Question:

I have a student in my second grade class who has Tourette syndrome. Tommy is more distractible than any student I have had in my 20 years of teaching. He gets NOTHING done unless someone sits next to him the whole time, and I can’t do that. Despite his lack of work production, he is able to do work at grade level.

He often reacts to small things in big ways and the other students don’t know what to make of him; he has no friends. He goes to the resource room for 45 minutes each day. I am wondering if he needs a smaller classroom because I don’t feel I can meet his needs. Please give me some suggestions.

Thanks.

Molly in San Jose

Answer:

Thanks for your question. You don’t mention any motor or vocal tics and the presence of both of these is required for a diagnosis of Tourette. These tics are often the focus of questions about including students in the general education classroom but since you don’t mention them, it raises doubts in my mind about the diagnosis. You also don’t mention any obsessive or compulsive behaviors that often accompany Tourette. What you describe is Attention Deficit behavior (I don’t hear in your description hyperactivity, as much as inattention) that is extreme in severity and what I interpret as his being very easily frustrated. Here is what I would think about for Tommy:

• If you are not seeing tics (and he must have motor and vocal), I would share that information with his family and ask them if Tommy’s physician could give the school some information.

• Is Tommy taking any medication for the ADD symptoms? While there is no medication for Tourette per se, medications that target symptoms that impact his functioning are available. Some stimulant medications are not appropriate for children with Tourette; Tommy’s physician should be one familiar with Tourette (see resources below)

• AskaSpecialist has our own Attention Deficit specialist, Shari Gent. Ooodles of ideas and suggestions for working with students who have difficulty with task initiation & completion and other attention problems. Check it out! http://www.askaspecialist.ca.gov/adhd.htm Check out the archives. Shari also offers a (free) full day training in Northern California. Our website gives dates and places where she will be presenting next school year. http://www.dcn-cde.ca.gov/Trainings/Scheduled-trainings.htm

• Tommy’s IEP team may wish to review the supports and services he needs to receive a free and appropriate education in the least restrictive setting. He may need more in-class support and/or some mental health services and/or some school counseling, for example to assist with implementing the ideas below.

• The short fuse and overreaction you describe are not unusual for children with Tourette syndrome. They can be very difficult for the child and for the rest of the class, including you. Some ideas:

• Tommy’s responses are not volitional, at least to some extent. He is wired to react strongly. He needs to learn to recognize his behavior and begin to know when he is beginning to feel the loss of control. See an archived Askaspecialist: http://www.askaspecialist.ca.gov/archives/2005/behavior/Sept_2005.htm
• Individualized rating Scales are another way to build self awareness and to see its connection to behavior.

Individualized Rating Scales

Individualized Rating Scales (IRSs), are tailor made for each situation and measure identified targets. The student rates herself, and so do relevant other persons (e.g., one-to-one aide, teacher, parent). IRSs are particularly useful in measuring intensity but can also rate seriousness, importance or frequency. They document change over time and the effectiveness of interventions.

Here is an example of an IRS for Irene:

Problem: I am asked to do something I am not in the mood for. Circle the best description of how I felt:

Outcome: Here’s how I handled it:

Have Irene use this IRS whenever she feels herself getting angry. Compare her scores with the ones the staff have graded. At the end of each day, make an average of her scores for each scale. At the end of the week, graph the cumulative average of each scale.

Adapted from: Bloom, M., Fischer, J., & Orne, J.G. (2003). Evaluating practice: Guidelines for the accountable professional (4 th ed.). Englewood Cliffs, NJ: Prentice-Hall.

Other Resources:
For you:

• (1995) Dornbush, M.P. & Pruitt, S.K.Teaching the tiger: a handbook for individuals involved in the education of students with attention deficit disorders, Tourette syndrome or obsessive compulsive disorders

For Tommy:

• (1990) Buehrens, A. Hi, I’m Adam a child’s book about Tourette Syndrome

For the Family:

• (1992) Haerle, T. Children with Tourette syndrome: a parent’s guide
• The Tourette’s & Tic Disorders Clinic UCSF Medical Center 415 476-7372
• http://www.tourettes-disorder.com/home.html
• http://www.tourettesyndrome.net/