Red Flags: Identifying Common Education Difficulties with TS

Kathy Giordano, Tourette Association Education Specialist

Common Challenges that Impact School Performance

Educators and families should be aware of common challenges or “red flags” that impact school performance among children with TS. Sometimes these challenges are misunderstood or thought of as ‘purposeful behaviors’ that are not related to TS, or other related conditions.

These challenges often become a larger issue in middle and high school than in elementary school. A common, yet highly unrecognized, reason, is that a student’s intellectual abilities can disguise symptoms in elementary school, while in higher grades, symptoms begin to interfere with demonstrating intellectual abilities. Additionally, students often put more energy into suppressing and/or masking symptoms due to social acceptance.

The following is a list of common education-related difficulties that children with TS and related conditions may exhibit.
Handwriting Issues/Dysgraphia: Sloppiness; frequent erasing; consumed with writing neatly; reduced output; slowness of handwriting; difficulty with punctuation, spelling, and capitalization; refusal to write.

  • Difficulty completing homework: Failure to understand the assignment; inconsistency in copying down assignments; not completing assignments on time; refusal to begin assignments.
  • Disorganization: Problems managing time, tasks, and belongings; difficulty beginning and/or following through on tasks, which may result in failure to produce a product.
  • Perfectionism: Erasing; must have things ‘just right’; hyper-vigilant regarding rules; insistent on performing rituals.
  • Difficulty attending: Complex and simple tics or obsessions can interfere with concentration even though the student appears to be focused. However, some students are able to attend to activities while experiencing tics even though it may appear otherwise.
  • Challenges with transitioning: Problems when transitioning between tasks and classes; resistance to changes in schedule and/or routine.
  • Difficulty following directions: Slow to respond; inability to complete tasks that have complex or multiple directions; repeated requests for directions.
  • Discrepancy between verbal and performance scores: Difference between scores on psycho-educational evaluations (e.g., high average range for reading comprehension with low average range for written language skills; high scores in verbal and low on performance).
  • Sensory Issues: Sensitivity to light, sound, touch, smells, or tastes; need to harm oneself physically; excessive chewing on objects, etc. to relieve a certain sensory urge.
  • Stress and Anxiety: school or academic avoidance: shutting down when overwhelmed; excessive trips to nurse, bathroom or counselor; emotional outbursts, etc.
  • Impulsivity: Shouting out answers; exhibiting impulsive behaviors.
  • Disinhibition or Dysinhibition: Behaviors that student recognizes as inappropriate or prohibited but has difficulty inhibiting. For example, touching certain objects, making inappropriate yet contextual statements, and shouting out answers.
  • Oppositional Behaviors: Inconsistent refusal to engage in an activity or task for reasons which are not obvious. Need to assess why, where, and when the oppositional behavior occurs, what led up to the behavior, and how we can support the student in being successful (which often will reduce oppositional behaviors).
  • Explosive Behaviors in School or at Home: Significant and disruptive behaviors which appear to be overly reactive to a situation. May be the result of suppressing symptoms, experiencing anxiety, feelings of failure, or being overwhelmed while at school or with homework.
  • Social Skills Deficits: Immature behaviors, rigid responses, socially inappropriate behaviors, inability to get along with peers.

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The information presented in this material was supported by Grant/Cooperative Agreeent Number CDC-RFA-DD13-1302 from the U.S. Centers for Disease Control and Prevention (CDC). The contents are solely the responsibility of the authors and do not necessarily represent the offical views of the CDC. The information is intended for the reference of and use by medical and allied professionals and educators. The material is displayed with the permission of the authors/publishers.