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Tic Disorders

 

Tic Disorders

Characteristics of Tic Disorders.

  • Repetition of involuntary muscle movement (motor tics) (UCLA, 2007).

  • Repetition of involuntary vocalization (vocal tics) (UCLA, 2007).

  • Associated with poor social skills, aggression, impulsivity, mood disturbance (UCLA, 2007).

  • Worsen in stressful situations (UCLA, 2007).

  • Movement or sound is brief, with no purpose (Packer, 2001-2005).

  • Can occur in any part of the body--external or internal (The Tourette Syndrome Association, Inc., 2007).

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DSM-IV Definition criteria for Tic Disorders

There are four disorders.

Tourette’s Disorder

Chronic motor or Vocal Tic Disorder

Transient Tic Disorder

Tic Disorder Not Otherwise Specified

Tic

Sudden

Rapid

Recurrent

Nonrhythmic

Stereotyped motor movement

Or vocalization

Exacerbated by stress.

Attenuated during absorbing activities.

Markedly diminished during sleep.

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Common Tics

Eye blinking

Neck jerking

Shoulder shrugging

Facial grimacing

Coughing

Grunting

Sniffling

Snorting

Barking

Facial gestures

Grooming behaviors

Jumping

Touching

Stamping

Smelling

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Complex Vocal Tics

Coprolalia: Repeating words or phrases out of context

Palilalia: Repeating one’s own sounds or words

Echolalia: Repeating the last-heard sound, word, or phrase

Echokinesis: Imitation of some else’s movements

DSM-IV Definition criteria for Tourette's Syndrome (Pediatric Nursing, 2002).

  1. Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently.

  2. The tics occur many times a day (usually in bouts), nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months.

  3. The disturbance causes marked distress or significant impairment in social, occupational, or other important areas of functioning.

  4. Onset is before age 18 years.

  5. The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington's disease or post-viral encephalitis).

Treatment

  • Medication

  • Behavior therapy of self-monitoring, reward charts to track progress, habit reversal training, stress management techniques (UCLA, 2007).

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Manner in which the disorder presents in school age children and adolescents.

  • "Good mental health is critical to everyone--as important as physical health in determining quality of life. . . . 1 in 10 children and adolescents suffers from a mental illness serious enough to impede development and learning" (Kerr & Nelson, 2006, p. 318) 

  • 1 in 100 have Tourette Syndrome (some estimates as high as 1/50).  Same incidence in all ethnicities all over the world.

  • Tics are common during childhood (13% boys and 11% girls) (UCLA, 2007).

  • More than 18% of all children have a tic at some point in development (Packer, 2001-2005).

  • Transient tics last less than one year (Packer, 2001-2005).

  • Chronic tics do not go away (The Tourette Syndrome Association, Inc., 2007).

  • Although rare, sometimes students with Tourette's may say obscene words or make obscene gestures (less than 10% of those with TS).  These students should not be blamed for that behavior (The Tourette Syndrome Association, Inc., 2007).

  • "3% of children in regular education classrooms may have Tourette's Syndrome; more than 7% of children in special education have Tourette's Syndrome. The majority of these children have never been diagnosed" (Packer, 2001-2005).

  • Average age of onset is 6-7, peak at age 10-12, and frequently end by age 18 (Packer, 2001-2005).

  • Tics may wax (increase) and wane (diminish) or erupt suddenly (Packer, 2001-2005).

  • Effort to suppress tic can distract from learning (Packer, 2001-2005).

  • ADHD and obsessive-compulsive disorder may be involved (TheTIC.info, 2006).

  • Most kids with TS will get better as they get older, some get worse, but 90% of adults still have tics.

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Quoted directly from Packer, 2001-2005

Factors that may Increase Tics:

  • Allergies

  • Arousal

  • Asked to suppress tics (delayed reaction)

  • Before and after performing skilled tasks

  • Caffeine

  • Environmental heat

  • Fatigued

  • Illness (infections)

  • Premenstrual period

  • Starting to relax

  • Stress

  • Talking to the student about their tics

  • Time pressure

  • Waxing cycle

Factors that May Decrease Tics:

  • Asked to suppress tics (initial response)

  • Distracted

  • Doctor's examining room

  • During skilled tasks

  • During sleep

  • Nicotine

  • Non-anxiously engrossed

  • Novel situation

  • Summer vacation

  • Waning cycle

 

Organizational Links

 

Anxiety Disorders among children

SchoolBehavior.com: Tourette's Syndrome

Tic Disorders | American Academy of Child & Adolescent Psychiatry

Tourette Syndrome Association TSA Home Page

Tourette Syndrome Plus - Education Table of Contents

Tourette's Syndrome at School - The Tic

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Academic Concerns & Interventions

40% of individuals with TS are reported to have learning problems (Prestia, 2003).

Academic challenges.

Emotional challenges.

Physical challenges.

Special education services or 504 (Prestia, 2003).

Refer for screening using multi-disciplinary team.

Give assignments in smaller sections.

Decrease paper & pencil tasks.

Allow oral response or dictate into recorder.

Preferential seating.

Grid paper for math problems.

 

 

Notebooks with contrasting colored lines.

Verbal with visual instructions.

Set reasonable limits for assignments.

Reducing assignment.

Provide testing modifications.

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Social-Emotional Concerns (Prestia, 2003).

Promote acceptance & understanding through modeling.

Provide accurate information to all students in kid-friendly terminology.

Use student strengths to connect to peers.

Advocate for all—Develop a friendship group.

Diffuse & prevent confrontations through information.

Teach students how to deal with bullying.

Create a predictable daily routine in a posted visual schedule.

Praise all positive behaviors & efforts.

Develop self-confidence.

Promote self-esteem.

Incorporate direct teaching of basic social skills.

 

Take time for the teachable moment.

Provide guidelines for addressing social skills and classroom interventions based on RtI models.

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Physical Concerns & Interventions (Prestia, 2003).

Can cause damage to muscles & joints.

Keep room clear accident spots.

Vocal tics – Drink plenty of water.

Home base or safe area away from others for releasing tics.

If self-injurious, show safer method (hit pillow instead of leg)

Ask Occupational Therapist or Special Ed Team

For ideas.

To complete a sensory profile (comprehensive evaluation of motor skills).

 

"Our best academics efforts and interventions will not suffice unless we also pay attention to the social-emotional well-being of students who tend to have problems interacting with and being accepted by peers.

In Conclusion

Identifying challenges, developing interventions that use the student’s strengths, and promoting an environment that values diversity and acceptance of others are key components to unlocking the potential of students with tic disorders.

With carefully planned interventions and adaptations, the success of students with tic disorders in the school setting can be enhanced.

 

 

 

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References and Resources

Baron-Cohen, S., & Izaguirre, J. (1999). The prevalence of Gilles de la Tourette's Syndrome in children and adolescents with autism. Journal of Child Psychology & Psychiatry & Allied Disciplines, 40(2), 213.

Burd, L., Freeman, R., Klug, M., & Kerbeshian, J. (2006). Variables associated with increased tic severity in 5,500 participants with Tourette Syndrome. Journal of Developmental & Physical Disabilities, 18(1), 13-24.

Canitano, R., & Vivanti, G. (2007). Tics and Tourette syndrome in autism spectrum disorders. Autism: The International Journal of Research & Practice, 11(1), 19-28.

Chamberlain, S. (2003). Susan Conners: An educator's observations about living with and educating others about Tourette's Syndrome. Intervention in School and Clinic, 39(2), 99-108.

Channon, S., Sinclair, E., Waller, D., Healey, L., & Robertson, M. (2004). Social cognition in Tourette's syndrome: intact theory of mind and impaired inhibitory functioning. Journal of Autism & Developmental Disorders, 34(6), 669-677.

Chowdhury, U., & Christie, D. (2002). Tourette syndrome: a training day for teachers. British Journal of Special Education, 29(3), 123-126.

Clarke, M., Bray, M., & Kehle, T. (2001). A school-based intervention designed to reduce the frequency of tics in children with Tourette's syndrome. The School Psychology Review, 30(1), 11-22.

Crawford, S., Channon, S., & Robertson, M. (2005). Tourette's syndrome: performance on tests of behavioural inhibition, working memory and gambling. Journal of Child Psychology & Psychiatry, 46(12), 1327-1336.

De Lange, N., Olivier, M., & Meyer, L. (2003). Tourette's syndrome: Isn't that the foul mouth disease?. Early Child Development & Care, 173(6), 613-635.

Gaze, C., Kepley, H., & Walkup, J. (2006). Co-occurring psychiatric disorders in children and adolescents with Tourette Syndrome. Journal of Child Neurology, 21(8), 657-664.

Himle, J., Fischer, D., Etten, M., Janeck, A., & Hanna, G. (2003). Group behavioral therapy for adolescents with tic-related and non-tic related obsessive compulsive disorder. Depression & Anxiety, 17(2), 73-77.

Iannucci, L. (2004). A harmless tic?. Parenting, 18(8), 36-36.

Kerr, M. M., Nelson, C. M. (2006). Strategies for addressing behavior problems in the classroom. (5th ed.) Upper Saddle River, NJ: Pearson.

Meidinger, A. L., Miltenberger, R. G., Himle, M., Omvig, M., Trainor, C., & Crosby, R. (2005). An investigation of tic suppression and the rebound effect in tourette's disorder. Behavior Modification, 29(5), 716-745.

Munson, B. (2005). . . . About Tourette's syndrome. Nursing, 35(8), 29-29.

Olson, L., Singer, H., Goodman, W., & Maria, B. (2006). Tourette syndrome: Diagnosis, strategies, therapies, pathogenesis, and future research directions. Journal of Child Neurology, 21(8), 630-641. 

O'Neill, T. (2002). Post-traumatic school disorder. Report / Newsmagazine (National Edition), 29(19), 51.

Packer, L. E. (2001-2005). Overview of tics and Tourette’s. SchoolBehavior.com. Rectrieved April 6, 2007 from http://www.schoolbehavior.com/conditions_ts.htm

Packer, L. E. (2005). Tic-related school problems: Impact on functioning, accommodations, and interventions. Behavior Modification, 29(6), 876-899.

Pediatric Nursing. (2002). Tourette's syndrome. Medscape Today. Retrieved April 6, 2007 from http://www.medscape.com/viewarticle/442029_2

Piacentini, J., & Chang, S. (2005). Habit reversal training for tic disorders in children and adolescents. Behavior Modification, 29(6), 803-822.

Prestia, K. (2003). Tourette's syndrome: Characteristics and interventions. Intervention in School & Clinic, 39(2), 67-71.

Robertson, M. (2006). Attention deficit hyperactivity disorder, tics and Tourette’s syndrome: the relationship and treatment implications. A commentary. European Child & Adolescent Psychiatry, 15(1), 1-11.

Scahill, L., Sukhodolsky, D., Bearss, K., Findley, D., Hamrin, V., Carroll, D. H., & Rains, A. L. (2006). Randomized Trial of Parent Management Training in Children With Tic Disorders and Disruptive Behavior. Journal of Child Neurology, 21(8), 650-656.

Shin, M., Kim, Y., Cho, S., & Kim, B. (2003). Neuropsychologic Characteristics of Children With Attention-Deficit Hyperactivity Disorder (ADHD), Learning Disorder, and Tic Disorder on the Rey-Osterreith Complex Figure. Journal of Child Neurology, 18(12), 835-844.

Spangler, J. (2005). Did you see…?. Update, 71(1), 9-9.

TheTIC.info (2006). Tourette's syndrome at school. The Tourette's Information Center. Retrieved April 6, 2007 from http://www.thetic.info/tourettes/school.php

The Tourette Syndrome Association, Inc. (2007). Tic disorders. Bayside, NY: American Academy of Child & Adolescent Psychiatry. Retrieved April 6, 2007 from http://aacap.org/page.ww?name=Tic+Disorders&section=Facts+for+Families

UCLA" Neuropsychiatric Institute, (2007). Tourette's disorder and other tic disorders. Los Angeles, CA: UCLA" Neuropsychiatric Institute. Retrieved April 6, 2007 from http://www.npi.ucla.edu/caap/anxieties/Tourette.htm

Watson, T., Dufrene, B., Weaver, A., Butler, T., & Meeks, C. (2005). Brief antecedent assessment and treatment of tics in the general education classroom: A preliminary investigation. Behavior Modification, 29(6), 839-857.

Wessman, C. (2000). Pedagogy and the unconscious: Tourette's syndrome in the classroom. ADE Bulletin, (124), 29-32.

Woods, D. W., & Himle, M. B. (2004). Creating tic suppression: Comparing the effects of verbal instruction to differential reinforcement. Journal of Applied Behavior Analysis, 37(3), 417.

Woods, D., & Marcks, B. (2005). Controlled evaluation of an educational intervention used to modify peer attitudes and behavior toward persons with Tourette's Syndrome. Behavior Modification, 29(6), 900-912.

Woods, D., Koch, M., & Miltenberger, R. (2003). The impact of tic severity on the effects of peer education about Tourette's Syndrome. Journal of Developmental & Physical Disabilities, 15(1), 67-78.

Zhu, Y., Leung, K., Liu, P., Zhou, M., & Su, L. (2006). Comorbid behavioural problems in Tourette's syndrome are positively correlated with the severity of tic symptoms. Australian & New Zealand Journal of Psychiatry, 40(1), 67-73.

 

 

 

Citation for this page: Aitken, J. E., & Sawyer, M. A. (2007). Tic disorders. Kansas City, MO: OnlineAcademics.Org.