Sunday, January 8, 2012

For Teachers

One of the things I do in my life is talk in teacher candidate classes.  I have been doing this for the last 2 years and I feel it is something very important.  I did not have a good time in school; I have always gotten good grades because I work hard, but good grades does not actually equate to learning in school.  I am friends with a lot of teachers and teacher candidates, many of whom I have not had the chance to share my story with.  For this reason, (and because I have done nothing of interest over the last few days except rest and ice my neck) today I wanted to talk about what you (a teacher) can do to help a student in the classroom who you know or suspect may have a tic disorder.

Onset for me was very late in childhood, typical age of onset is around 7 or 8 and I wasn't symptomatic until 15 years old.  Because of this, I still vividly remember coming to terms with my disability and having to quickly learn to adapt to my environment in school without my grades slipping.  I can relate to kids with disabilities, not because I think I know what it's like to walk in their shoes, but because I know what it is like to not be able to attend to a class.  I know what it's like to be bullied.  I know how it feels when you catch your peers imitating you and mocking you behind your back.  I know that feeling of dread and shame when you realize you slept through a class, not because you were out late the night before, but because the medications you are on knocked you on your ass.  I can relate to all these things, and I would be remiss if I didn't use my experiences to help teachers.  I implore teachers to share this post with other teachers; if I were able to help one teacher with one child with tics in their class, sharing these sometimes painful stories is worth it.

Children with Tourette Syndrome or other tic disorders are eligible to have a 504 plan; this allows for accomodations to their schooling.   A child whose only diagnosis is Tourette Syndrome does not qualify for self-contained special education classrooms.  Tourette's does not affect intelligence; it can make it difficult to share what you know with people due to motor tics while test-taking or verbal tics while talking, but it does not affect how smart a person is.  Students with Tourette's and other tic disorders will be in regular education classrooms and it is up to their teachers to accommodate them and make them as successful as possible

The first thing to note when talking about a person with tics in any setting is that they can NOT control it.  I write and say that I have a good deal of control; but that is in no way to say that I can make them go away.  I can mask them and hide them for a time, but eventually it becomes too much to try and squash down, and the tics come out.  Most times, after trying to suppress and block for so long the tics come out stronger and longer than they would have if I just let them express when I felt the urge.  If you know somebody who has tics, please don't every say "stop that" (or any permutation of that phrase).  Trust me, a Touretter knows that they are ticcing.  They know that they are distracting people and annoying people around them.  Bringing attention to that fact and informing a ticcer that you wish they would stop is like rubbing salt in a wound.

In the classroom, it is okay to talk about it.  In fact, it is probably better if you can talk about it so that the other kids in a class realize that what that child is doing is normal.  Yes, it can be annoying sometimes, but they don't do it on purpose.  My medical ID card says on the back "I'm sorry if it bothers you, it bothers me more."  This is the attitude I try and embrace everywhere I go; I acknowledge that I can be distracting and I try not to put myself in situations where I will bother people, but sometimes that cannot be helped.  And please, don't expect me to apologize for something that is out of my control.

If you have a ticcer in your classroom who is willing to talk about it, a presentation from them will have more meaning.  If your class is very young, maybe have a parent come in and talk or talk to your class yourself.  The Tourette's Syndrome Association has resources for teachers and parents.

One of the things I vividly remember from school is planning my day around which teachers would allow me to go to the bathroom without having to ask and sign out and make a scene.  I can still tell you more than 6 years later, which classes I would leave from and which I had to sit through.  Escaping to the bathroom to "let the tics out" is a coping skill nearly every child with Tourette's develops to be able to get through classes.  Don't argue with them.  Let a child with tics go to the bathroom as they feel necessary, if they know that you won't bother them about it and they know it is an option whenever they need it, chances are the anxiety around the tics will be reduced and the tics themselves might actually become less frequent.  If you have a younger student with tics, send them on errands, even if they are pretend errands.  Have a teacher they can bring "notes" to throughout the day when you feel that their tics and/or anxiety are escalating.

Let a child with Tourettes stand up as necessary.  It is still tortorous for me in a lecture to have to sit still in a desk at times.  I used to jump as a tic (complex motor) and if I got that urge it would be impossible for me to remain sitting.  Talk with the student about what might help; if they want a desk in the back of the room so they can get up and move, please let them.  Sometimes movement is all that I need to stave off a big tic attack; I go for walks a lot during classes just to move my muscles and get my anxiety back under control.

Also in regards to seating placement, the middle of the room is the worst place to be as a Touretter.  I like to sit in the front row now because that way I can pay the most attention.  However, in the front row I know I am a distraction to everyone behind me; I just don't care if people stare or notice anymore.  When I was in high school I wanted to sit in the back of the room; this minimized the number of people exposed to my tics and made it less likely I would become a distraction.  I also try and sit near doors, this way if I have to get up and leave during a class I can do so with minimal disruption to the class.  If I'm in the back or middle of a classroom and I get the sudden tic urge to squeak or clap or something just as equally disruptive, it is much harder to leave than if I am in a seat by the door. 

Individuals with Tourette's are typically on a variety of medications.  Because nobody knows what causes Tourette Syndrome, or why it occurs, there is no blanket medication for it.  There are classes of medications to try (anti-hypertensives, anti-convulsants, anti-anxiety, etc.) but these are only a vague guideline.  Not only that, but the medications can have severe side-effects.  I stopped taking medication for 4 years because I could not live with the side-effects.  I am trying new medication now, but I have yet to find something that makes my tics more manageable, much less actually gets rid of the tics.  I slept through a good deal of class in high school because it was physically impossible for me to remain awake.  Right now as I write this I am dizzy and nauseous because I just increased the amount of medication I am on.  If you have a child with Tourette's in your classroom, understand that there is a high likelihood of them being medicated.  Medications can cause all sorts of side effects and the fact that they are lethargic all the time, that they rapidly gain weight, or that they turn into absolute crabs (a possible side effect of my medication apparently) isn't always their fault.

If you are teaching older students, all these things and more apply.  Talk to the student, if they want to be able to go to a quiet testing room, arrange it.  There is nothing that makes me need to tic more than being in a quiet room with people trying to concentrate.  If you have a student who has trouble writing, allow them to dictate their tests to somebody else or type them (writing with a pen and typing are very different processes; I can type much easier than I can write).  Make accomodations as necessary for your student so that their grades don't become reflective of their disability.

If you use notes or powerpoints in class, print out copies for your student.  Having to stay quiet in a chair without ticcing while taking notes and paying attention to a lesson is too much.  I gave up on note-taking a long time ago because my writing would be illegible, I would tear holes in the paper, and on one occasion I actually threw a pen at another student in my class.  Now, I rely on guided notes and powerpoint lectures; I will recreate the lesson at home and re-teach myself material I missed so that I do not fall behind. 

Most importantly though, talk to the student.  Their tics will dictate the accomodations they need.  Every Touretter is different and while I have tried to lay out generic guidelines, a student will know what they need.  They will know what makes it difficult for them to learn.  Please, do not hesitate to comment or contact me if you have further questions or want to know how to get the conversation started with a student or a parent.

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