About Tourette Syndrome
Tourette syndrome is a neurodevelopmental condition characterised by multiple motor tics and at least one vocal tic, lasting for more than a year. It is not a behavioural disorder; tics are involuntary.
Tourette syndrome affects approximately 1 in 100 children, with symptoms usually appearing between the ages of 4 and 7. It is more commonly diagnosed in boys, though it also affects girls. The condition tends to fluctuate, with tics waxing and waning in frequency and intensity over time. Many young people find that tics reduce during late adolescence and adulthood, though for some they continue into adult life.
It is important to understand that Tourette syndrome is a neurological condition. The child cannot simply stop their tics any more than they could stop a sneeze. Suppressing tics temporarily is possible for some children, but this requires significant effort and often leads to a surge of tics afterwards.
Types of Tics
Motor Tics
- Simple motor tics: Eye blinking, nose twitching, shoulder shrugging, facial grimacing, head jerking
- Complex motor tics: Touching objects, jumping, spinning, mimicking other people's movements (echopraxia)
Vocal (Phonic) Tics
- Simple vocal tics: Throat clearing, sniffing, grunting, coughing, squeaking
- Complex vocal tics: Repeating words or phrases, repeating others' words (echolalia), using socially inappropriate language (coprolalia, which affects only about 10-15% of people with Tourette syndrome)
Tics often increase with stress, anxiety, excitement, tiredness or illness. They may decrease during focused activities that the child enjoys.
Co-occurring Conditions
Tourette syndrome frequently co-occurs with other neurodevelopmental conditions. Staff should be aware that these associated conditions often have a greater impact on the child's daily life and learning than the tics themselves:
- ADHD: Occurs in approximately 60-70% of children with Tourette syndrome
- OCD (Obsessive Compulsive Disorder): Affects approximately 50% of children with Tourette syndrome
- Anxiety: Very common, often related to social situations and the fear of ticcing
- Specific learning difficulties: Including difficulties with handwriting, processing speed and executive function
- Sensory processing differences
- Sleep difficulties
- Emotional regulation difficulties
Strengths
Many people with Tourette syndrome report specific strengths that may be related to their neurological differences:
- Creativity and original thinking
- High energy and enthusiasm
- Resilience developed through managing a challenging condition
- Empathy and understanding of difference
- Strong observational skills
- Quick reflexes
- A well-developed sense of humour
Classroom and School Strategies
Creating a Supportive Environment
- Ignore tics as far as possible; treat them as you would a cough or sneeze
- Never punish a pupil for ticcing
- Discuss with the pupil and parents how they would like tics to be handled in front of peers
- Consider whether the pupil would like the class to know about their condition (always with the child's consent)
- Provide a discreet exit pass so the pupil can leave the room briefly if tics become overwhelming
- Offer a quiet, private space where the pupil can go to release tics if needed
- Seat the pupil where they will feel comfortable, considering that being at the front or back has different advantages
Supporting Learning
- Be aware that suppressing tics uses significant mental energy, leaving less capacity for concentration
- Allow extra time for tasks and assessments, as tics can interrupt work
- Provide alternatives to handwriting if motor tics affect writing (laptop, scribe, voice recording)
- Break tasks into smaller chunks with rest breaks
- Provide written instructions to supplement verbal ones, as the pupil may miss parts due to tics
- Address any co-occurring ADHD or OCD with appropriate strategies
- Be flexible about fidgeting; allowing movement breaks or fidget tools can help manage tics
Assessment and Examinations
- Apply for access arrangements (extra time, rest breaks, separate room) if tics affect exam performance
- Consider the impact of co-occurring conditions when planning access arrangements
- A separate room may be needed to avoid disrupting other pupils and to reduce the pupil's anxiety about ticcing
- Allow the use of a laptop if motor tics affect handwriting
Social and Emotional Support
- Be proactive in addressing bullying or teasing related to tics
- Foster a school culture of acceptance and understanding of neurodiversity
- Provide access to pastoral support or counselling
- Support the pupil in developing self-advocacy skills
- Be aware that adolescence can be a particularly challenging time as self-awareness and social pressures increase
- Watch for signs of anxiety, low mood or social withdrawal
Further Information and Resources
Tourettes Action provides schools guidance, training, factsheets and a helpline.
NHS information on Tourette syndrome offers accessible medical information.