Tic suppression in the classroom
Posted on 1 February 2016 by Helen Robbins
Research Manager Seonaid Anderson examines current thinking around environmental effects on TS, specifically the disparity that is often noticed between home and school.
Tic suppression in the classroom
By Seonaid Anderson
At Tourettes Action we often get asked questions about young people with tics and Tourettes Syndrome in school and how parents can explain TS to their children’s teachers. One such issue about TS in school is that of tic suppression in the classroom.
Can we explain to teachers using evidence based research what tic suppression is, that it is occurring and show how effortful it is and how it will affect schoolwork as the child is concentrating on suppression?
Often in different environments children with TS will act differently and there are ‘environmental effects’ on TS. If the child has a diagnosis of TS but doesn’t tic in school that doesn’t mean he doesn’t have TS! He will probably be supressing.
The research papers which will be most relevant in regards to this are from Doug Woods in the States , he does a lot of work and research to do with behaviour therapy.
You can watch Professor Woods videos explaining behavioural therapy which includes tic suppression:
What is even better is that Tourettes Action are running Behavioural Therapy workshops in 2016, where we are going to discuss things exactly like this! So educational professionals and parents can come to a Saturday workshop that is going to be held. For information and online booking go to this page. Please do come along if you can and encourage the education professionals to come too!
Returning to the issue of tic suppression, what Doug Woods states is that:
1. tic suppression is possible
2. and his research supported the idea that after tic suppression there WOULDN’T be a 'rebound'
(more tics or an explosion of tics after suppression), a lot of parents report that children have an explosion of tics when returning home from school - BUT Doug Woods suggested this was an environmental factor and not due to ‘holding in’ or suppressing tics at school.
3. In addition to debunking the rebound myth, Doug Wood's studies demonstrate that environmental factors can influence the expression of Tourette syndrome, so how TS is going to look in different environments like home and school.
This paper below describes some of the environmental factors:
J Psychosom Res. 2008 Nov;65(5):487-96.
The influence of contextual factors on tic expression in Tourette's syndrome: a review.
Conelea CA, Woods DW.
In the paper the authors state ‘the symptoms of Tourette's syndrome vary in frequency and intensity. Although such variability may be the result of deficits in the underlying neurological system, tic expression can also be systematically impacted by contextual factors. This article reviews research on the impact of several contextual factors on tic expression and discusses implications for future research and treatment development’.
So this might help the case for showing that TS can be different in school and at home. The teachers may not see the student tic, because he is capable of and actively supressing his tics, in that environment (explaining variability in tic symptom expression).
In regards to whether tic suppression affects concentration or schoolwork, this paper is the most relevant one:
Behav Res Ther. 2008 Nov;46(11):1193-200. Examining the impact of distraction on tic suppression in children and adolescents with Tourette syndrome. Conelea CA, Woods DW.
Behavioural therapy can be incredibly useful. And as Doug Wood says ‘can enhance voluntary tic suppression’, ‘can successfully be used in environments that include attention-demanding or “distracting” stimuli, such as a classroom’.
From the Conlea and Woods (2008) paper (in the discussion section of the paper) – ‘results also indicate that successful suppression may come at the expense of accuracy on a task performed simultaneously’ – this is of great interest to teachers and parents!
He goes on to say practice doing suppression (especially helped by doing CBITS or behavioural therapy with a therapist) can ‘increase the automaticity of suppression….make it easier to supress in distracting situations and engage in simultaneous tasks’.
From the Conlea and Woods (2008) paper it is suggested that ‘tic suppression involves attentional processes’ and ‘it has been suggested that performance deficits on attention-demanding tasks may occur when attentional efforts are directed to tic suppression’ (Shimberg, 1995).
So there is some evidence for tic suppression taking up attention but this can be helped by behavioural therapy. If you would like a copy of the Tourettes Action list of therapists who can deliver behavioural therapy please contact the helpdesk .
If you would like information about attending the parent workshop for parents, carers and educational professionals go to this page.
If there are any questions please get in touch and any educational professionals are welcome to contact Seonaid Anderson, Research Manager .