Best Practice

Tic disorders in school: Supporting students

Neurodiversity Inclusion
Tourette Syndrome or other tic disorders can affect the learning and wellbeing of young people. Dr Pooky Knightsmith looks at how they manifest and how schools can support students
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Tics are involuntary, sudden movements or sounds that individuals with Tourette Syndrome or other tic disorders experience. While tics vary widely in form and intensity, they can present unique challenges for children and young people.

Tourettes Action UK estimates that Tourette Syndrome in particular affects one school child in 100 and that more than 300,000 children and adults in the UK live with the condition.

Tourette Syndrome is more prevalent in boys and it is thought that approximately half of children with a diagnosis will see a significant reduction in their symptoms as they approach adulthood.

In this article, let’s explore what tics are, how they impact students, and practical ways educators can provide support.

 

What are tics? 

Tics are classified into two main types: motor tics and vocal tics. Motor tics involve physical movements such as:

  • Shoulder shrugging.
  • Blinking, nose-wrinkling, grimacing.
  • Lip-biting.
  • Touching people or things.
  • Jerking, banging.

Vocal tics, meanwhile, are auditory in their nature and include actions such as:

  • Throat-clearing.
  • Humming.
  • Sniffing, snorting.
  • Squealing or shouting.
  • Repeating words.

Tics can be simple or complex and their frequency may change over time. Individuals with tics often experience a build-up of tension before the tic occurs, followed by a sense of relief afterwards.

Tics are involuntary and unintentional. A child cannot simply choose to control them. Pressure to repress tics, be it from the child themselves or an expectation from those around them, can lead to a worsening of tics and/or an increase in other anxiety-driven responses or behaviours. Tics tend to get worse if they are focused on.

 

How can tics affect pupils?

Common challenges that children with tics may face include distraction and potential disruption in the classroom, social stigma and possible teasing or bullying from peers, anxiety and stress related to tic suppression, fatigue due to the effort required to manage tics, as well as reduced school engagement or attendance as a result.

 

Can tics be treated?

Tics can appear and disappear quickly, but if they persist over time and are having an impact on a child’s ability to engage with and enjoy everyday life it is worth seeking support from your GP, mental health support team or even CAMHS.

While there is no cure for tic disorders, various strategies can help manage and minimise their impact. And at the end of the article, I include a link to some excellent charities from whom you can seek further information and support.

  • Habit Reversal Therapy: This therapeutic approach focuses on teaching intentional movements that act as a “counterforce” to tics. By engaging in these intentional movements, the occurrence of tics at the same time is hindered.
  • Comprehensive Behavioural Intervention for Tics: CBIT involves a collection of behavioural techniques designed to impart skills that effectively reduce the frequency and intensity of tics.
  • Exposure with Response Prevention: This method is aimed at helping individuals, become accustomed to the uncomfortable sensations typically experienced just before a tic with the goal of preventing the tic from manifesting.

 

Practical support in school

There are practical ways schools and educators can support pupils with tics:

  • Open communication: Foster open communication between school and home to ensure a consistent approach to support.
  • Bullying awareness: Be vigilant for potential bullying related to tics and take steps to address and prevent it.
  • Educate peers: Educating pupils about tics can promote understanding and empathy.
  • Avoiding public attention: Be mindful of situations that might draw attention to the student’s tics, such as public speaking or unexpected class activities.
  • Teacher CPD: Run a short session to educate staff about tic disorders, fostering a more understanding and supportive teaching environment.
  • Quiet spaces: Designate quiet spaces where students can retreat if they need a break to manage their tics.
  • Classroom routine and predictability: Maintain consistent routines to minimise surprises, which can trigger anxiety and exacerbate tics.
  • Visual schedules: Provide visual schedules outlining daily activities to enhance predictability and reduce stress.
  • Regular check-ins: Schedule regular check-ins with the child to assess their wellbeing and to address any emerging concerns promptly.
  • Role-play responses: Use play, role-play or social scripts with the student and their peers to explore common scenarios and responses that feel comfortable and constructive when their tics arise or are mentioned.
  • Flexible assessment methods: Consider alternative assessment methods to accommodate the student’s unique needs, ensuring fair evaluation, e.g. if a student would struggle with a public oral presentation could it be recorded or delivered one-to-one?
  • Tic-friendly classroom seating: Allow the student to choose a seat where they feel most comfortable; this might mean away from the gaze of others or away from tic trigger sources.
  • Sensory tools: Provide discreet sensory tools, such as stress balls or fidget spinners, to help the student self-regulate and redirect their focus.
  • Communication cards: Enable the student to express their needs or indicate when they require a break without verbalising it.
  • Flexible testing arrangements: Offer flexibility in testing arrangements, such as extended time or a quiet room.
  • Classroom buddies: Pair the child with a “classroom buddy” who can provide additional support during challenging situations or act as a friendly presence.
  • Digital note-taking options: Allow the use of digital devices for note-taking to accommodate pupils who may struggle with handwriting due to motor tics.
  • Quiet transition times: Implement quiet transition times between activities to reduce sensory overload and potential triggers for tics.
  • Self-advocacy training: Provide guidance and support for the pupil to develop self-advocacy skills, empowering them to communicate their needs and preferences effectively.  

 

Dr Pooky Knightsmith is a passionate ambassador for mental health, wellbeing and PSHE. Her work is backed up both by a PhD in child and adolescent mental health and her own lived experience of PTSD, anorexia, self-harm, anxiety and depression. Follow her on X (Twitter) @PookyH and visit www.pookyknightsmith.com. Find her previous articles and podcast/webinar appearances for SecEd via www.sec-ed.co.uk/authors/dr-pooky-knightsmith  

 

Further information & resources