Tics and Tourette Syndrome Lesson Plan

Tics and Tourette Syndrome Lesson Plan © 2024 by Emily C. Bihun, Jennifer K. Stenger, Lynn Dunlap, Kevin J. Black is licensed under CC BY-NC 4.0. Contact the authors for any uses not covered by the CC BY-NC license.

Time required for each lesson: 30 minutes

Lesson Title: Understanding tics and Tourette syndrome, Respecting individual differences

Social/Emotional Development

Major Points

The content is designed to help students in grades K-8:

  1. Gain knowledge and understanding about tics and Tourette Syndrome
  2. Understanding self as an individual and as a member of diverse local and global communities. Learning includes knowledge that contributes to an understanding of the importance of each person in his or her extended (global) as well as immediate community (e.g. family, classroom, school, city or town) and each person’s role and inter-relatedness with all other people of the world.1
  3. Reduce bullying associated with students exhibiting tics through interacting with others in ways that respect individual and group differences The learning includes developing an understanding of the similarities and differences of others and ways these similarities and differences contribute to working together in our diverse world.  Students will learn about their roles in advocating for respect for all human beings.1

       Materials:

  • Pencil and paper
  • Video screen and internet to display video, How do you live with Tourette’s? 

Goals

  1. The student will understand what are tics and the urge to tic.
  2. The students will understand what it feels like to have a tic while in the classroom.
  3. The students will understand how to reduce bullying behaviors by interacting with others in ways that respect individual differences.

Procedures

1. What is Tourette Syndrome?

Tourette Syndrome, or TS for short, happens when your brain makes your body move or make a sound that you might not want to. When this happens it is called a tic.2 Tics occur repeatedly, usually many times a day, usually for weeks, months or years. Many people with tics know when they’re about to tic. Tics do not include things that you do over and over again for a reason. While tics are sometimes noticeable, oftentimes they may go unnoticed, especially if they look or sound purposeful, like eye rolling or sniffing.3

2. What are the different types of tics?

Motor tics: Brief movements that people make over and over again even though they don’t want to. They can happen in any part of the body (examples: blinking, head jerking, shrugging, or face scrunching).

Vocal tics: Brief sounds that people make over and over again even though they don’t want to (examples: humming, sniffing, or coughing even when you’re not sick).

Play video clip 00:00-01:50 min from the video, How do you live with Tourette’s?

3. What is an urge to tic?

Many people know when they’re about to tic, like when you’re about to yawn.3 The urge to tic can feel like an itch you need to scratch, like when you have a mosquito bite. It can feel like pressure, tingling, or could be difficult for someone to describe. Like with the urge to scratch a mosquito bite, the urge to tic might be more intense, distracting or difficult than doing the tic.

  • What happens if we hold back from scratching a mosquito bite? Does the itching go away?  It’s hard work trying not to tic.

Play video clip 3:47- 5:28 min.

4. Challenges tics cause for learning

      Play video clip 1:50-3:46 min.

      Pledge of Allegiance with Tics Activity

  1. Distribute paper and pencil to group.
  2. Now, we are going to pretend that you are students and I am the teacher.  I am going to give you a chance to experience tics symptoms firsthand.  This will be a timed test and you will be graded on neatness and accuracy.
  3. Your task will be to write, “The Pledge of Allegiance.” (Note: Adjust writing activity for grade level, such as using the alphabet for younger grades or displaying the words students will write.)  I will give you 90 seconds to do this, but I am going to give you movements to perform.  Each time I clap my hands you must stop writing and touch the top of the paper with your pinky finger with the hand with which you write, then open and close both hands, then turn your head to the left and whisper, “Hi.”  Then you may continue.  OK?
  4. Class, you may begin.
  5. Clap your hands every 2-4 seconds randomly and time the group for 90 seconds.
  6. OK class, please set your pencils down and look up.  How many of you finished writing the entire pledge?  How did you feel while taking this test?  How many of you lost track of what you were writing?  Was this an accurate reflection of your knowledge of “The Pledge of Allegiance”?  How do you think you would feel about yourself if you were compared to students who had no tics?  What are some other ways we could test the knowledge of a student with TS?
  7. In this exercise, you were given only one complex tic example – however, individuals with TS have multiple tics and very often experience other issues that can interfere with everyday tasks.  What you experienced for 90 seconds is only a snapshot of what most individuals with TS experience all day long.
  • How would having tics affect you in school? Would it be hard to concentrate or stay focused on what the teacher was saying?
  • Why might it be difficult to read silently or even follow along as the teacher is reading if you had an eye blinking or neck jerking tic?

5. Bullying

Play video clip 6:58-8:24min.

  • How were some of the people in the video bullied (examples: embarrassed, excluded, name-called, picked on)?
  • How do you feel when this happens to you? OR How do you feel when someone calls you names?

Can you stop that? When you ask someone with tics not to tic, it can make them feel like they have to do it more, making it harder to stop. It can be hard not to think about something when someone tells you not to. It is like this with tics.

Don’t Think About Monkeys Activity

  1. Raise your hand if you have thought about monkeys today.
  2. I want you to NOT think about monkeys for the next minute.
  3. Raise your hand if you didn’t think about monkeys at all.
  • How did this make you feel?
  • Would it be difficult to learn the information being taught if you were focused on not ticcing?  
  • How would your concentration in class be affected if your classmates picked on you or made fun of you because of your tics?

6. Unit Classroom Discussion

  • What have you learned about tics and Tourette Syndrome?  
  • What can you do to support a classmate with tics?
  • How should we treat people? Everybody is struggling with something and it’s important to respect individual differences.
  • Think of something you do that you don’t like. Maybe you bite your nails or pick your nose. Imagine if everyone saw you doing it every day.

Tic and Tourette Syndrome Educator Resources

TS and tics for school counselors
Anxiety Management in the Classroom
Educator’s Guide for Developing Plans for Students with Tourette Syndrome
An Educator’s Guide to Planning and Support (Tool Kit)
Tools for Educators
Disinhibition

Acknowledgments

This lesson plan was developed with funding from the U. S. Centers for Disease Control and Prevention (CDC) via the Tourette Association of America, awarded to the Washington University in St. Louis TAA Center of Excellence.

Lynn Dunlap developed the “Don’t Think About Monkeys” activity. Jen Stenger developed the “Pledge of Allegiance with Tics” activity.

References

Martino D, Leckman JF (eds.), Tourette Syndrome, 2nd ed. Oxford: Oxford University Press, 2022. doi: 10.1093/med/9780197543214.003.0014. ISBN 978‑0197543214.

Matlin, O. “How Do You Live with Tourette’s?” YouTube, uploaded by Tourette Association of America (@TouretteTV), 2011, https://www.youtube.com/watch?v=Ch8Jt1Zgnnc.

Missouri Department of Elementary and Secondary Education, “Elementary Interactions, Gr 1 / SE2-Gr1-Unit1,” 2016. [Online]. Available at: https://dese.mo.gov/media/pdf/se2-1st-grade-all-units. Accessed: February 13, 2024.

Tourette Association of America: A Children’s Guide to Tourette Syndrome (brochure). TAA, Bayside, NY (n.d.).

Vachon, M.J., Striley, C.W., Gordon, M.R., Schroeder, M.L., Bihun, E.C., Koller, J.M., and Black, K.J., VISIT-TS: A multimedia tool for population studies on tic disorders. F1000Res, 2016. 5: 1518. DOI 10.12688/f1000research.7196.2

Vachon, M.J., et al: VISIT-TS video. 2016. Available at Zenodo. DOI 10.5281/zenodo.55604

Footnotes

1 Preceding text was quoted from dese.mo.gov.

2 Preceding text was copied from “A Children’s Guide to Tourette Syndrome.”

3 Preceding text was copied or adapted from the VISIT-TS video.