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A Guide for Paraprofessionals
Working with Students with TS

Educational success often is dependent on the student experiencing school as a safe environment in which to take risks. Therefore, a paraprofessional who can provide positive supports will assist the student in being successful which will provide a sense of safety that encourages risk taking by that student.  The following are some suggestions for creating this environment.

• The student must know that the paraprofessional is "On his side and not on his back".   The goal should be that the child sees this person as someone who provides appropriate supports and acts as a “safety net”.  He should not perceive this person as someone who is there to correct and/or punish him.  If the student thinks that the purpose of the paraprofessional is to keep him "in line", the result will most likely lead to more difficult symptoms.  Increasing stress will increase symptoms, while decreasing stress typically helps to reduce symptoms.  Reduced symptoms will, in most instances, help to reduce any behavioral difficulties that may be interfering with the educational process.
   
• TS is an extremely complex neuro-behavioral disorder and can involve several other related disorders (ADHD, OCD, sensory issues).  Due to this, it is sometimes helpful for support personnel to consider the student’s difficulties as “symptoms of his disability” rather than JUST “tics”.  For example, inhibiting behaviors can be very difficult for a student with TS.  Simply put, the student’s mental brakes may malfunction.  This can result in behaviors that seem to be purposeful, when in realty they are “symptoms” of this complex disorder.  Inappropriate remarks may be a combination of three common symptoms of TS: social skills deficits, difficulty inhibiting mental responses, and vocal tics.
   
• It is a good idea to provide the paraprofessional time to meet with a teacher, a consultant teacher and/or counselor on a regular basis.  This allows the paraprofessional an opportunity to receive support, to ask questions, to brainstorm and to have a place to vent the frustrations that may arise.  It also provides an opportunity for the paraprofessional to be reminded of the important role he or she plays regarding the success of the student.
  
  
• It is most often preferable to have the paraprofessional work with other students when the student with TS does not require assistance.  In this way, the paraprofessional will be perceived as an assistant to the entire class which will lessen the possibility of the student with TS being stigmatized.
  
  
• Prior to working with the student, the paraprofessional should be provided information regarding TS and educated as to how specific symptoms of the TS and/or related disorders affect this student.  It is important that everyone understand that while a student’s difficult behaviors may appear to be purposeful, in reality they are very likely symptoms of TS or related disorders.  Also students, at times, are able to suppress symptoms, the severity waxes and wanes, and symptoms change. This all adds to the 'appearance' of control on the part of the student thus leading to the misconception that the student can control his symptoms.  The complexity of this neuro-behavioral disorder contributes to the difficulties of working with students who have TS.  The only consistency of TS is the inconsistency.
  
  

Suggestions for paraprofessionals:

• Do not take behaviors personally. This will help reduce anger and frustrations which can result in a strained relationship that is not helpful to the student.
  
  
• Recognize the student's talents and strengths.  They can sometimes be a resource for discussion and assist in developing a positive relationship as well as a good self-esteem for the student.  They may also sometimes be used as a distraction or as a calming strategy.
  
  
• Be aware that behavioral modification techniques and negative consequences are not typically effective approaches for students with TS.  Because symptoms of TS appear to be within the control of the child, it is easy to believe that negative consequence will be an incentive for them to change the behavior.  However, punishment generally does not work because the student's difficult behaviors are due to a chemical imbalance in the brain and, as such, are not purposeful misbehaving, even though they may appear that way.  Instead, strategies or new skills must be taught with the addition of positive and proactive support being provided by adults in order to reinforce these new strategies and skills.
  
  
• By being "tuned in" to the student's needs, a paraprofessional can assist the educational team in developing and implementing proactive and positive strategy as part of the child’s behavior plan.
  
  
• The paraprofessional is often the best person to observe whether specific strategies are successful or not.
  
  
• Be available to the student without hovering over his shoulder.  This can be accomplished by allowing the paraprofessional to assist other students while also recognizing and providing appropriate assistance to the student with TS as needed.  In this way, the paraprofessional will be perceived as an assistant to the entire class which will lessen the possibility of the student with TS being stigmatized.
  
  
• Having an extra adult in the classroom who can provide extra support to other students may make it possible for the teacher to more frequently provide the 1:1 attention the student with TS may require.
  
  
• Much success has been experienced when providing a paraprofessional for a student who has social skills deficits.  The paraprofessional is able to work in conjunction with the counselor or the speech therapist by reinforcing techniques that have been taught during individual or group sessions.
  
  
• It is important to know when to “step back” and to allow interaction with other students.  While in many cases a paraprofessional is helpful in discouraging teasing and bullying, it is also important to remember that typical interaction with peers is important for social skills growth.
  
  
•  A paraprofessional should never take on the role of advisor or therapist for the student.  Students with TS may require counseling support but it must be from a person trained as a counselor and is familiar with TS.  A child’s emotional well-being is fragile and a well-intended remark can sometimes affect a student in a manner that is not planned and can be counterproductive.  It is important that the paraprofessional keep in mind that his/her role is to provide educational assistance and not counseling.  Example:  A paraprofessional was repeatedly telling a young boy with TS that if he continued to say “bad things” that he would never have any friends.  The paraprofessional was attempting to provide the student with an incentive to change his behavior when in reality she was adding stress and a sense of hopelessness for the student who had uncontrollable vocalizations. 
  
  
• There may be situations where it works well to have the same paraprofessional work with a student year after year.  Other times, it may be necessary to rotate paraprofessionals if the student and/or the paraprofessional loses the sense of boundaries necessary for the relationship to foster educational independence. This should not be seen as failure - only that the situation needs to be changed for the well being of the student.
  
  
• For children with mood or rage issues, the paraprofessional can often recognize an when frustration or anxiety begin to escalate and assist in implementing the positive and proactive strategies that assist the student remain calm and in control.
  
  
•  A debriefing session the last 5-10 minutes of school MAY be invaluable in assisting with the school/home transition. Some students work hard to “keep it together” during the school day.  It may be helpful for the teacher or paraprofessional to privately ask the student to tell them one thing that was stressful today and one thing that was successful. This can be very helpful to some students as it allows them an opportunity to validate their difficulties as well as their accomplishments for that day.
  
  
• It must be noted that symptoms and difficulties vary dramatically from student to student and one must never generalize one student's difficulties, symptoms or successful strategies to be representative of all student with TS.  This is a common mistake that can have a devastating outcome.  Remember, the only thing that is consistent about TS is the inconsistencies.
  
  
• Many of the resources available through this Tourette Syndrome Association, Inc. website (tsa-usa.org)can be of assistance to paraprofessionals.

For additional general special education resources visit the IDEA Practices Website: www.ideapractices.org and www.fape.org