ED 385 078

`UTHOR

INSTITUTIONPUB DATENOTEAVAILABLE FROM

PUB TYPE

EDRS PRICEDESCRIPTORS

IDENTIFIERS

ABSTRACT

DOCUMENT RESUME

EC 304 111

Fisher-Collins, RamonaDiscipline and the TS Child: A Guide for Parents andTeachers of Children with Tourette Syndrome.Tourette Syndrome Association, Inc., Bayside, NY.9421p.Tourette Syndrome Association, Inc., 42-40 BellBlvd., Bayside, NY 11361-2874 ($3).Guides Non-Classroom Use (055)

MF01/PC01 Plus Postage.Behavior Change; *Behavior Modification; *BehaviorProblems; *Discipline; Elementary SecondaryEducation; *Neurological Impairments; Parent Role;*Self Control; Teacher Role*Tourette Syndrome

This parent and teacher guide consid,:b disciplinefor children with Tourette Syndrome (TS) who have difficulty withbehavioral compliance. Discipline is defined primarily as "trainingto act in accordance with rules," and is not punishment but involvesteaching self-control and observance of'societal expectations.Controversy and misconceptions about discipline are noted.Consideration is given to redirecting the child from undesirablebehaviors which can occur with TS, such as the urge to spit or touchor grab other people's personal body parts. Ways to redirect thechild from obsessive thought repetition are also addressed to helpavoid the child's distress when saying phrases c. words of an obsceneor violent nature which stick in their minds. Practice inanticipating outcomes of behaviors can be helpful for the child withTS who has difficulty with impulse control and does not see theconnection between actions and consequences. In addition to teachingthe child the concept of cause and effect, children can be taught howto make choices and to accept consequences for them. Also importantis providing the child with structure, direction, and limitsregarding the expression of explosive anger. Included are briefannotations of three videotapes and three publications on TS. (SW)

************************************************************************ Reproductions supplied by EDRS are the best that can be made

from the original document.***********************************************************************

U.S. DEPARTMENT OF EDUCATIONOffice of Educational Research and Improvement

EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)

This document has been reproduced asreceived from the person or Organizationoriginating it.

o Minor changes have been made to improvereproduction quality.

Points of view or opinions stated in this docu-

ment do not necessarily represent officialOERI position or policy.

DISCIPLINE

AND THE

TS CHILDA Guide for Parents and

Teachers of Children withTourette Syndrome

"PERMISSIC.". TO REPRODUCE THIS

MATERIAL HAS BEEN GRANTED BY

. U2 2:(---9ect_ \

TO THE EDUCATIONAL RESOURCES

INFORMATION CENTER (ERIC)."

n by: Ramona Fisher-Collins, M.Ed.

2

BEST COPY AVAILABLE

A special thank you to Ecological Fibers, Inc. and M & MBindery for their valuable efforts and cooperation in the

publication of this brochure.

Funding provided by members ofTSA's President's Club

IntroductionFor the majority of children who exhibit mild

symptoms of Tourette Syndrome (TS), the issue ofdiscipline at home and at school may not require anyspecial considerations. At home, many parents of chil-dren with mild manifestations of TS find no need toalter their expectations for their child's ability to fol-low the rules for appropriate behavior and to ob-serve the limits set for them. They are able to parenttheir children with TS in a manner consistent withparenting their other, non-affected children. Similarly,in school, th::, structure and rules of the regularclassroom are an appropriate setting for the childwith TS and his* mildly invasive symptoms, providedhe is with a teacher and students accepting of hisunusual mannerisms or vocalizations. This is all tothe good.

However, TS is a neurobehavioral disorder that canvary greatly from individual to individual in its sever-ity, intensity, and implications for problematic behav-ior. This discussion is meant to offer helpful guide-lines for those parents and teachers who are in aquandary about the issue of disciplining a child whohas proven that a "regular" setting in either home orschool is not sufficiently structured to foster behav-ioral compliance on the part of that child.

* The pronouns "his" or "he" have been used here to designateboth "he" and "she" so as not to unnecessarily encumber thereader. It is recognized that females, too, may have TouretteSyndrome, though they are, in this case, the minority.

4

How can we tell when a behavior is an expres-sion of TS as opposed to when it is simply unruli-ness? When should we intervene, and when should weallow the child to continue behavior which appears tobe out of control? At what point should we start hold-ing him responsible for his own actions? In short,how do we teach this child discipline?

These are fundamental and very pertinent questionsmost often asked by parents and teachers chargedwith the primary responsibility for raising and educat-ing a child with TS to be a healthy, functioning adult.

What Is Discipline?Discipline is defined primarily as "training to act

in accordance with rules." Many people mistakenlythink of discipline as being a matter of punishment;this misconception clouds the issue of what is, inactuality, teaching self-control and observance of soci-etal and cultural rules. For a child with a lifelongneurological disorder involving impulse control, under-standing and observing societal rules are very rel-evant issues.

Unfortunately, for some, teaching discipline to childrenwith TS has become unnecessarily complicated. Thisdiscussion will attempt to clarify this issue for thoseparents and teachers in charge of teaching theknowledge of and observation of society's rules tochildren who, by the very nature of their disorderone of control are in greatest need of thatknowledge.

Discipline and Self-EsteemHaving TS means coping with a very complex set,

of conditions. The accepted diagnostic criteria for TSdescribe only the tip of the iceberg; i.e. the observ-able criteria. While one can observe various manifesta-tions of motor and vocal tics and rituals of a con-sdous, but involuntary nature in a person with TS,one does not observe all the other underlying andhidden neurobiological processes which have vast so-cial and behavioral implications not only for the

5 2

person with TS, but also for those who live and inter-act with him.

Currently, (due to parents and teachers sharing theirobservations with one another, as well as communica-tion among researchers from various professional per-spectives) it is known that obsessive-compulsive disor-der (OCD) and attention deficit disorder with hyperac-tivity (ADHD) are very often related and complicatingphenomena of TS. Also, we now realize that tics canoccur in the thought processes as well as in the body.Furthermore, we recognize how vastly important it isfor the child growing up with TS to have an under-standing and united support system with parents andteachers working together, so that he may have thebest chance of emerging into adulthood with that all-important sense of self-esteem. We know that it is ahealthy sense of self that will help him shrug off thepuzzled stares and taunts of others that may followhim throughout his life. A strong self-esteem appearsto be the single all-important factor which will ulti-mately divide the triumphant survivors from thosewho never find their niche in society.

And yet, amid all the sophisticated research beingconducted about TS, how much do we really knowabout instilling that sense of self-esteem? This ob-server submits that we know relatively very littleabout it, because in following our instincts to pre-serve self-esteem, we are often hesitant to offer ap-propriate guidance, fearful of wrongfully chastising achild for actions we suspect he might not be able tocontrol. Ironically, it is that uncertainty, that fear ofmaking a mistake in judgment which most often pre-vents us from giving the child with TS the guidanceand structure the discipline he so desperatelyneeds.

Imagine how it feels to live inside a body and beaware that it may at any moment erupt with involun-tary jerks, noises and strange looking rituals. Not onlythat, but your mind seems to have a will of its own,going off on meaningless counting sprees or runningover and over a phrase just heard in conversation. In-habit that body and preside over that mind for ashort time and one simple fact soon becomes appar-ent: the only difference between you and your peers

3

is an ability to control. Your body works properly,but only after it has satisfied its irresistible urges toJump, jerk, spin three times, and crow. With TS, yourmind works, but only when it is temporarily satiated".th counting, ordering and repeating. One must in-deed have inordinate amounts of patience to co-existwith all these manifestations of TS!

And yet, if the individual is to grow into adulthoodfeeling good and confident, or at least okay abouthimself, with a healthy sense of self-esteem, thenthat is exactly what he must do with his symptomson both the physical and mental levels: learn to co-exist. For as one grows and develops a personalitywithin the context of his TS symptoms, whethermedicated or not, the symptoms are gradually butcertainly incorporated into his self-image. He wouldnot be himself without his TS symptoms; they are apart of who he is. Though able to laugh and cry, tofeel love, hurt and hope, the individual must do allthose things working around his TS symptoms. Theelement that he does not have to help him contendwith the rigors of life frustrating as it may be, theelement of which his neurological set of circum-stances robs him is the element of Control.

What more appropriate or loving gift, then, couldnurturers of the child with TS give him than to re-turn to him a degree of that control he lacks neuro-logically by teaching him the control involved in self-discipline? (Again, self-discipline here does not meansuppression of tics.) What could he value more, andwhat would be more helpful than teaching him howto live within the unspoken but accepted rules of so-ciety? No parent or teacher would argue about want-ing for their child or student a life of social adjust-ment, satisfying relationships, and a fulfilling career.When you think about it, these things are achievedonly by observing the rules for achieving them therules of living as a member of a society.

Having said that, It is unfortunate to note that thesubject of discipline often becomes a debatable, com-plicated and controversial one, because the basic pre-mises about the issue of discipline appear to be builton some popular misconceptions.

MisconceptionsA common misconception about discipline arises

when we unnecessarily attach the connotation of pun-ishment. At first glance, disciplining a child with TSmay appear to mean punishing the child for havinghis TS symptoms. On the contrary, what is hoped tobe achieved in disciplining this child is instilling inhim a growing sense of responsibility for and self-control over his behavior in general and particu-larly for those rituals, thoughts and tics that are so-cially unacceptable because they are dangerous orharmful to either the person with TS or to others.

The concept of discipline becomes complicated evenmore when we erroneously attempt to separate outthe person with TS from the TS symptoms them-selves. In the final analysis, asking whether a behav-ior is generated by TS or is, instead, purposefullygenerated is a moot question because:

1) Any behavior comes from the same indi-vidual, not from either his "TS part" or his"non-TS part," and,

2) As far as society is concerned, unacceptablebehavior is unacceptable behavior, regardlessof its cause.

In order to live within our culture's mores and there-by attain the acceptance they desire and deserve,people with TS must be able to distinguish, and overtime, learn to control the expression of those im-pulses which are unacceptable. This can be accom-plished either by deliberate symptom substitution, orby learning to become aware of one's own potentiallyout of control situations, and creatively work aroundthem.

Because of the complex, involuntary nature of TS,parents and teachers may be easily confused abouthow to address each episode of destructive, harmful,or otherwise inappropriate behavior. They may ques-tion whether or not to address the episode with thechild or to simply overlook it one more time. Whileunderstandable from an adult point of view, think fora moment of how this ambivalence on the part of his

5

nurturers might adversely affect the self-confidenceof the child with TS. The child who, because of hislack of impulse control, is so in need of feeling somesense of control in his life, finds himself In a never-never land of intellectually puzzled and emotionallytorn adults who are hesitant to set and enforce lim-its, fearful of demanding that the child conform to alevel of which he may be incapable. That atmosphereof uncertainty is ripe for the development of manipu-lative tendencies on the part of the child, which caneventually evolve into a full-blown personality/conductdisorder.

Quite simply, if we hope to adequately meet hisneeds, those of us in charge of rearing this child donot have the luxury of time to debate the question.To find his place within the larger society, this childneeds to learn explicitly which behaviors his contem-poraries view as okay, and which behaviors theydon't. Surely he deserves the chance to be taughtthis distinction, and then guided through the practiceof it.

Impulse Control Via RedirectionSince TS appears to be a disorder of the censor-

ing mechanism governing impulses, some urges gen-erated by TS may be socially offensive, or even physi-cally dangerous. A rather commonplace example isthe urge to touch or grab other people's personalbody parts. Obviously, this act will not be well toler-ated, and is likely to push others' acceptance of TSsymptoms to the limits. Another symptom that manyfind offensive is spitting. Though a legitimate expres-sion of a neurological disorder, behavior with nega-tive social connotations requires special guidancefrom caretakers. This guidance requires a careful bal-ance of:

1) Non-judgmental acceptance of the child as heis, regardless of the nature of his arges, and

2) Creativity in helping the child to brainstormabout an alternative behavior or adaptationof the behavior that will both satisfy the mo-tor, vocal, or sensory urge, and yet not of-fend others.

6

For example, to satisfy the urge to touch others, itwould be reasonable for the adult in charge to sug-gest the child with TS first ask permission of theperson to touch them, and then to touch that personon the shoulder, arm or some other less private bodypart. In this way, the guiding adult is accepting thechild, TS and all, and the child is acknowledging hisurges, and learning to live with and accept his TSrather than holding it in. Further, through brain-storming creative options, the child is learning fromthe adult that others in society also have their rightto be who they are, and to have their wishes re-spected.

With spitting, a very simple but effective solutionmight be for the child to carry with him a handker-chief or tissue, and spit into it. In this way, he is notjudged by others harshly for something he cannothelp, plus he is being considerate of the sensibilitiesand the rights of others in his culture.

As mentioned, sometimes TS urges can compel a per-son to behave in a way that may be physically dan-gerous to himself or others. In this case, the adultshould be very practical in attempts to avoid bodilyharm. Sometimes this may mean being creative insetting house or classroom rules for the child. Forexample, if the child has a compulsion to place hishand on a hot stove whenever he sees one, allowhim in the kitchen only after the stove is turned off,or if he is allowed to cook, allow him only use of themicrowave, and declare the conventional range offlimits to him for the time being.

Caring parents and teachers never hesitate to inter-vene when there is the possibility of physical harm.It is important to realize that they have just as muchresponsibility to intervene when the danger is poten-tial social or psychological ostracism. Otherwise wecannot expect him to emerge into adulthood with thenecessary social skills to take care of himself, formrelationships and maintain employment. The childwith TS simply may not inherently understand that agiven impulse is socially unacceptable, particularlygiven the high incidence of learning disabilitiesamong the TS population. If his primary caregiversare, for whatever reason, negligent in teaching and

7 1 0

illustrating this distinction between socially unaccept-able behaviors and acceptable ones on a continualand consistent basis, then that child is denied theopportunity to learn to live In harmonious relation-ship with his peers. In the long run, this may proveto be much more handicapping than tics, noises, ritu-als, and obsessions.

Obsession Control Via RedirectionMany children with TS are quite distressed when

phrases or words of an obscene, violent or cruel na-ture turn over and over in their minus. They maysubvocalize these phrases or just hear them relent-lessly. Examples might be, "I hate God," or "Mom willdie." Not realizing that such intrusive thoughts arecommon to childhood and because they are unable tocontrol the repetition of them, children with TS mayfear becoming "evil", and assume moral responsibilityfor their thoughts. To help ease his mind, it may beuseful to frequently reassure the child that thoughtrepetition may be an aspect of his TS symptoms, andencourage him to talk openly with you about the in-trusive thoughts he has that may frighten him. Talk-ing about them and just acknowledging that they ex-ist will help to demystify them and make them lessscary. It may also be useful to suggest a more pleas-ant phrase with a more pleasant image to substituteand repeat. Rather than repeating "I hate God," sub-stitute "I love God," or "I hate cod." If the child is ofsufficient maturity to distinguish between humor ofan affectionate, accepting nature and hurtful teasing,humor is always appropriate when dealing with thesymptoms of TS.

Teach Cause and EffectDisorders of impulse control affect how a child

reasons and thinks. Often to his parents' and teach-ers' exasperation, this child truly lives for the mo-ment. Though he may be of normal or above-averageintelligence, foresight and thinking ahead to antici-pate consequences are not often a part of this child'sthinking processes. Therefore, often he truly fails tofeel any responsibility for his own actions. He is not

11 8

necessarily being purposefully irresponsible: he simplydoesn't see the connection between his actions andtheir consequences. Yet some degree of foresight andanticipation must be cultivated and practiced throughthe formative years in order for the child to matureinto an adult who is capable of taking responsibilityfor his actions and his choices. What nature has notprovided neurologically, teachers and parents can andmust supply externally. Children may have to be toldrepeatedly and shown how their actions and wordswill prompt responses from others. This is not apopulation for whom one illustration will ever beenough.

Practice in anticipating outcomes of behaviors can beincorporated informally into daily casual conversation.For example, a parent might ask, "What do you thinkmight happen if you leave the lid off the peanut but-ter jar?" After the child is directed to brainstorm al-ternatives such as, "The peanut butter would dryout," "Ants would get in it," or "It would be ruined,"the parent might then ask the child to choose thedesired outcome, (salvaging the peanut butter,) andthen guide him through the steps to bring about thatoutcome, (replace the lid.) In short, the child must betaught, through practice and more practice, the rea-soning process that those of us without problems ofimpulsivity take for granted. In order to be most ef-fective, this exercise can be practiced as an ongoingfamily game of sorts and not just in the momentsafter a minor disaster has occurred.

Another example might be a teacher nonjudgmentallyasking an overly-active student before he is in-structed to line up for lunch "What might happenif you were to push the person standing in front ofyou in the lunch line?" The student might respond,"He would push me back," "I might knock him down,"or "I would get sent back to the room and have toeat lunch by myself." As with the parent, the teachercan ask the child to choose the desired outcomefrom the various alternatives, (eating lunch in thecafeteria with no problems,) and then guide the childto bring about that outcome; ("Then don't you thinkit might be a good idea to put your hands in yourpockets, so you won't forget to keep them to your-

self?") Again, the child Is guided through the reason-ing process, and given the opportunity to make a pre-considered choice about his behavior. In this way, hisself-esteem is not threatened, because his actions hadbeen considered before they occured. Many times, thispreventive approach can avert a catastrophe. Overtime, through continuous practice, this process willteach him by illustration that his actions always haveconsequences.

Moreover, as he matures, he will begin to realize thathe has some degree of control over what happens tohim and how he is treated by others. This is not aconcept that a child with impulsivity problems cansense inherently. For this reason, he desperatelyneeds our consistent, ongoing guidance in demonstrat-ing that there is indeed a relationship between hischoices of behavior, and how others treat him.

Teach Responsibility for ChoicesAs an outgrowth of teaching the cause and effect

concept, children can be taught specifically how tomake choices and to accept the consequences fortheir choices. As with other behaviors, this will taketime, demonstration and practice.

Initially, offer only two alternatives, such as, "Wouldyou like to work with the group in math today, orwork the problems at your own pace at your desk? Ifyou work with the group, you will be expected tocomplete the whole page of problems, and you willget a sticker when they're finished. If you work byyourself, you will be expected to do only problemsone through ten, but no sticker. Which do youchoose?" The choices may have to be repeated, but atime limit should be set for making the decision, pos-sibly using a timer. Whatever the child chooses isimplemented, with no argument or discussion toler-ated from him at any point in the process. Allow himto either endure or enjoy the natural consequences ofhis decision. Though this approach sounds rigid, re-member that you are trying to provide the child witha mental structure and order the cause and effectreasoning that he does not inherently possess.

10

Similarly, parents might ask, "Would you like to doyour homework now and then watch television aftersupper, or would you like to go out and play now,and do homework after supper? Remember, if youchoose homework later, there will be no television to-night." Then firmly implement the child's choice, tothe letter, and refuse to engage in discussion or ar-gument of terms at any point. If the child refuses tohold up his end of the bargain, then privileges maybe revoked at the appropriate level. The point is tolet the natural consequences of his decision stand asthe rule.

If practiced consistently over time, the child beginsto realize that he can take you at your word, andwill feel secure in knowing what to expect from theenvironment. This sense of security will ultimately nipa great deal of oppositional behavior in the bud,though it may take many repetitions and attemptedarguments from the child before he learns to trust 1

the process. This will require, at times, the patienceof a saint and the endurance of a marathon runneron the part of the caregiving adult. Parents andteachers must not fail to give themselves well-de-served congratulations for their perseverance!

Control of Explosive Anger Via RedirectionPerhaps the most problematic and misunderstood

aspect of both TS and ADHD is the very real phe-nomenon of explosive, out-of-proportion anger. Stem-ming from the same organic source as mental impul-sivity, explosive anger can override the better judg-ment of a child or adult with little apparent provoca-tion. This, too, is neurologically based and generallyaccepted by those who live in close proximity tosomeone with TS or ADHD. It is often referred to as"having a short fuse." However, structure, directionand limits in its expression must be set during child-hood if this problem is not to become a major handi-cap in building relationships and maintaining employ-ment as an adult.

It has often been suggested that a punching bag beinstalled in the child's room to provide a physicaloutlet for aggression. However, unless the child car-

1114

ries a punching bag with him day and night, this ispretty much a useless solution, because explosive an-ger of this kind will not wait until the child is ableto reach his room and his punching bag. Such is thelightning-quick nature of the anger response thatcomes with a disorder of impulse control. The indi-vidual is literally incapable of waiting for a propertime and place to express it. Again, his neurologydoesn't give him that choice.

To compensate and return what sense of self-controlhe still has available, we can teach him to direct hisanger in ways which will bring about the least harm-ful consequences. For example, if, when in a rage, hesenses that something is going to be broken, it ispossible to be taught to have the presence of mindto reach for the plastic dishes instead of the Frenchlead crystal. The crystal is off-limits as far as an ac-ceptable expression of anger is concerned. Period. Ifthe limits are violated, then privileges could be re-voked, with the "penalty" fitting the "crime." Eachfamily can discuss explicitly with the impulsive child(and his siblings) its own list of off-limits actions forexpressions of anger.

This process involves recognizing the direct relation-ship between cause and effect referred to earlier,and will likewise take time and practice to perfect.However. it will be well worth the effort when weconsider the alternative of out-of-control adult anger.For his own good, we must put limits on how, andfor how long, a child is allowed to express his anger.Then we must see that those limits are enforced. Be-cause of the neurology involved, he may find himselfgoing over and over a perceived injustice, unable tolet go of the persistent thought. When, after an ex-plosion of anger, we help him to structure his furyby setting a time limit on its expression, and thenkindly but firmly help him to redirect his attentionand energies elsewhere, we are giving him a mostvaluable coping tool. For example, "You have spentthirty minutes now being angry because Michaeldidn't invite you to his party. I can surely understandyour feelings; you're justified in feeling hurt. I'msorry that happened, but now it's time to put it be-hind you. Right now I need your help in putting

15 12

away the groceries. Come with me." Then insist thathe does, physically taking his hand and leading himaway, if necessary.

For obvious reasons, this child may be extremely up-set by not feeling "in command" of his own behavior,and therefore may become quite defensive whengiven an order or assignment. When told to do some-thing, he can very easily be made to feel inferior andsubservient, and take the whole thing as a personalaffront a situation which may spark an explosionof impulsive anger and frustration. For this reason, itis very helpful to monitor how our parental and edu-cational commands, requests, suggestions and rulesare stated. By using tactful language and short,structured assignments, we can foster compliant be-havior and still allow the child a feeling of controlever his own actions. This sense of control, as we'veseen repeatedly, is tenuous and something thatshould be protected and nurtured whenever appropri-ate. It can be maintained with thoughtful wording.

As an example, if a well-meaning parent should say,"If you don't have your room cleaned by noon, youcan't go to the movie," he or she is unknowingly wav-ing a red flag in front of a bull. Why? Because thecommand is stated negatively, using the words"don't" and "can't." This emotionally volatile child willprobably focus on those negatives and not even hearthe rest. Furthermore, he can easily be overwhelmedwith frustration and disintegrate into tears or rageat the prospect of a task like cleaning his room, be-

cause quite simply he may not know how or whereto begin a task that has so many components. He lit-erally feels incapable of the task. Though it may looklike willful noncompliance or laziness, we must re-member that incoming information doesn't organizeitself in the brains of these children the way itwould in a child without a disorder of impulse con-trol. So what can be done?

Instead, try saying, "I'll bet you can get all yourclothes off the floor and hung up in five minutes. I'll

time you. Go!" After that segment is completed with

your verbal coaching, ask, "How long do you think itwill take you to make your bed? Let's see, Go!"Throughout the process, give plenty of positive, en-

13

16

thusiastic feedback. Then when the task is completed,say the equivalent of, "Since you did such a great jobon your room, and saw the job through to the endwithout arguing or complaining, I think you deserveto go to the movie this afternoon." By breaking ei-ther domestic or academic tasks into segments, put-ting them in sequence, and outlining time limits, weare able to transform a potentially overwhelming taskinto a series of achievable activities. And by gentlyeliciting the child's cooperation rather than issuingstrict orders, we do not put him on the defensiveand threaten his shaky sense of independence andcompetence, but instead we build on it.

Over time, if consistently practiced, the child willgradually begin to approach tasks in this manner onhis own, and it will evolve into his own strategy forapproaching tasks as he grows into adulthood. Admit-tedly this takes much time, attention and repetitioninitially. It also reqUires dedication, belief in thechild, patience, energy and resilience. However, whenwe consider the alternative of the child growing intoan adult who, without our intervention, will likelyhave to daily face his own rages, noncompliance, andoverwhelming frustrations, living in isolation, whatchoice do we realty have?

SummaryIn summary, to adequately serve these children

as parents and teachers, it is our right, responsibil-ity, and duty to provide support in basically twoways. First, by allowing and accepting the expressionof tics, noises, and other urges which are not of adangerous nature in either a physical or a socialsense, we show the TS child acceptance and support.Sometimes, this may require us to try and simplytune out or overlook continual noises or movementsthat may grate on our nerves. In showing this accep-tance of his neurological disorder as an intricate andunique aspect of his personhood, we give him asense of "okayness" which is absolutely necessary inbuilding the self-esteem he will certainly need tokeep plugging away daily, despite the considerableannoyances that having TS can bring.

17 14

Secondly. we must also not be afraid to offer struc-ture, direction, and the caring counsel of distinguish-ing right from wrong, appropriate from inappropriate;we must not be afraid to discipline. By providing thismuch-needed guidance In directing his energies andimpulses, over time this will give him the knowledgeand self-confidence that he can function autono-mously, without us there, in any social situation.

All children need to have explicit limits set for them.Though they may balk and complain at the time,knowing the parameters within which they are ex-pected to operate gives them a sense of security.Children with TS and/or ADHD are first and fore-most children, and in that sense not very differentfrom others as far as their needs for parenting andnurturing are concerned. They may, however, requiremany more repetitions and examples, more extensiveand explicit demonstrations of appropriate behavior,more encouragement in seeing a task through to theend, and more short-term and concrete rewards formaking progress than their peers. However, the re-ward of witnessing a child once considered "at risk"function happily on his own, confident in his abilitiesand in his future, is second to none.

I5

18

Ramona Fisher-Collins has a bachelor's degree in specialeducation, learning disabilities, and a master's degree inspecial education. She currently teaches a self-containedclass for elementary school children with behavioral prob-lems in Oklahoma City, OK. For the past ten years, she hasconducted research on the school problems experiencedby children with TS. Ms. Fisher-Collins serves on the TSANational Board of Directors.

For their conceptual and editor;:11 contributions, theauthor wishes to gratefully acknowledge:

Edward C. Collins, Ph.D., educatorMort Doran, M.D., surgeon

Sue Levi-Pearl, TSA Liaison for Scientificand Medical Programs

Sue Conners, M.A., educatorBarbara Duenas, parent

ADDITIONAL RESOURCES

VHS FILMS

An Inservice Film For EducatorsA new aid forteachers to help understand the complexities of teach-ing children with TS. Includes explanation of the com-plexities and suggests interventions that work. 45 min.

Tourette Syndrome: The Parent's Perspective -Diplomacy in Action Features E. Collins and R.Fisher-Collins providing guidance to TS families onschool advocacy issucs. Concrete suggestions to insurethe success of the TS child's school experience. 45 min.

Talking About TS Dr. Orrin Palmer (who has TS)leads an in depth discussion with a brother and sister,both of whom have TS. 45 min.

LITERATURE

Tourette Syndrome and Behavior Drs. R. Bruun,K. Rickler and E. Kelman-Bravo, CSW,MS. 1991. De-scribes recent research and what is now known aboutthe relationship of a variety of behaviors and TS. Con-tains helpful advice about the management of problembehaviors for families and individuals with TS. 21 pgs.

An Educator's Guide to Tourette Syndrome S.Bronheim, Ph.D. Covers symptoms, techniques forclassroom management, attentional, writing and lan-guage problems. 16-pgs.

Coping with TSA Parent's Viewpoint - E. Shimberg.Covers parental and family acceptance, behavior man-agement. 23 pgs.

An up to date Catalog of Publications and Films,including prices, can be obtained by writing to:

TOURETTE SYNDROME ASSOCIATION, INC.42-40 Bell BoulevardBayside, NY 11361

Tel # (718) 224-2999Fax # (718) 279-9596

20

Permission to reprint this publication must beobtained from the national:

EziTourette Syndrome Association, Inc.4240 Bell BoulevardBayside, New York 11361-2874Tel: (718) 224-2999Fax: (718) 279-9596

© TSA, Inc. 10M194

21

U.S. Dept. of Education

Office of EducationalResearch and Improvement (OERI)

E 1 CDate Filmed

December 14, 1995

U.S. DEPARTMENT OF EDUCATIONOffice of Educational Research and Improvement (OERI)

Educational Resources Information Center (ERIC)

REPRODUCTION RELEASE(Specific Document)

I. DOCUMENT IDENTIFICATION: LC.304(//

I ERIC

Title: Discipline and the TS Child; Educati-Onal Rights for Students with TS;Coping with Tourette Syndrome in the Classroom; Tourette Syndrome andthe School Nurse; Tourette Syndrome and the School Psychologist; and

AUth041.° en' Behaviors an oureLLe SyndLout

Corporate Source:

Tourette Syndrome AssociationPublication Date:

II. REPRODUCTION RELEASE:

In order to disseminate as wideiy as possible timely and significant materials of interest to the educational community, documentsannounced in the monthly abstract journal of the ERIC system, Resources in Education (RIE), are usually made available to usersin microfiche, reproduced paper copy, and electronic/optical media, and sold through the ERIC Document Reproduction Service(EDRS) or other ERIC vendors. Credit is given to the source of each document, and, if reproduction release is granted, one of thefollowing notices is affixed to the document.

If permission is granted to reproduce the identified docum, 'It, please CHECK ONE of the following options and sign the release

SIN Sample sticker to be affixed to document Sample sticker to be affixed to document MO

Check he:-Permittingmicrofiche(4" x 6" film),paper copy,electronic, andoptical mediareproduction.

"PERMISSION TO REPRODUCE THISMATERIAL HAS BEEN GRANTED BY

TO THE EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC)"

Level 1

"PERMISSION TO REPRODUCE THISMATERIAL IN OTHER THAN PAPER

COPY HAS BEEN GRANTED BY

AO.

TO THE EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC)"

Level 2

or here

Permittingreproductionin other thanpaper copy.

Sign Here, Please

Documents will be processed as Indicated provided reproduction quality permits. If permission to reproduce is granted, butneither box is checked, documents will be processed at Level 1.

"I hereby grant to the Educational Resources Information Center (ERIC) nonexclusive permission to reproduce this document asIndicated above. Reproduction from the ERIC microfiche or electronicloptical media by persons other than ERIC employees and itssystem contractors requires permission from the copyright holder. Exception Is made for nonprofit reproduction by libraries and otherservice agencies to fy infor n needs of ucators iryesponse to discrete inquiries."

Signature:

Printed Name:

Tourette Syndrome Association, Inc.42.40 Bell Boulevard. Bayside. New York 11361.2861

Sue LeviPearlLiaison for Medical &

718-224.2999

Fax: 71 &279.9596

Position:

Organization:

ephone Number:

Date: <.6% VASOVER