Educational accommodations for Tourette’s +

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Having support in school, college and university is vital for those of us with Tourette’s because without it we may struggle to get through school and having this support put in place allows us to feel at ease in an inclusive school environment. Schools have the duty to provide reasonable adjustments and make accommodations to suit a students needs.

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One of the most important things when working with a student with Tourette Syndrome is  to not punish the symptoms as they are neurological and involuntary so this includes the tics, OCD compulsions, rage attacks and ADHD symptoms, instead it is more important to understand and accept whilst helping the student in a way that works for them.

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A list of possible accommodations is as follows , it is important to remember that this is not a complete list as support will have to be tailored to the individual and these are just some ideas for support that can be put in place.

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• A time out card – A time out card can be used for somebody to go and take a short break out the classroom in order to let off some steam, cool off, use coping mechanisms or regulate emotions , some people may be able to leave the classroom to go work in a separate room if their tics, OCD, sensory issues or anxiety etc are too severe to function in the classroom. It is important to note that an individual should never be told to leave the classroom due to their symptoms as that would be classed as discrimination, but an individual can choose to leave the class if they think that it would be beneficial to their wellbeing or if they can feel some severe tics coming on and would rather be in another setting or think that they can complete their work easier in a smaller room with less people and less stimulation . 

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• Half days or a reduced timetable - Some people with Tourette’s will need half days or reduced timetable in order to reduce anxiety and decrease the amount of time ticcing if tics are worse in school environment due to sensory stimulation. 

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• Skip the lunch que – Some people with ADHD may need to skip the lunch que if they cannot wait in line due to the hyperactivity and some people may need to skip the que if they have tics that include hitting out, kicking or full body movements so that they don’t cause any issues.

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• A reminder card – Some people may need a reminder card that reminds them not to forget certain things such as their homework or PE kit as some people may walk out of classes without essential items or possessions and may lose things if they struggle with executive dysfunction or ADHD symptoms. It is also important that teachers are understanding if a student doesn’t have the needed equipment or forgets things as we don’t want to be forgetting things all the time and we do want to be organised, but at times it can be exceedingly difficult.

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• Mentor- Some people have a mentor who they can go and speak to if they are struggling and a mentor can also sometimes help someone work through any emotional issues or worries that may arise in the school environment and can sometimes help people manage their workload. A mentor can be a trusted member of staff or even an older student who volunteers to help younger students in the school setting.

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• Homework extensions and exemptions - When dealing with Tourette’s, OCD, ADHD, depression, and any other issues that an individual may be facing, it can be exceedingly difficult to complete homework on time, if at all. The OCD may mean that hours of an individuals day are taken up by debilitating rituals that leaves them with no time to do the homework, or their intrusive thoughts and anxiety may be so severe that an individual is exhausted once they return home and they need to rest and cannot focus as their mind is filled with unwanted thoughts. For some people, they may have been supressing tics in the school environment, leading to rebounds and explosions of severe symptoms when they get home so they are unable to complete the homework or they may be exhausted from ticcing all day in school so they might need to have home time to relax, and some people with ADHD may struggle with executive dysfunction and time blindness, where they procrastinate from doing the work until the last minute, so they may need an extension. For some people, co-occurring mental health issues such as depression can lead to emotional distress and a lack of motivation , and this can make getting work done difficult and a persons mental wellbeing is always more important than their grades. One thing I would say to people with Tourette’s and related conditions reading this , is that it is okay to ask for help and to ask for extensions, sometimes we tend to judge ourselves and think that we are not trying hard enough, but in fact we are working so much harder than most people as we are trying to do the work with a brain that doesn’t always want to co-operate therefore the homework extensions and exemptions are a reasonable adjustment.

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• Modifications to how things are done by the individual in lessons – sometimes tics and other symptoms can make it difficult to do certain tasks in the same way as the other students, for example, I used to struggle to dress myself for PE and sport lessons , so instead of changing into my PE kit I had permission to keep my school uniform on but just take my tie off and undo my top button on my shirt and put some trainers on. All modifications will be different for everyone as we all have different difficulties so it does have to be tailored to the individual, but being able to work around the tics and other symptoms by changing the way some things are done can be helpful as an individual can do something in their own way, in a way that works for them.

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• Tutoring - Tourette syndrome doesn’t affect intelligence, however some people may have co-occurring specific learning difficulties such as dyscalculia, which is a difficulty with maths / mental arithmetic, so an individual may need extra support and tuition to ensure that they are making progress and to make sure that they understand what is being taught to them. Some people may have more severe tics in some classes meaning that they struggle to focus and retain information, so having tuition could allow them to go over what has been taught in class, and if people are out of class a lot because of the symptoms then tuition can ensure that they are catching up and not behind their peers.

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• Working in a smaller group - Some people may prefer to do work in a smaller group or separately out of the classroom if they think that it would benefit them and help them learn, this has to be an individuals choice, they cannot be sent out of class as this could be seen as discrimination.

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• Being allowed chewing gum in class - Some people find that chewing gum can help reduce vocal tics for some people, it doesn’t stop them as it is not a cure, but can help someone manage tics so that they do not become disruptive to the individuals learning. Chewing gum should not be used if there is any risk of choking or if people have breathing tics where they may inhale the gum.

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• Using fidget tools - Some people with ADHD symptoms find that having fidget tools helps them focus, as their hands need something to fidget with otherwise it is virtually impossible to focus as we have to be doing something else at the same time. It can also help with managing anxiety for some people.

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• Leaving classes early - Some people find it beneficial to leave class 5 minutes early to avoid being near too many other people in the corridors in between classes and to avoid excess sensory input which may worsen tics and anxiety or lead to sensory overload. Some people leave class up to 15 minutes early to have a break from class and relax before the next lesson starts and to let more tics out to avoid suppression.

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• Having lunch in a smaller setting - Some people can be overwhelmed by all of the stimulation in the lunch hall, and this sensory input can make tics worse and being near so many people can lead to anxiety for some people, so having lunch in a smaller setting or with a small group of friends can sometimes be arranged. 

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• Missing assemblies - Some people might have to miss assemblies because they may be too anxious to attend, imagine sitting in a quiet room packed with lots of people, and having a condition that makes it difficult not to draw attention to yourself as you involuntarily make noises. This is why people can be given permission not to attend assemblies if they find it too difficult, so it is important to work around it and allow someone to leave if they do not feel comfortable in the assembly hall, but it is important not to send people out as this would be discrimination.

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• Having a laptop / word processor in class and in exams - Some tics can make it difficult to write as we may throw pens, rip up paper, scribble over the page, have hand tics or writing tics such as coprographia etc which make a person unable to write, and some people also have dysgraphia or hypermobility which can make it difficult to write, so having a laptop to take notes and do work can be beneficial, but this may not work for everyone as some people may have compulsions where they repeatedly erase and retype things or keep scrolling up and down the page a certain number of times and some people may have tics such as hitting or smashing the laptop which can be dangerous, so in these cases a person may have a scribe, where they say what they want to write and a teaching assistant writes it down for them.

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• Scribe – This is where the student may say what they want to write and someone such as a teaching assistant notes it down for them due to the struggles listed above that can affect someone's ability to write.

 

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• Using other people’s notes – if a person is struggling to write or focus in class, then the teacher can photocopy another classmate’s notes with their permission and share it with the individual.

 

• Skip reading aloud – Some people may become very anxious at the thought of reading aloud and they might have OCD rituals where they read the same line repeatedly, and a persons vocal tics may become more prominent when reading aloud so it is important to allow the individual to skip reading aloud if it might cause harm to their wellbeing.

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• Laminated sheets: having laminated worksheets can be beneficial if an individual has tics that involve ripping up paper, and then they can type up the answers on a laptop.

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• Having seating arrangements - So that people are not near any distractions and can leave class easily if they feel something coming on like an episode of severe tics or severe anxiety.

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• Audiobooks - These can be helpful if people have OCD rituals that involve rereading lines or if people have tics that make it difficult to read such as blinking or ripping out the pages, and some people with ADHD may find it easier to focus on an audiobook than reading text.

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• Be understanding of poor presentation and poor handwriting - Many people in the Tourette’s community can have difficulties with handwriting and presentation due to hand tics, OCD causing you to go over certain letters when writing, dysgraphia, hypermobility, visual processing issues and other issues. It is important not to punish someone for their handwriting or presentation difficulties as we do want to do our work neatly, but it can be very difficult.

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• Keep the desks as clear as possible -  This is because some people may get easily distracted but also because some people may have tics that involve throwing items across the classroom, sometimes it's best to keep the desk clear to prevent anything else from being thrown as a tic.

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• A social and emotional group - Some schools have social and emotional groups where the students can talk about their emotions and develop social skills, it can help people cope with difficulties and manage difficult emotions and can help with self-esteem and can allow people to make friends who understand.

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• Allow the student to move around as they do their work - A lot of people with Tourette’s have ADHD or ADHD traits and it can make it virtually impossible to stay still and it is important to let someone stand up, move around, fidget etc so that they can feel at ease and focus in class. It is important for people to understand that we may work in a different way to others, but that shouldn’t be an issue as it is what works for us.

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• Provide activity breaks – some people cannot sit still for long periods of time so some teachers may incorporate a mini dance break in the middle of the class.

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• Having class notes emailed to the individual or put onto an online portal after class - Tics, OCD and ADHD can make it difficult to get all of the information down and focus so having the notes available after class can be beneficial.

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• Extra time in exams – Some people need extra time in exams as the tics, intrusive thoughts or ADHD can make it very difficult to focus or write all the answers down, and having extra time can also relieve some tension and anxiety so that people can have a clearer mind when completing the paper, and the anxiety being decreased can also lead to a reduction of tics. Most people have 25% extra time, but some people have 100% extra time so that the stress is reduced, and an individual does not need to rush and so that people with near constant tics can get a fair chance.

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• Rest breaks for exams – Some people may need rest breaks in exams where they can stop and have a break whilst being supervised by the invigilator, this can be beneficial in reducing anxiety, allowing people to regain focus or if there is a bad episode of tics and the if individual needs a break that isn’t included in the exam time to wait for the severe episode of tics to pass and so the individual knows that it isn’t affecting the amount of time they have to complete the paper.

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• Separate room for exams - Some people have a separate room for exams with just the individual and the invigilator, this is beneficial as the individual can tic freely without worrying about disturbing others and can also reduce anxiety. 

It is important for teachers to be understanding and empathetic of the challenges a student may be facing. There are many other issues that people with Tourette’s might face in the school environment aside from the tics as many symptoms are hidden such as the intrusive thoughts, mental tics, inattention and difficulties focusing, executive dysfunction, anxiety, strong premonitory urges and more. Having a supportive teacher who encourages our strengths and listens to us when we need help can make the world of difference for a student with TS as it can raise our self-esteem, help us to feel valued, cared about and accepted and can give us a good start in life that can have a positive impact on us for a lifetime. It is important that teachers lead a good example on how to treat the student with TS by being accepting and non-judgemental, as the teacher is the role model to the other students and shows them what is acceptable.