2010­2011 Special Education Paraprofessional Training Series

Supporting Students Who Have Tourette’s Syndrome

January 25, 2011

Dennis Cullen

PaTTAN

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Pennsylvania Training and Technical Assistance Network

PaTTAN’s Mission

The mission of the Pennsylvania Training and Technical Assistance

Network (PaTTAN) is to support the efforts and initiatives of the Bureau of

Special Education, and to build the capacity of local educational agencies to serve students who receive special

education services.

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PDE’s Commitment to Least Restrictive Environment (LRE)

Our goal for each child is to ensure Individualized Education Program (IEP)

teams begin with the general education setting with the use of Supplementary Aids and Services

before considering a more restrictive environment.

Local Policy

Your local school district, IU, preschool or employing agency’s policies regarding paraprofessional job descriptions, duties, and responsibilities provide the final word!

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Learner Outcomes

Participants will

• Develop an understanding of Tourette’s Syndrome

• Identify symptoms and difficulties associated with Tourette’s Syndrome

• Discuss specific ways to respond to students with Tourette’s Syndrome

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Agenda

• Introduction

• What is Tourette’s Syndrome?

• Tic Disorders and Their Impact

– MotorTics

– Vocal Tics

• Associated Symptoms/ Strategies for:

– Attention­Deficit Hyperactivity

– Obsessive Compulsive Disorder

– Learning Disabilities

• Recommendations for paraprofessionals

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Introduction

• Identified by Gilles de la Tourette in 1885

• First reports of a successful drug treatment for TS in the early 1960s

• Current estimates – some 200,000 in the U.S. have the most severe form of TS. – As many as 1 in 100 exhibit milder symptoms

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What is Tourette’s Syndrome?

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Tourette’s Syndrome is a neurological disorder characterized by repetitive, stereotyped, involuntary movements, and vocalizations called tics.

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What is Tourette’s Syndrome (TS)

What is Tourette’s Syndrome (TS)?

• DSM­IV­TR A. Motor and vocal tics need to be present, not

necessarily at the same time

B. Tics occur nearly daily throughout one year, no more than a 3 month tic­free period

C. Tics cause distress or significant impairment in important areas of functioning

D. Onset before age 18

E. Tics cannot be due to effects of a substance or general medical condition

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What is Tourette’s Syndrome (TS)

• Precise cause of Tourette’s unknown

• Current research points to abnormalities in certain brain regions including: – Basal ganglia

– Frontal lobes

– Cortex

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http://tsa­usa.org/index.html

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Tic Disorders and Their Impact

Tic Disorders and Their Impact

• What is a tic?

– Sudden, rapid, recurrent, involuntary or semi­voluntary movement (motor tic) or vocalization (vocal tic)

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Motor Tics

• Simple tics are fast, purposeless movements such as eye­blinking, neck­jerking, shoulder­shrugging, or facial grimacing

• Complex tics may be slower or consist of stereotyped movements, may appear to have purpose, and at some point may be characterized as a “compulsion”

• Echopraxia – involuntary copying of other’s words or behaviors

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Vocal Tics

• Simple vocal tics are characterized as meaningless sounds and noises such as sniffing, throat clearing, snorting, clicking, screeching and barking

• Complex vocal tics are linguistically meaningful utterances such as words or phrases – palilalia ­ repeating one’s own sounds or words – echolalia –repeating what someone else has said – coprolalia ­ obscene, inappropriate & aggressive

words and statements; it is not very common, occurring in less than 5% of TS patients

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Impact of Tics

• Tend to “wax and wane” in response to environmental factors

• May change in frequency, type, and location over time

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Impact of Tics

• May worsen with: • May worsen during – Stress puberty – Anxiety

– Excitement

– Fatigue

– Illness

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Impact of Tics

• Controlling Tics – Some can suppress, 

camouflage, or manage tics

– May result in substantial buildup in tension

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Associated Disorders 

Tourette’s Syndrome Attention  Obsessive­

Deficit Compulsive Hyperactivity 

Disorder Disorder

Learning Disabilities

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Associated Disorders

• Obsessive­Compulsive Disorder (OCD)

• Attention Deficit Hyperactivity Disorder (ADHD)

• Learning Disability (LD)

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Obsessive­Compulsive Disorder (OCD)

• Often described as “tics of the mind”

• Children rarely discuss for fear of being thought of as “crazy”

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Common Obsessions and Compulsions

• Need for • Constant doubt symmetry and • Germ obsessions perfectionism • Ritualistic

• Neatness behaviors • Counting • Need for things to • Checking things be even

repeatedly

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Attention Deficit/Hyperactivity Disorder

• May be the most problematic aspect of TS

• Characterized by – Disorganization

– Disruptiveness

– Impulsivity

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Attention Deficit/Hyperactivity Disorder

• Likely to have difficulty with the following: – Starting a task

– Sequencing information

– Organizing materials

– Regulating the intensity of their emotional responses to situations

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Attention Deficit/Hyperactivity Disorder

• Dysregulated arousal system – “Storms” – uncontrollable rages for what appear

to be absolutely no reason

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Learning Disabilities

• May affect all the basic skills – Reading

– Writing

– Spelling

– Math

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Working with Students with Tic Disorders

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Working with Students with Tic Disorder

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• Draw no attention to the tic

• Allow child to leave the classroom to let out the tics

• Explain to substitutes what might happen in the classroom

• Adjust academic and behavioral expectations as necessary

Working with Students with Tic Disorders

• The student must know that you are “On his side and not on his back.” – Provide appropriate support

– Is the “Safety Net”

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Working with Students with Tic Disorders

• Consider the tics as “symptoms of the disability”

• Inappropriate comments may be a combination of three common symptoms: – Social skills deficits

– Difficulty inhibiting mental responses

– Vocal tics

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Working with Students with Tic Disorders

• Don’t take behaviors personally

• Recognize the student’s strengths and talents

• Behavior modification techniques & negative consequences are not usually effective

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Working with Students with Tic Disorders

• Know when to step back

• Remember the role of the paraprofessional is to provide educational assistance

• Debriefing sessions at the end of the day

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Working with Students with Tic Disorders

• Symptoms and difficulties vary dramatically from student to student

• Never generalize one student’s difficulties, symptoms, or successful strategies – The only thing consistent about TS is the

inconsistencies.

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Resources

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Tourette Syndrome Association, Inc.

http://tsa-usa.org 42-40 Bell Blvd.

Bayside, New York 11361

Information from the National Institute of Neurological

Disorders and Strokes (NINDS)

http://www.ninds.nih.gov/

Contact Information www.pattan.net

Dennis Cullen

dcullen@pattan.net

Phone # 610­265­7321 ext. 7232

Commonwealth of Pennsylvania Thomas W, Corbett, Governor

Pennsylvania Department of Education Amy C. Morton,Acting Secretary

John J.Tommasini, Director Bureau of Special Education

Patricia Hozella,Assistant Director Bureau of Special Education

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Pennsylvania Training and Technical Assistance Network (PaTTAN)

Certificate of Attendance

This certificate is awarded to:

For participation in Training for Special Education Paraprofessionals: Supporting Students Who Have Tourette’s Syndrome

January 25, 2011

The material presented in this training provided coverage of the following skill and knowledge areas:

2K1- Effects an exceptional condition(s) can have on an individual’s life 3K1 - Rights and responsibilities of families and children as they relate to individual learning needs 3S1 - Demonstrate sensitivity to the diversity of individuals and families 4K1 - Basic instructional and remedial strategies and materials 4K2 - Basic technologies appropriate to individuals with exceptional learning needs 4S3 - Use strategies as directed to facilitate effective integration into various settings 5K2 - Rules and procedural safeguards regarding the management of behaviors of individuals with exceptional learning needs 5S3 - Use strategies for behavior management as directed

2 Hours

To validate this certificate, participant must answer the four questions and fill in the code below:

Questions: 1.____ 2.____ 3.____ 4.____ 5.____ Code __________________