Students with Tourette syndrome have tics, which can be involuntary movements or vocalizations. Special education teachers may notice students with the disorder have particular speech and language characteristics.
Characterized by Tics
Tourette syndrome, a neurological condition, affects between one to 10 children in every 1,000, according to Genetics Home Reference. Symptoms of Tourette syndrome begin during childhood — on average, between ages 7 and 10. The disorder is more common among boys—the National Institute of Neurological Disorders and Stroke notes that boys have Tourette syndrome three to four times more than girls do. The disorder is characterized by tics, which are involuntary actions that are repetitive; the actions can be movements or vocalizations. These tics can be further categorized as simple or complex. With a simple tic, the action uses a few muscle groups and is sudden, but with a complex tic, more muscle groups are used and the actions are distinct. For example, with motor tics, a simple tic would be eye blinking, while a complex tic would be flapping the arms. With a vocal tic, a simple tic would be throat clearing, barking or yelling, while a complex tic would be repeating someone else’s words. The vocal tics in Tourette syndrome appear later in life than motor tics. As some children with Tourette syndrome have vocal tics, different speech and language issues can arise.
Speech and Language Issues
The simple and complex vocal tics in Tourette syndrome differ in speech production. Burd, Christensen and Kerbeshian explain that with simple vocal tics, children “often incorporate poorly synchronized sequences of respiratory, vocal cord and oral articulatory mechanism," while complex vocal tics may include a sequence of simple motor tics, interruptive phonemes or pragmatically misplaced verbalizations. One misconception about Tourette syndrome is that patients say obscene of inappropriate words as their tics. Genetics Home Reference notes that while this type of tic, called coprolalia, can occur, it is uncommon. If a child does have coprolalia, she may say one word or a phrase.
Some children with Tourette syndrome may repeat words. If the child repeats somebody else’s words, it is called echolalia, but if she repeats her own words, it is considered palilalia. Children who have echolalia can have immediate echolalia or delayed echolalia. With immediate echolalia, the child immediately repeats what the other person was saying. Children with Tourette syndrome who have delayed echolalia as a vocal tic repeat what another person has said, but there is a delay before the repetition. In cases of palilalia, the repetition may be a word or phrase and the child may whisper the repetition. When speaking, a student with Tourette syndrome may use different voice intonations. Burd, Christensen and Kerbeshian note that whether a student has simple or complex vocal tics, they break semantic rules, “because of their insertion into larger units of conversation where they have no apparent contextual meaning."
The National Institute of Neurological Disorders and Stroke adds that children with Tourette syndrome may have other language problems, such as difficulties with writing or reading. Students with reading problems can have trouble retaining the information they just read. Shaw, Woo and Valo note that other reading problems that may be seen in students with this disorder include problems with reading speech and reversal of letters, words and numbers. Reading and writing issues may also arise if the child has motor tics such as rapid eye-blinking, which interferes when trying to keep her eyes on the page.
Speech production problems are also possible with Tourette syndrome. For example, a child with the disorder may speak rapidly that it is difficult to understand what she is saying. Some children may stutter. Dysfluency is another issue that may be seen with this syndrome. Shaw, Woo and Valo note that these speech problems are not due to the tics alone; in fact, these speech production problems are the result of the TS gene.
What are the Treatment Options?
Education on Tourette syndrome is important when children with the disorder start attending school. The Centers for Disease Control and Prevention notes that educating other students and educators about Tourette syndrome can reduce teasing and the amount of stress that the student with the disorder is under. This can help clear up misconceptions, such as the student saying things to be disruptive on purpose or that the student can control what she is saying.
Different therapies can help struggling students manage their symptoms. For example, behavior therapy may help with reducing the number or severity of the tics. Speech therapy may help students with certain speech and language issues, such as stuttering. The child’s doctor may recommend medical treatment for vocal tics. The Mayo Clinic states that an injection of botulinum toxin type A, or Botox, to the muscle affected can reduce the tics.
It is essential that special education teachers and parents strive to learn about this condition and make accommodations necessary to help with these types of language and speech issues brought on by Tourette's so students can be overall successful.