Tic, Tic, Tic
In Teaching the Tiger, Darin reflects in adulthood what living with Tourette’s Syndrome was like: “How did school go today?” I tic tic wish fidget scratch I tic were scratch twitch more wink tic wink like the swallow tic twitch other fidget kids tic swallow scratch at wink fidget tic tic pop school sigh blink tic.” “I know you do, dear.” Tourette’s was discovered by Georges Gilles de la Tourette. Doctors have concluded that Tourette’s is overwhelmingly genetic, although parents may not notice their own symptoms. Christner and Dieker note that it is common for sufferers of tic disorders to also have other learning disabilities, ADHD, ADD, but most common is OCD (2). In order to diagnose a Chronic Single Tic Disorder, the patient must have multiple motor tics, at least one vocal tic, and have occurred almost every day or intermittently for more than 12 months. Onset is usually by the age of 7, but must be by the age of 21 to be considered Tourette’s. Transient Tic Disorder is different in that the symptoms may change in type, location, frequency, and severity. Chronic Multiple Tic Disorder is characterized by motor OR vocal tics, but not both. Approximately 10-15% of those diagnosed with Tourette’s will develop coprolalia, which is the involuntary vocalizations such as cursing (Dornbush and Pruitt 9, 11).
Motor tics can be the flailing of arms or legs, jerking, facial grimacing, hand clenching, clapping, spitting, and many other physical movements. Vocal tics are usually seen as throat
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clearing, gasping, making motor noises, but also can be shouting, snorting, clicking, or even laughing, just to name a few. Tic disorders can be treated with medication in severe cases. Most cases are mild and are best treated by the acceptance, understanding, and the encouragement of family, teachers, and friends (Packer, np). In the article “Locus of Control, Perceived Parenting Style, and Symptoms of Anxiety and Depression in Children with Tourette’s Syndrome”, the authors suggest that a there is a higher rate of anxiety and depression among children that have an external locus of control, meaning that they don’t believe they can control their thoughts, or that they are not responsible for their surroundings (Cohen et al. 2). There are some children whose symptoms nearly disappear by adolescence, and others that get worse. Many sufferers learn more control and thus their tics seem less in adulthood.
Teaching a student with TS can be challenging. Motor and vocal tics can be disruptive to other students. There must be acceptance and an understanding of the disorder from peers, and just as important, patience from the teacher. A child with TS cannot control the tics. They may be able to hold them in for a while, but eventually they have to get them out. A beautiful clip of several young children coping with Tourette’s tells the story at http://www.youtube.com/watch?v=HPmpIY7XJVE. Dornbush and Pruitt stress the importance that the teachers “remain aware that the student is being bombarded with internal stimuli” (35). A teacher reflects on her student with TS: “In fact, just when I thought I had one of the boys all figured out, his
tics changed leading to a resulting change in behavior. I tried instructional strategies that worked for a while and then suddenly become ineffective” (Christner and Dieker, 1). The TS student often has bad handwriting, difficulty following verbal instructions and completing work, disorganization of work, and is often inattentive or distracted (Prestia, 2). As noted before, many TS sufferers also exhibit OCD
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symptoms and so that must be taken into consideration in the classroom. Praising the student frequently encourages him, motivates him, and gives him a feeling of self worth. As one article explores the profound importance of this confidence, the lack thereof can be devastating (Cohen et al. 2). Teaching the Tiger gives hundreds of tips, everything from inclusion to long division. An issue in School Psychology Review suggests that habit reversal using competing responses is a great tool in reducing the severity of tics (Bray et al. 1).
My son started showing symptoms when he was about 3. He used to complain that his bum hurt, so I would softly rub his little bum every night in bed. His body was so tense from the tics it was making him sore. He still sleeps with a heating pad. He blinked a lot. He made funny faces that I would desperately ask him to stop. He frequently had night terrors. He responded to many situations by hitting himself, or, for example, the table that he stubbed his toe on. It wasn’t until his 6th birthday that I decided to challenge my pediatrician’s assumption that kids have tics, and eventually they will stop. I’ll never forget sitting outside at Fiesta Fun Center where we decided to celebrate his birthday. He was so excited, and his tics became more noticeable that afternoon. It alarmed me, and so I sat for 15 minutes or so, trying to figure out if he could stop. Coaxing him to relax and concentrate on holding still made them more pronounced. I realized that day that he couldn’t help it, so I followed up with a neurologist and the doctor confirmed he had a mild form of Tourette’s. His kindergarten teacher barely noticed anything besides the throat clearing. His first grade teacher noticed the eye blinking. At home he would let it all out. Throat clearing, stretching his face, blinking, shaking his arms, or kicking out a leg. It made nightly reading a real challenge. I couldn’t imagine how difficult it must be for him to focus on a sentence in a book, only to be jolted by a tic, and have to try and pick up where he left off. I noticed that the tics gained momentum when he was nervous, in an unfamiliar place, around unfamiliar people, tired, or angry. His 2nd grade teacher called me one day and said she thought he was going to have a
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seizure, even after I explained Tourette’s to her. Some children have made comments to him, but he has dealt with them well. He is very popular in school, a bit of a class clown sometimes, and well above his grade level most subjects. He is struggling in math this year, learning about borrowing and carrying over. Trying to keep his numbers in columns so he can see what he is doing is a bit of a challenge. A visit to his assigned desk one day revealed that he destroys his pencils. Shaving them, cutting them, and ripping the erasers off. Little does he know, he is probably successfully suppressing his tics, saving them for a more appropriate time. He doesn’t notice his tics. He doesn’t need intervention at this point. I have asked the Special Education Director at his school to check on him periodically. She offered him some jolly ranchers one day. She said, “Nick, these might help you when you feel like you need to make that noise in your throat.” His reply was, “I don’t really think that’s necessary.” There are children whose symptoms disappear as they get older. There are others that get worse. Only time will tell. Helping my son to help himself is what motivated me to major in Special Education. If I can help other children succeed as I have my own son, I will be satisfied.
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