Testing & Evaluation

Many children with Tourette Syndrome (TS) are routinely disciplined for symptoms that appear to be purposefully disruptive and/or oppositional. Under the Individuals with Disabilities Education Act (IDEA), the school is obligated to provide a Functional Behavior Assessment (FBA) whenever a student’s behavior interferes with the ability to learn. Information and data provided by an FBA is then used to develop a Positive/proactive Behavior Intervention Supports (PBIS), so that the behaviors are less likely to reoccur.

Similarly to other assessments, FBAs are assessments that can be requested regardless of whether the student has an Individualized Education Plan (IEP) or not. Just as speech, reading, sensory, math and other assessments are conducted to determine a student’s strength and struggles in a specific area, the same is true regarding FBAs.

FBAs should examine where, when, and in what context a specific behavior occurs and, equally as important, where and when the behavior does not occur. These specifics are critical for the team to understand the roots of the behavior and develop positive proactive educational supports to manage the symptoms.

The accuracy of the FBA is critical to the appropriateness of the PBIS. For optimal results in developing behavioral supports for a student with TS, it is beneficial to have someone who is knowledgeable about TS and its associated disorders and management strategies. Using information from the Tourette Association website, the Association Education Specialist, local chapters, and the student’s parents, can be helpful in providing accurate information regarding the complexities of TS and related disorders.

Every student and situation is unique and may need unique supports to facilitate success.

Psycho-Educational Evaluations measure a student’s potential as well as how the disability negatively impacts a student’s ability to demonstrate their potential. It clarifies the specific areas of deficits as well as areas of strength.

These evaluations are essential and mandated by the U.S. Department of Education in order to achieve an accurate picture of a student’s abilities and performance, determine eligibility for services and to develop a plan that meets the individualized needs of a specific student resulting in academic, social and emotional success. The evaluations process generally consists of assessing a student’s ability and performance related to all areas of suspected disability (i.e., speech, written language, reading, math, comprehension, sensory issues, social skills, ability to attend, memory, processing, fine motor skills, etc.)

It’s preferable that the evaluations and the subsequent interpretation of these evaluations be performed by professionals who are knowledgeable about the complexities of Tourette Syndrome and its related disorders. If the IEP team doesn’t have accurate and up-to-date information about TS, it is likely that the intuitions that the team will depend on to develop the strategies for intervention and support may be misinterpreted and possibly result in false conclusions and inappropriate interventions.

Parents or someone on the team may need to research the Tourette Association website for brochures, videos and articles that can be helpful in providing an effective plan. It also may be necessary to contact the Tourette Association for a discussion with a representative from its Education Advisory Board.

Dysgraphia (difficulty with written language skills) occurs in the vast majority of children with Tourette Syndrome and ADHD. An evaluator must be knowledgeable about the inconsistencies of all TS symptoms, including dysgraphia. For example, a student’s handwriting may be fine in a one-on-one setting with the evaluator, but in the classroom setting a student may experience such distress that he or she refuses to write. Also,an evaluator not familiar with TS may make the mistake of requesting only a brief writing sample when a longer sample would provide a more accurate picture of the student’s difficulty with writing.

When information gained through evaluations is misinterpreted, it may increase frustration for the student and the support team. If this occurs, it may be detrimental to the student’s success as well as his/her emotional well-being.

Reading the report may provide clues as to whether the evaluator is knowledgeable about TS and the many related issues or not. Too often students with TS have above-average capabilities but specific skill deficits get in the way of their being able to demonstrate their true abilities. Education evaluations/assessments should provide the information to determine precisely which skill deficits are interfering and what supports can be provided so that the student can be successful. Symptoms may interfere during the evaluation and it is not unusual to have a statement in the conclusion indicating that the results of the evaluation may not be a true depiction of the student’s true capabilities.

Looking for significant differences in percentiles (what kind of percentiles?) or grade equivalencies can provide important information. Imagine the frustration for a student who demonstrates a high ability in the mechanics of reading but has below-average skills in comprehension; or a student who has high ability in math but a low processing speed that interferes with the student’s ability to finish work. A significant difference in scores should be a red flag for more investigation and the possible need for accommodations or special education supports.

It is always wise for the parent to read any and all evaluations prior to an IEP or 504 Plan meeting. However, they often find the evaluation report to be overwhelming, especially if it includes many unfamiliar terms. A copy of all evaluations should be provided to the parent before the meeting so they have time to review it, prepare for the meeting and be aware of any recommendations that are being made. They may also elect to meet with the person who conducted the evaluation before the IEP or 504 Plan meeting so that questions about the evaluation can be answered.

When developing a behavior plan, remember that behavior is communication. When “behaviors” occur, they frequently provide clues regarding an underlying skills deficit, which is actually causing the behavior to occur. If you can identify the needed skill and teach it, the behavior will often extinguish.
Teaching these skills is often much more effective than using consequences or punishments because the student is learning to do things differently and in a more successful or meaningful manner. Teaching skills gives the student the tools they need to do things differently and can have life-long and positive results.

Extinguishing behaviors through consequences or punishments may not have lasting effects because the student is not learning the strategies necessary to manage symptoms of this complex disorder. In fact, using consequences may often increase behaviors due to the suggestibility of TS (described above), the frustration of being punished for symptoms and the resulting anxiety.