Any teacher who has taught a child with Tourette Syndrome will be familiar with tics.
These sudden twitches, movements or sounds, which are out of the child’s control and occur repeatedly, usually appear around the age of 6 and are relatively common.
However, secondary teachers may now be noticing more of their female students developing tics for the very first time.
According to research published by Great Ormond Street Hospital in March 2021, the number of teenage girls presenting with tics has increased since the start of the Covid-19 pandemic.
In a normal year, the specialist clinics for Tourette Syndrome at Great Ormond Street Hospital and Guy’s, King’s and St Thomas’ School of Medicine receive, on average, around four to six referrals a year specifically for acute onset tics in teenage girls.
But between November 2020 and January 2021 they received three to four referrals per week, which research at the time predicted would amount to around 150-200 cases per year: effectively doubling the clinics’ referral rate.
So what do secondary teachers need to know about the implications of that increase?
We spoke to Dr Tara Murphy, a consultant paediatric neuropsychologist and clinical psychologist at Great Ormond Street Hospital, and Dr Morvwen Duncan who works alongside her as a clinical psychologist, to find out more.
Tes: What types of tics are on the increase?
Murphy: We’re seeing an increase in “functional tics”, which are quite different from classical tics. Tourette Syndrome, for example, tends to present with “simple tics” like eye blinking, throat clearing, sniffing, head jerking; but functional tics are typically bigger, louder and more complex. They look like a behaviour, rather than clusters of repetitive behaviours, and can include shouting a whole phrase, hitting out, banging the table or throwing something across the room.
They also onset much later: since the pandemic, a lot of the girls presenting with these difficulties are in their early to mid-teens, much older than we’ve previously seen in children with Tourette Syndrome.
Why do you think this is? Some research suggests that girls developing these tics have had prior experience of watching others with Tourette Syndrome on TikTok. Is this a factor?
Murphy: It’s a combination of different factors, but one of the common things we’re seeing is diagnosed or suspected neurodevelopmental vulnerabilities.
Children may, in addition to the tics, have a history of autism spectrum disorder, attention deficit hyperactivity disorder or specific learning disorders like dyslexia, dyspraxia or dyscalculia. They may indeed also have Tourette Syndrome. The way that we were formulating this is that those difficulties, perhaps if they’re undiagnosed and in addition to the stress of the pandemic, factor in the development and persistence of tics.
It may be that some people have been affected by social media, but we’ve also seen a lot of young people who haven’t had extended access to social media. TikTok is probably one of several variables impacting this increase.
What sort of impact do functional tics have on children’s lives?
Murphy: It’s significant; educational experience can be disrupted because the capacity to stay in the classroom can be limited. At home, things can be tough too, particularly when the tics are undiagnosed, and there’s little understanding of what may be contributing to but also maintaining them.
The young people we’ve seen are extremely distressed, not only because of the impact on their lives but also because the adults around them are worried and don’t know how to deal with them effectively.
How can teachers support these young people?
Duncan: Teachers need to be on the lookout for signs. These are quite similar to other mental health difficulties: changes in attendance or struggling in lessons. We know that neurodevelopmental or mental health difficulties, if they’re not diagnosed, may be a factor in developing these tics, so teachers need to be on the lookout for signs of anxiety, autism or ADHD, for example.
To be clinically diagnosed with functional tics, children need to be presenting with a number of tics for an extended amount of time, and there needs to be an impact on their day-to-day life. Unfortunately, as we have limited research in the area, the diagnostic criteria for diagnosing the condition may differ to some degree between clinicians.
If a teacher notices a new tic, what should they do?
Duncan: Parents and teachers should seek help from the GP or local Camhs teams to refer the child. It’s also helpful for clinicians if they keep notes about the pattern and progression of the tic, and how the child is dealing with it.
Teachers should take the time to learn about the condition; a lot of young people tell us that when adults around them understand the functional tic and then put adjustments into place, it makes a significant difference to their lives.
What sort of adjustments might help?
Duncan: Sometimes it’s around understanding, supporting and managing co-occurring difficulties, and getting conditions diagnosed, in order to reduce levels of stress or anxiety in the classroom.
We know that functional tics have increased, in part, because of the stress induced by the pandemic, so employ a range of anxiety management strategies if you can. Supporting the student to manage that anxiety should, in turn, help to reduce the tics.
It’s also really important to identify any triggers; if there is bullying or stress around a particular lesson or subject difficulty, children need support around that, just as you would with any other condition.
Where teachers have identified a particular lesson as a trigger, should they aim to simply remove the child from those lessons?
Sometimes a child with tics might respond by not completing homework or not attending school. Functional tics occur when the body is responding to stress, so removing the person from that situation can teach the body that the way to reduce stress is to have functional tics, so it’s really important that routines stay stable.
Where possible the children need to remain in the classroom, or the school environment, and hopefully, over time, this will increase the young person’s ability to stay there.
Social embarrassment is a reinforcer for functional tics, too, though. So, if other children, or indeed adults, respond to a tic, perhaps by laughing or commenting, that can increase the young person’s discomfort in the classroom. Other children, therefore, need to be taught to not engage and to continue with their own work.
