From TSA Educator's In-Service Program on Tourette Syndrome ...
From TSA Educator's In-Service Program on Tourette Syndrome,
pages 4-7, 14-15, 25-27
TS is a hereditary, neurological disorder that begins in childhood. Tourette
Syndrome is much more prevalent and not the rare disorder it was once thought
to be. It occurs three times more commonly in boys than in girls.
TS is characterized by motor and vocal tics. A motor tic is an involuntary, rapid,
sudden movement that occurs repeatedly. Examples of motor tics might include
but are not limited to:
• head- jerking;
• facial grimaces.
A vocal tic is a sound, noise, word, or group of words that is meaningless or out
of context. Common examples of vocal tics are:
In addition, there are three other unusual types of vocal tics that people with TS
• Echolalia is the involuntary repetition of what someone else has just said.
Part or all of what has been said may be repeated.
• Palilalia is the involuntary repetition of one’s own words.
• Coprolalia is the most infamous and problematic type of vocal tic. It refers
to the involuntary utterance of curse words, ethnic or racial slurs, or
socially inappropriate phrases or sentences, often with sexual
connotations. These may be quite elaborate in nature and, therefore,
misinterpreted as intentional utterances. Coprolalia is not necessary for a
diagnosis of TS.
Since tics are idiosyncratic in nature, virtually any movement or sound that is
involuntarily repeated can be thought of as a tic. It is a common occurrence
for people with TS to imitate the movements of others including tics of other
people with the disorder. Therefore, words or behaviors of others may be
involuntarily copied and become a tic. This is called Echopraxia.
Unfortunately, for people with TS, this is often perceived as intentional
You should not rely on the information in these materials as a substitute for consultations with qualified health care
professionals who are familiar with individual medical conditions and needs. TSA strongly recommends that care and treatment
decisions related to Tourette Syndrome and any other medical condition be made in consultation with a patient's physician
or other qualified health care professionals who are familiar with the specific individual's health situation.
Both motor and vocal tics tend to “wax and wane” in response to
environmental factors. Tics may change in frequency, type, and location over
time. Environmental factors that make tics worse include:
• stress anxiety
The symptoms of TS may worsen during puberty and may improve after the
adolescent years. TS is a chronic, lifelong disorder.
Tell the class that the disorder is probably caused by abnormal metabolism of
at least one brain chemical causing varying symptoms in different family
At present, there is no medical test to prove or disprove the presence of TS
and the carrier gene or genes have not yet been identified. Below are the
criteria that physicians use to diagnose TS:
1. Multiple motor and one or more vocal tics present for at least one year
although not necessarily simultaneously.
2. The occurrence of tics many times a day (usually in bouts) nearly every
day or intermittently throughout a span of more than one year.
3. Periodic changes in the number, frequency, severity, type, and location of
the tics. Symptoms can sometimes disappear for weeks or months at a
4. Onset before the age of 18 years but most typically between the ages of 6
and 8 years.
Not everyone with tics has TS. Tic disorders can be differentiated on the basis of
duration of the tics and age at onset. Transient Tic Disorder is characterized by
tics lasting for at least four weeks, but for no longer than 12 consecutive months.
Chronic Motor Tic Disorder is characterized by at least one motor tic and no
vocal tics, while Chronic Vocal Tic Disorder is characterized by at least one
vocal tic and no motor tics.
Tell the class that Tourette Syndrome is a neurobiological spectrum disorder
and, therefore, is most often accompanied by other neurological conditions. The
most common associated genetic neurological disorders are:
• Obsessive-Compulsive Disorder;
• Attention Deficit Hyperactivity Disorder;
• Learning Disabilities.
In addition, students may exhibit other neurobiological symptoms including
executive dysfunction, depression, anxiety disorders, sleep disorders, fine-motor
difficulties, aggressive and/or explosive behavior, and sensory defensiveness.
Tell the audience that these associated characteristics often create the greatest
challenge, not only to the student but to the classroom teacher.
Emphasize the importance of knowing that with Tourette Syndrome and its
associated disorders, the tics may not be the most disruptive problem in a
classroom setting. Understanding the associated disorders is as crucial to
educating the student as understanding Tourette Syndrome.
Tell the class that OCD is often not apparent to other students or to the teacher
but is a related neurological disorder that affects an extremely large number of
persons with TS. It is often described as “tics of the mind” and may be another
expression of the TS gene. Children with OCD rarely disclose their troublesome
thoughts, hesitating to discuss them for fear that others will think they are “crazy.”
Emphasize that little of the OCD process is visible to the teacher or to other
Tell the class that obsessions are intrusive thoughts, images, or impulses that
are very unpleasant and on which your mind gets stuck. Compulsions are
behaviors that are used to reduce the anxiety accompanying the obsessions.
Common obsessions and compulsions include:
• Need for symmetry and perfectionism;
• Evening things up;
• Checking things repeatedly;
• Constant doubt; Germ obsessions;
• Ritualistic behavior.
Emphasize that OCD is a neurological disorder characterized by being stuck,
driven and perfectionistic. Tell the class to review the other handout from TSA’s
Educator’s Curriculum for diagnostic criteria of OCD.
From Educator’s In-service Program on Tourette Syndrome
Information from Pages 14 and 15
The Truth about Common Fears and Misconceptions
People with TS are NOT emotionally disturbed and are NOT dangerous.
TS is primarily a neurological disorder. Although there are sometimes problems
Associated with TS (ex. Anxiety, depression), people with TS are NOT crazy.
People with TS are NOT mentally retarded.
People with TS reflect the general population, although their intelligence is skewed
slightly toward the superior end or the spectrum.
Yon CANNOT catch TS and you CANNOT die from TS.
TS is a genetic disorder that is not life threatening.
Children with TS ARE responsible for their actions.
Children with TS must be helped to take responsibility for their own behavior and not
be punished for it. Children with TS are NOT responsible for their medical disorder, but
are responsible for its impact on other people.
Children with TS DO NOT manifest the same symptoms, or severity of
symptoms, all the time.
The disorder waxes and wanes over time. People with neurological impairments, such
as TS, manifest a wide variability in functioning from hour to hour. Things are always
Tics CANNOT always be clearly differentiated from behaviors.
TS is far more than tics. Tics and associated behaviors seem to merge and are difficult
Disorganization and impulsivity in NOT willful.
Often children with TS manifest symptoms of ADHD. This is an associated disorder
and the symptoms are not willful.
People with TS DO NOT always swear.
Actually, only about 10% of people with TS demonstrate Coprolalia (which means they
Medication will NOT cure TS.
Medications can help with some of the symptoms, sometime…but they do not
generally suppress the wide range of symptoms associated with TS.
People with TS CANNOT control the symptoms if they want to.
The fact that some people can control the symptoms some of the time confuses
TOURETTE SYNDROME - fr. Ed.Curric.p.25-27
Tourette Syndrome (TS) is a neurological disorder characterized by tics – involuntary, rapid,
sudden movements that occur repeatedly in the same way. The tics may occur many times a day
nearly every day or intermittently. Tics periodically change in number and frequency, type and
location and wax and wane in their severity. While some persons with TS have limited control of
their symptoms from seconds to hours at a time, suppressing them may merely postpone more
severe outbursts. Tics increase as a result of stress anxiety, excitement and fatigue. They often
decrease with relaxation or concentration on a absorbing task.
MOTOR TICS VOCAL TICS
Eye Blinking Hair Tossing Throat Clearing
Eye Rolling Arm Flexing Grunting
Head Jerking Arm Flapping Sniffing
Facial Grimaces Smelling Fingers Belching
Facial Contortions Abdominal Jerking Spitting
Nose Twitching Tearing Things Snorting
Scratching Squatting Squeaking
Kissing Gesture Skipping Coughing
Hitting Self Stepping Backwards Humming
Clapping Walking On Toes Yelling
Pinching Twirling Whistling
Shoulder Shrug Knee Bending Hissing
Knee Knocking Foot Tapping Laughing
Leg Jerks Foot Shaking Screaming
Stooping Foot Dragging Yelping
Jumping/Hopping Chewing On Clothes Barking
Stomping Kicking Moaning
Finger Tapping Pulling At Clothes Saying Words
Lip Pouting Somersaults Clicking
Lip Licking Body Slamming Gasping
Tongue Thrusting Mouth Stretching Guttural Sounds
COMPLEX TICS – Repeating phrases, words, parts of words; Animal sounds; Stuttering;
Amplitude of speech; Muttering; Palilalia – repeating one’s own words; Echolalia – repeating
other’s words; Coprolalia – using obscenities/socially taboo phrases.
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OBSESSIVE COMPULSIVE DISORDER
Obsessions are repetitive, unwanted thoughts. Compulsions are repetitive, ritualistic acts
that must be performed to rid oneself of the obsession.
Concern for symmetry/order Adjusting clothing to
Concern for cleanliness feel just right
Over focusing on minute details Evening things up
Having to have “just right” feeling Counting objects
Over focusing on moral issues Excessive ordering/arranging
Over focusing on one idea objects fiddling with
Focusing on specific numbers
Needing to experience sensations Checking & rechecking
Preoccupation with knives/blood, etc. Repeating actions
Worrying about harming self or others Needing to say or do what
Concerned about germs/dirt told not to do
Hoarding/collecting Needing to start over if
Thinking about forbidden behaviors interrupted
Mental coprolalia (sexual thoughts/images) Repeating the same questions
Aggressive thoughts/images Perseverating on a task
Obsessive fears Not able to change tasks
Echopraxia (repeating the actions
Touching objects, others, self
Sexually touching self
Tourette Syndrome Association, Inc. Picking skin/sores
0 42-40 Bell Boulevard
Bayside, NY 11361-2820
Smelling hands or objects
Licking self or others
Excessive hand washing/bathing
• Often fidgets with hands/feet
• Difficulty remaining seated
• Easily distracted/engages in physically dangerous activities
• Blurts out answers – loses everything
• Difficulty waiting turn
• Difficulty following through on instructions/organizing work
• Shifts from one uncompleted task to another
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FEARS AND MISCONCEPTIONS ABOUT TOURETTE SYNDROME
• That people with TS are emotionally disturbed and dangerous. TS is primarily a
neurological disorder. Although there are sometimes associated psychiatric problems
(e.g., anxiety, depression), persons with TS are not crazy;
• That people with TS are mentally retarded. People with TS reflect the general
population, although their intelligence is slightly skewed toward the superior end of the
• That you might catch the disorder and even die from it. TS is a genetic disorder that is
not life threatening;
• That children with TS are not responsible for any of their actions. The child with TS
must be helped to take responsibility for his/her behavior and not be punished for it. The
child is not responsible for his/her medical disorder, but he is responsible for its impact
on other people;
• That children with TS manifest the same symptoms and severity of symptoms all the
time. The disorder waxes and wanes over time. People with neurological impairments,
such as TS, manifest wide variability in functioning from hour to hour. Therefore, all
interventions must be highly flexible;
• That the tics can be clearly differentiated from the behaviors. TS is far more than tics.
The tics and behaviors associated with TS and the associated disorders merge and are
difficult to separate;
• That the disorganization and impulsivity is willful. Often, these symptoms are
manifestations of ADHD, an associated disorder, and are not willful;
• That people with TS always swear. Less than one-third of persons with TS have
• That medication will cure the disorder. Medications will help to ameliorate some of the
symptoms some of the time, but they generally do not fully suppress the wide range of
symptoms associated with TS;
• That people with TS could control the symptoms if they want to. The fact that people can
control the symptoms some of the time confuses everyone.
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