Tourette Syndrome (TS) is a neurological disorder, which most often begins between the ages of 2 & 21 years. and lasts for life. TS is characterised by rapid, repetitive, involuntary muscle movements and vocalisations, called ‘tics’. TS often involves behaviour difficulties.
People with TS do have some control over the ‘tics’, but the period of control only delays more severe outbursts of the symptoms. Their struggle to control their tics leads to poor concentration and can result in a build-up of tension – a vicious cycle of wanting to control their tics but simply being unable to do so. Consequently people may suffer from bouts of anxiety, depression or social withdrawal. Typically, an increase in tension or stress increases the ‘tic’s and periods of relaxation or concentration on a task, decreases them.
Behaviour problems that may be associated with TS include:
Obsessive Compulsive Disorder – people feel a need to do something over and over again e.g. check a door is closed.
Attention Deficit Hyperactivity Disorder – may include difficulty in concentrating, being easily distracted, failing to finish tasks, acting on impulse, not seeming to listen, shifting constantly from one activity to another, needing a great deal of supervision, being unable to sit still, calling out and lack of self-control.
Each person with TS is unique and most are able to lead normal lives.
- Keep to a routine and timetable where possible.
- Encourage responsibilities, offer options, be flexible and negotiate the limits to how far you are prepared to tolerate certain behaviour.
- Do not continually accelerate the excitement level of a program, especially before meal times.
Strategies for Inclusion
- Focus on what the participant is good at and encourage them to develop their abilities.
- Enlist their help for a task or errandas this provides an opportunity for positive feedback and self-esteem enhancement.
Behaviour Management Issues
- Be clear, consistent and positive. Set clear rules for behaviour and tell them what they should do rather than what they cannot.
- Be clear about what happens if they do not follow acceptable behaviour and have a reward system in place for good behaviour.
- Timeout by themselves is often a good coping strategy and assists them to focus on an activity when they re-join the group.
- Breaking activities into specific steps or smaller tasks helps them to stay focussed on the task at hand.
- If punishment cannot be avoided, make it immediate, and relate the punishment to the offence.
- Instructions and explanations may need to be repeated daily.
- Recognise that dignified retreat is preferable to a bloody victory; be prepared to walk away rather than lose self-control.