Tourette Syndrome

Overview

Tourette Syndrome is a neurological disorder characterised by repeated and involuntary body movements (tics) and uncontrollable vocal sounds. In a minority of cases, the vocalisations can include socially inappropriate words and phrases, called coprolalia. These outbursts are neither intentional nor purposeful. Involuntary symptoms can include eye blinking, repeated throat clearing or sniffing, arm thrusting, kicking movements, shoulder shrugging or jumping.

These and other symptoms usually appear before the age of 18 and the condition occurs in all ethnic groups with males affected 3 to 4 times more often than females. Although the symptoms of Tourette Syndrome vary from person to person and range from very mild to severe, the majority of cases fall into the mild category. Associated conditions can include attention problems, impulsiveness and learning disabilities.

People with Tourette Syndrome rarely have all symptoms and the symptoms can come and go. To avoid embarrassment or ridicule, some people with Tourette Syndrome will try to suppress the symptoms. Symptoms however, will usually emerge more explosively when the person is in a 'safe' environment. It requires a great deal of energy and concentration to inhibit tics and vocalisations and can cause further stress for people with Tourette Syndrome.

The effects of the condition

Apart from the symptoms mentioned above, people with Tourette Syndrome can have secondary problems including depression, social seclusion and difficulty maintaining employment and study. Difficulty maintaining work or study is not as a direct result of the condition or the person’s capabilities, but merely due to the effects of self-esteem, lack of self-confidence and misunderstanding of the condition within the community.

Tics often cause soreness, irritability, and are exhausting.

Appropriate adjustments in the tertiary education environment

As each student will have different experiences, it is important to negotiate the needs on an individual basis. The following is a list of adjustments that may assist the student.

General

• Make book and reading lists available prior to the commencement of lectures (preferably at least two weeks prior to the commencement of the semester)
• Provide students with chapter outlines or study guides. These should also be available at least two weeks prior to the commencement of semester

Lecture/classroom adjustments

• Have hard copies of overheads available for students prior to the commencement of lectures
• Repeat and rephrase important points
• Speak clearly and face the students whenever talking
• Always verbalise any points that are either written on the board or put up on overheads
• Use a microphone whenever the equipment is provided
• Tape lectures and place in the library so students are able to copy
• Have regular breaks in long lectures - this will assist to prevent 'information overload'
• Avoid putting the student on the spot by targeting them for questions or reading aloud in class - unless the student has indicated their willingness to participate (i.e. raised hand etc)
• Be flexible in relation to what constitutes 'participation' in tutorials. High anxiety levels of the student and concerns they will have noticeable tics or vocalisations may mean that they avoid participating in discussions
• Supply comprehensive lecture notes
• At the beginning of each lecture, outline the key points that will be raised in the lecture; reiterate these at the conclusion of the lecture
• Try to make sure there is good lighting in the lecture theatre/class room. If possible adjust blinds to ensure their is no glare on the board or where overheads are being projected
• The student may need to leave class with little or no notice or turn up to class late. Allow this without drawing attention to the student
• The student may display some unusual behaviours. Again, allow this without drawing attention to the student. If the behaviours are disruptive, talk to the student privately and discuss the effect the behaviour is having in the class. There may be ways of accommodating these behaviours without them impacting on the class. The key issue is to display acceptance and understanding and to work with the student to think of lateral and creative solutions to the issue

Assignments

• Be flexible with deadlines and extensions
• Provide clear feedback to the student both verbally and in writing;
• Consider negotiating an individual learning program for the student. This can include:
• Flexible deadlines for assignments to take into account the effects of their disability and the requirements of other subjects
• Alternative marking arrangements such as allowing the student to hand in a 'draft' for comment prior to submitting their final paper

Examinations

• Allow extra time in formal exams, school exams and class tests
• Allow the student to complete oral exams if requested
• Allow the student to use a PC
• Allow the student to use a PC with software that accommodates the needs of students
• The student may require natural or non-fluorescent lighting. They also may require their question and answer sheets to be on alternative coloured paper etc
• The student may require a reader and/or a scribe (amanuenses)
• The student may need a private room
• The student may require a split exam
• Allow time for rest breaks
• Allow the student to take in food, drink and medication if required

*Remember: Alternative Adjustments is about providing the opportunity for equality, not the attainment of a particular outcome. A student with a disability is still required to present work that is of a recognised standard. Providing flexibility in the process of learning does not mean that the subject standards are lowered.