
- Section 504 - provision of the Rehabilitation Act of 1973 (Federal Law) which prohibits recipients of federal funds from discrimination against persons with disabilities
Section 504 Plan - A legal document outlining accommodations and modifications provided by the school so that a child is not discriminated against.
- Individuals with Disabilities Education Act (IDEA) - Federal Law - stated purpose (in Section 1400 (d)(1)) is “…to ensure that all children with disabilities have available to them a free appropriate public education that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment and independent living” and “to ensure that the rights of children with disabilities and parents of such children are protected….”
IDEA specifically includes Tourette Syndrome under the definition of Other Health Impairment (OHI)§300.8(c)(9)); the Department of Education explains why Tourette Syndrome is included under OHI:
"Discussion: ... we do believe that Tourette syndrome is commonly misunderstood to be a behavioral or emotional condition, rather than a neurological condition. Therefore, including Tourette syndrome in the definition of other health impairment may help correct the misperception of Tourette syndrome as a behavioral or conduct disorder and prevent the misdiagnosis of their needs.
Changes: We have added Tourette syndrome as an example of an acute or chronic health problem in §300.8(c)(9)(i)."
§300.8(c) "Definition of disability terms. The terms used in this definition of a child with a disability are defined as follows:
...(9) Other health impairment means having limited strength, vitality or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that:
(i) is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia, and Tourette Syndrome; and
(ii) adversely affects a child's educational performance"
IDEA regulates Independent Education Programs (IEPs).
- IDEA Basics- audio and slides
- IEP (Individualized Education Program) - Each public school child who receives special education and related services must have an Individualized Education Program (IEP), designed for that student, and must be a truly individualized document. The IEP is developed by teachers, parents, school administrators, related services personnel, and students (when appropriate) documenting the specific supports school personnel will be provided to enable the child to meet individualized academic and functional goals.
- in our online store - IEP Essentials for Parents - Publication #E128 (or downloadable E128DD) - Explains the basics of the IEP including what it is, the steps
to obtain one, the formal meeting process, eligibility, and developing an IEP.
- Understanding Assessments & Evaluations - audio and slides
- IEE (Independent Educational Evaluations) - audio and slides
- LRE (Least Restrictive Environment) - students with disabilities must be educated with non-disabled peers, to the greatest extent appropriate - audio and slides
- F.A.P.E. - Section 504 and the IDEA require that a Free and Appropriate Public Education be provided to all eligible students who attend school which receives funds from the US Dept. of Education.
- FERPA - Family Education Rights and Privacy Act. A Federal statute with the purposes of ensuring that parents have access to their children's education records, and to protect the rights of children and parents by limiting access to these records without parental consent, and to manage misleading or incorrect information.
- Red Flags - article
- Understanding Behavioral Symptoms of Tourette Syndrome- article
- Educator's Guide for Developing IEP and 504 Plans for Students with Tourette Syndrome - article
- Classroom Strategies, Accommodations and Modifications for Students with
Tourette Syndrome - publication #E115b available in our online store for a nominal charge
- Vocal Tics in the Classroom - an Educator's Guide- Webinar - slides, audio, downloads
- Handwriting Issues - article
- A Guide for Paraprofessionals - article
- Tourette Syndrome InService - developed so that anyone can make a presentation about TS
and related issues - slides, videos, downloads, and a video about how to present - view online or ORDER FREE DVD
- Tourette Syndrome in the Classroom, School and Community - Seminar for educators - filmed at an all-day live presentation by members of the Tourette Association Education Advisory Board- addresses the following topics:
- Online Video "Stand Up for Tourette Syndrome"
Short video (3 min., 39 sec.) in which school kids STAND UP for TOURETTE SYNDROME by helping Luke, a young boy with TS explain his TS to a group of kids who have been acting really mean to him - video is downloadable as is a Teachers' Guide - click here.
- DVD with Teacher's Resources:
HBO Documentary, I Have Tourette's But Tourette's Doesn't Have Me.
The DVD features content shown on the HBO broadcast plus a variety of resources for educators, families, and children interested in learning more about Tourette Syndrome, and supplementary information from experts John Walkup, M.D., Susan Conners, M.Ed., and Evan Trost, M.D. DVD available through our online store (#DVD-13M, DVD-13NM, DVD-13V).
Free Teacher's Guide - Click here to View or Download
- Book with Teacher's Resources:
In this novel, Carrie, a seventh-grade girl has just been diagnosed with TS. Targeted to early teens, Quit It explores Carrie's struggles to cope with TS while trying to fit in with her peers. Available in our online store (C100M, C100NM).
Free School Reading Program and Sample Lesson Plan Using Quit It. Click here.
- School-Based Educator/Clinician Programs
The Tourette Association offers programs to special education directors, IEP team chairpersons, regular and special education teachers, school psychologists and social workers, school nurses, paraprofessionals, speech therapists, occupational therapists in professional association, conference, and university settings. Presentations are given on Tourette Syndrome and associated disorders; attendees receive course materials and may receive CEU Approved Credit if available (click here for program details and contact information).
- in our online store - A Workbook for Conducting a Functional Behavioral Assessment and Writing
a Positive Behavior Intervention Plan for a Student with Tourette Syndrome - Publication #E126 - Practical guide and valuable resource to address complex behavioral issues. Includes Overview of Functional Behavioral Assessments, FBA Worksheets, Positive Behavior Interventions.
SELECTED ADDITIONAL RESOURCES