School is back in session! Lots of emotions around the start of the school year. For some kids, this means increased tics and/or anxiety. Here’s the breakdown on how to handle the upcoming school year if you’re child’s tics are present.

Start at Home

A lot of children worry what others will think or say about their tics. Whether the tics are very noticeable or fairly discrete, their worry about what others think will impact their engagement and attention in school. At home, conversations about the tics MUST be had. These conversations should be centered around normalizing the tics. Together, talk about how tics are normal movements and sounds that happen at a high frequency. Research successful individuals with Tic Disorders and Tourette Syndrome. The home should be a safe place for kids to freely tic and talk about their tics.

When children are asked about their tics by peers, they often tell me their typical response is “nothing,” or “I don’t know what you’re talking about.” It’s best to have a simple go-to response so they feel empowered and equipped to handle the curiosity of others. It’s also a great opportunity to educate and advocate for Tic disorders. I have a YouTube video on explaining tics to others here. My favorite responses include:

• “I have twitches that I can’t control sometimes, you can ignore it
• “It’s a condition where I can’t control some of my movements and sounds. I’m okay, and you can just ignore it.”

I think it’s really important to tell others how you want them to handle the tics. Ignoring tics, is the best response. Tics love attention (positive or negative), so the less you give them, the less likely they are to occur (or increase). Practice this response at home. Even if they don’t feel confident explaining their tics, practice speaking with confidence. The more they view tics as a separate part of themselves and not part of their identity, the better! Other kids will see that the tics don’t change who they are or what they do.

Start Early with School

If you have the opportunity, get in contact with the ESE director, head of disability resources center, or guidance counselor and explain your child’s situation. Unfortunately, the education and understanding of Tic Disorders and Tourette Syndrome is still very limited, so providing education material for the school staff can be really helpful. The Tourette Association of America (TAA) has a ton of resources for educators, support staff, students with tics, and parents on their website here: https://tourette.org/resources/overview/tools-for-educators/. I highly recommended printing their Educator’s Toolkit and bringing it for a few of the staff members.

This is also the time to discuss the need for a 504 plan. I find that most students with Tic Disorders or Tourette Syndrome really only need the 504 plan versus and IEP (Individualized Education Plan). The 504 plan is a written list of accommodations that the student may need over the year. The student doesn’t HAVE to use these accommodations, but they’re there if needed. Students who are distracted by their tics, worry they’ll disturb others because of the tics, have trouble staying on task because of the tics, or even suppress their tics during class would highly benefit from a 504 plan. Here’s some accommodations, I recommend…

• Set up a signal for student to use when there is a need to leave the classroom when tics are interfering with focus, learning, and the classroom setting.  
• Model appropriate responses (especially planned ignoring) for the student’s peers; they will
  follow your lead. If your response is not supportive, it may inadvertently encourage students to
  mock or shun the student with tics.
• Test in a separate location so student does not have to worry about suppressing tics or disturbing
  others. This will allow the student to better focus on the test.
• Increased time for testing and/or alternate assignments as tics are distracting and interrupt learning and attention
• Preferential seating so the student is not distracting other students or self during class, as well as giving the student the opportunity easily step-out of the classroom if tics are disrupting.
• Allow student/parent to follow-up with teacher after class to clarify teaching and assignments

Educate and Advocate

In my experience, students who make the class and teachers aware of their tics before the school year progresses too far have a much more positive experience than those who do not. It can be incredibly helpful to educate the students and staff around them by doing a presentation (in each class depending on the grade) about Tic disorders and/or Tourette Syndrome, especially if the tics are noticeable to others or their tics includes inappropriate words, phrases, or gestures. A lot of students don’t know what these conditions are and just need to be educated on what to expect and how to react. There’s a few ways your child can do this:

• Pass out a brochure or handout educating students/peers about what tics are. Here’s one I’ve created for you: Understanding Tics Classroom Handout
• Stand in front of the class and give a quick speech about what tics are and what tics other students might see. Also, tell the class how to respond or react to the tics (ignore them)
• Record a short video explaining tics and what you want the class/teachers to know about them, then play it in the class. This decreases the stress of standing in the front of class presenting.
• Find a youtube video explaining tics
• The Tourette Association is a great resource for this! They will send families informational packets and video links to play for the school

Avoid Suppression

Students who are bothered by their tics in school will often try to hold them in or make them more discrete. This is usually their ONLY strategy to help reduce the frequency and severity of the tics. I completely understand why they do it, but it suppressing or holding in tics can actually make them worse. Not only is suppression uncomfortable, distracting, and difficult, it can cause the brain and body to develop new versions of current tics or new tics completely. If the student holds in their tics all day, you may see a “tic explosion” after school. This is their way of finally letting the tics go. It’s a sign that they’re finally in a comfortable and safe place to freely tic. Please allow them to tic freely in your presence. However, if they’re holding their tics in all day, it’s a good sign that they’re ready or in need some better strategies. Some simple things to do at school include

• Letting the tics go as often as possible. Whether it’s stepping out of the classroom, going to the bathroom, doing it when no one is looking, or when walking down the hall or in busy environments. The less suppression the better
• A small, non-distracting fidget for their hands can be super helpful. Hair ties, bracelets, clips, etc. can be super helpful for those with long hair. I really like small gear ties (link on Amazon here) or Wikki Stix (link on Amazon here) because they’re discrete and require some muscle force to bend. Tics are less likely to occur during physical movement, so this is a subtle way to provide a similar effect.
• Ask to be positioned in the classroom where it’ll be less likely for others to see/hear the tics. This can reduce stress.
• ADHD is a common condition that individuals with tics have. Managing their executive function skills, providing structure, and allowing their body to move frequently during the day can reduce tic frequency.
• Anxiety is also a very common condition that individuals with tics have. Managing anxiety is crucial! One of my favorite books for parents is called “Anxious Parents, Anxious Kids.” It outlines anxiety and gives you and understanding of its patterns. The author also has a podcast called “Fluster Clux” that provides strategies for you to implement at home.

Learn about CBIT – Therapy to Reduce Tics

If you’ve tried these strategies above and just need more help or resources, it might be time to consult a professional. Comprehensive Behavior Intervention for Tics (CBIT) is the most effective therapeutic treatment to reduce the frequency and severity of tics. It’s incredibly helpful and empowering for kids to learn to understand what’s happening in their brain and body and give them the tools to change it. I provide tele-health services across the globe for children, teens, and adults in the CBIT program. Here’s more info on it: CBIT Therapy Program. It’s helpful for all types of tics and it’s perfect for children 7 years or older who are bothered by their tics. It’s a simple once-a-week program that teaches you the foundation skills to control tics for the long-term!

I hope you’ve found this resource helpful for you and/or your family! I’d love your feedback and welcome any other recommendations you might have below!

Peace + Blessings,

Emily Reid

Occupational Therapist