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Improving Social Outcomes for Children with Tourette Syndrome and Other Neurodevelopmental Disorders

Presented by Azlen Theobald, Psy.D.

View the webinar’s corresponding slides here        Download the Webinar

An estimated 5% to 10% of the population are affected by neurodevelopmental disorders. Children with disabilities are at risk for peer rejection and stigmatization, which often leads to feelings of depression and isolation. Finding ways to help peers better understand the symptoms and presentation of neurodevelopmental disorders, such as Tourette Syndrome, can greatly improve social outcomes and reduce mental health risk among this vulnerable population. This webinar will focus on strategies to help increase positive social interactions for children with neurodevelopmental differences.

Azlen Theobald, Psy.D. is completing a post-doctoral fellowship in clinical neuropsychology. Areas of expertise and specialization include Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), Tourette syndrome, Traumatic Brain Injury (TBI), and dementia. Dr. Theobald completed her masters and doctoral degrees in Clinical Psychology at La Salle University in Philadelphia with a concentration in child and family psychology. Dr. Theobald’s current research focuses on improving social outcomes for children with Tourette Syndrome.

My name is Kelly Teabo, and I’m with the New Jersey Center for Tourette Syndrome and Associated Disorders. And I will be your organizer for this evening and would like to welcome you to our webinar on Improving Social Outcomes for Children with Tourette syndrome and other neurodevelopmental disorders. Thank you all for joining us.

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Before I have my colleague introduce the speaker for tonight, I’m going to cover some housekeeping items with you. All participants are muted.

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If you have a question, please type it in the bottom of your question box and click send. You may send questions during the webinar, however, we will have doctor Theobald answer the questions at the end of her presentation. We will get to as many queries as time allows. In addition, tonight’s presenter is available to take your questions on the Wednesday webinar blog, which is accessed from our homepage under the Heading programs. This blog will be monitored for the next seven days. Feel free to look and post questions as often as you like.

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Answers will be archived for future reference.

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If you missed part of the presentation, or would like to watch it again, an archived version of the webinar will be posted to the website. We value your input, and in order to expand the webinar experience, in the future, we need everyone to fill the survey out as they exit the webinar.

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The New Jersey Center for Tourette Syndrome and Associated Disorders and its directors and employees, no assume no responsibility, for the accuracy, completeness, or objectivity, or usefulness of the information presented on this site.

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We do not endorse any recommendation, or opinion by any member or physician, nor do we advocate for any treatment. You are responsible for your own medical decisions. Now, I’m going to turn over the introduction of our speaker to Martha Butterfield, the webinar co-ordinator of N J. CTS, Marty Kelly. Thank you and good evening, everyone. Welcome to tonight’s webinar. Before I introduce our presenter, I’d like to take a couple of minutes to bring some upcoming … happenings to your attention. Our next youth advocate training is scheduled for Saturday March 21st Basking Ridge, New Jersey for kids between the ages of 10 and 17.

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The objective of our youth development program is to provide young people with … the opportunity to develop courage and confidence while also learning to embrace their differences and advocate for themselves and for others.

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We are still accepting applications for Educator of the Year, which is about honoring an educator who has made a difference in the life of the child with T S. This award is not restricted to classroom teachers, school nurses, guidance counselors, and others on the faculty or staff who has made a difference for your child are all eligible for this award.

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Additionally, we continue to accept scholarship applications from high school seniors. Applicants must be residents of New Jersey, have a T S diagnosis, and are continuing their education in a 2 or 4 year program.

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Finally, there is still space available for families who want to work who want to attend our family retreat weekend. That would be June fifth through seventh being held this year at YMCA camp, Bernie in hundred and County, New Jersey. Kids participate in a broad range of outdoor activities, rekindle old friendships and cultivate new ones. There are many opportunities for parents to do activities with their kids but also to connect with other parents and share their stories. Workshops provide a safe place for both youth and parents to ask questions about T S and learn from peer mentors.

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Now, to the introduction of doctor Azlen Theobald completed her doctoral degree in clinical psychology at LaSalle University in Philadelphia with a concentration in Child and Family Psychology.

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She completed an American Psychological Association Internship at Terry Childrens Psychiatric Center in Newcastle, Delaware, and has also trained at Children’s Hospital in Philadelphia.

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She specializes in providing neuropsychological evaluations for various populations across the lifespan from toddlers to older adults.

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Areas of expertise and specialization include Tourette syndrome, attention deficit hyperactivity, autism spectrum disorder, traumatic brain injury and dementia. She has conducted research among elementary and middle school aged children to identify effective interventions designed to improve knowledge, perceptions and attitudes towards children with neurodevelopmental disorder. Dr. Theobald is a clinician at neuro abilities healthcare in Voorhees, New Jersey, which specializes in providing care for those with neurodevelopmental and neurological disorders. Now, without further introduction, please turn tonight’s program over to Doctor Theobald.

5:29

Thank you so much for that warm welcome, and thank you to our attendees for taking time out of your day to attend this webinar. I’m very excited you’re here and to talk about this topic.

5:39

I was introduced to learning about the Neurodevelopmental subset of Disorders by doctor Judith Neuman, who was one of my Professors and mentors at Penn State University. And her area of expertise was children’s concepts of illness, and more specifically, the impact of a child’s diagnosis and symptom presentation on his or her siblings. Doctor Newman has been involved personally and professionally with NJCTS conducting training sessions, and she’s conducted support groups. Some of you may even be on this call who have known doctor Newman, and she’s a very valued member of their community for several decades and she’s a very dear friend of mine.

6:13

In my doctoral program, I worked with doctor Diana Montague and the Area of Emotion Development among Young Children. And from there, I really began to develop an interest in how children formulate conceptualized differences in peers.

6:25

And I thought if I could use existing knowledge about what the literature has shown regarding how children, formula concepts, of how, or why appear as different from them. Then perhaps we can work toward developing an intervention to really bridge that gap and help peers develop a more accurate understanding of one another that are developmentally appropriate. So I’m grateful to my past mentors for introducing me to these areas of research and allowing me to learn from them. And continue on this trajectory toward building resilience. In among children who have neurodevelopmental disorders. On a personal note, I know many of you who registered for this webinar, parents, who have a child with Tourette syndrome, or perhaps you’re a caregiver of a child with Tourette’s.

7:06

And part of what drove me toward the learning more about this population and how to improve their social success is that I’m not only a clinician, but I’m also a parent of a young teenager who has struggled with tics, and she was about seven years old. And now that she’s in junior high, I live with the daily struggle of wondering if today was a success. Or, was this a perceived failure? So I truly empathize with those of you who are doing your very best, day in and day out to help support your child as best you can. And I applaud the teachers and mentors and school personnel who are really the bright spots and say pavements in your child’s day.

7:40

And they’re really the first line of defense when things do go wrong. It’s sport for these kids.

7:45

So, so we’re going to talk tonight about strategies that can help children feel more comfortable and more accepted, which will hopefully improve their social outcomes.

7:58

So, a couple of objectives for tonight are to first outlined the criteria for a Tourette syndrome diagnosis. And second, we’ll talk about the influence of stigma, rejection among children who are of different neurodevelopmental presentations. We’ll discuss ways children perceive others from different stages of development and interventions that have been studied to date to help improve peer acceptance. And lastly, we’ll discuss interventions that I and others have more recently considered to help improve peer acceptance and how parents, teachers, and caregivers can help bridge that gap between peers to help our children feel more safe and more comfortable, and ultimately really enhance their self-esteem and resilience.

8:34

So first off, let’s just review quickly the DSM five criteria for Tourette’s Syndrome, autism spectrum disorder and ADHD. So these are kinda like the core neurodevelopmental disorders. And Tourette’s Syndrome meet that criteria. First, it’s a heritable neurodevelopmental disorder with having two or more motor text. So for example, that’s blinking, shrugging his shoulders. At least one vocal tic that could be humming clearing your throat, or in pretty rare, very rare cases, yelling at a certain word or phrase. Although these ticks might not always happen at the same time, you must have had ticks for at least 12 months. The ticks can occur many times a day. They’re usually in bouts. Nearly every day or they could occur off and on.

9:17

Tics must have begun before the child was 18 years old and the symptoms are not due to medication and other drugs, or medical conditions like Huntington’s Disease or post viral encephalitis.

9:29

Autism spectrum disorder, according to the DSM five criteria as persistent deficits in social communication and social interaction, it’s really across multiple contexts. And it’s manifested by deficits in something called social emotional reciprocity, as well as deficits in non-verbal, communicative behaviors that are used for social interaction.

9:52

Also manifested by restricted and repetitive patterns of behavior, interests, or activities. Things like stereotyped, repetitive motor movements. This hyper or hypo reactivity to sensory input, unusual interest in sensory aspects of the environment. And the symptoms are present in the early developmental period, and they do cause functional impairment.

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And ADHD;

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That is six or more symptoms of an attention for kids that are up to age 16. 5 or more for adults and adolescents aged 17 years and older, Symptoms of attention must have been present for at least six months, and they’re inappropriate for their developmental level. For hyperactivity and impulsivity, there’s six or more symptoms for kids up to 16, 5 or more for adolescents age 17 and up.

10:42

And the symptoms, again, must have been present for six months to an extent, where truly disruptive and inappropriate for that person’s developmental level.

10:50

Again, symptoms have to be present before age 12, and in two or more settings, and again, they have to really interfere with, or reduce the quality of school social work functioning.

11:03

So since we are focusing on Tourette syndrome. At this time tonight, I just wanted to give some brief statistics from the CDC’s most recent 2012 study. We, we don’t know exactly how many people have Tourette’s Syndrome. There are studies that included children with diagnosed and undiagnosed Tourette’s that those have estimated that about one in every 162 or 0.6% have Tourette’s syndrome.

11:27

According to parent reported data, one, in every 360 children, ages 6 to 17. In the United States have received a diagnosis of tourettes. So that’s about 138,000 children.

11:39

So this really suggests that about half of children with Tourette syndrome are not diagnosed, and among those diagnosed, 37% have been reported as having moderate to severe forms of the condition.

11:51

Boys are 3 to 5 times as likely to have Tourette’s than girls with non hispanic White children twice as likely to have a Tourette Syndrome diagnosis compared to Hispanic and non hispanic black children.

12:03

Worldwide does have prevalence of 1% of the population having the diagnosis.

12:09

So a couple of parents, perspectives that, I’ve looked at, this was called from, from a large group of parents, you know, ask answering questionnaires about their children’s symptom presentation. They really first noticed tics in their children at about six years of age on average. That’s early elementary school. The average time from initially noticing tics to actually receiving a diagnosis was about two years. The average age, when Tourette syndrome was most severe, was about nine years of age.

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Most parents reported their child’s tics were noticeable to strangers.

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Tic severity really interfered with their daily functioning.

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So the more severe the tics, the more impairing for the child, Almost 70% of parents reported that major changes like starting a new school, moving to a new classroom or fatigue, made their child symptoms much worse.

13:02

Here’s just kind of a graphic of, just to show you the extent of overlap or comorbidity of Tourette syndrome with a number of other difficulties that children can face.

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So you see, like Tourette syndrome, really it rarely occurs in a vacuum.

13:20

And looking on, on the National Survey of Children’s Health Study from 2012, serving children ages 6 to 17, clearly see just the percentage of kids with Tourette syndrome having another condition. So 86% of children who are diagnosed with Tourette’s also have been diagnosed with at least one additional, either mental health, behavioral, or developmental disorder. That could be ADHD with the highest prevalence of behavioral problems. Mood difficulties, like depression and anxiety, autism spectrum, learning disabilities. So you can, you can really see just how impactful that this can be for children and for their families.

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So when we consider that large proportion of children with Tourette who also have comorbid ADHD, we can imagine that these difficulties are quite noticeable to peers.

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And previous studies have shown that children can recognize individual differences in their peers by about the age of three.

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Compared to children with physical disabilities, like blindness, children with neurodevelopmental disabilities encounter, social scenarios like teasing and rejection.

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And experienced greater difficulty in maintaining friendships, which really presents a significant risk for adverse physical and mental consequences, like stress, low self-esteem, depression, and anxiety.

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And because children, especially in the early elementary school age range, often associate one’s behavior to be within their control.

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So, you know, they’re able to control what they’re doing. These children make inferences that a child who is exhibiting symptoms associated with the disorder that’s not physical in nature. So that may be getting out of his or her seat being hyperactive versus being in a wheelchair using a cane. And those inferences are often negative because children attribute symptoms of peers with neurodevelopmental disorder as very intentional in nature especially at these younger ages. So students with neurodevelopmental disorders, like ADHD and autism spectrum disorder and threats, can experience limited friendships and exclusion from social activities with peers. And, as a result, they’re really deprived of important socialization experiences, and opportunities that help develop and refine their social skills, and really are important sources of social support.

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Peer rejection in childhood, it predicts a wide range of externalizing problems and adolescents, including things like delinquency, conduct disorder, attention, difficulties, and substance abuse. Children who are accepted by their peers, on the other hand, they tend to show better school adjustment.

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They have higher quality friendships, they are friendlier. They’re more co-operative and more adept at initiating and maintaining social interactions compared with other classmates.

16:14

Children with neurodevelopmental disorders are much more likely to experience bullying behaviors, as well compared to neurotypical children and just to make sure we’re all on the same page, Bullying is really a behavior that must occur repeatedly. So one incident or some teasing doesn’t quite constitute bullying even though it’s, you know, very difficult for parents to, you know, have to kind of navigate with their child and very difficult for the child to have to experience.

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So once the bullying is repeated, it really becomes dreaded by the victim.

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It also has to include a power differential. So it could be a bigger in stature person toward a lesser stature individual, and it could be in social situations as well. So, bullying takes a lot of forms, like aggression, but also teasing, gossiping, shunning, or rejection, and using looks or gestures to really deride. So it could be eye rolling or a certain glare. Cyberbullying is also a huge problem and that kids really no longer have the safe haven of leaving school feeling that relief away from a peer. So, Bullying often often follows kids from school to home, and for kids who have access to their phones or devices at night , as I’m sure, you know, I know my children do. I’m sure yours, too, as well. Those attacks can really continue well into the night when parents are unaware of the extent of the frequency that a child is getting targeted.

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So, you know, when I was in high school, we didn’t have phones, so we went home, and if you were having difficulties with the peer at school, you were kind of, you know, away from it, you were able to breathe a sigh of relief, and now these kids really can’t, no neurotypical, or not. So it’s a very difficult situation with cyberbullying.

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Among children with disabilities, they are bullied at a high rate, particularly during the middle school years, and the victimization rate for children with autism spectrum disorder in particular is substantially higher than what we know is about 10% rate for typically developing children.

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It can really become quite a vicious cycle.

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So not having friends make a child with a neurodevelopmental disabilities like autism or tourettes really vulnerable to bullying and being a victim makes a child with autism or Tourette’s much less likely to get friends. Then we really have the beginnings of comorbid depression, social anxiety, and things like that. So the frequency of either being bullied overtly or rejected it’s highly associated with the load of the psychological issues that can go on in this population.

18:42

Why are they socially isolated?

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Well, there’s the social blindness among kids with autism. That can include things like not knowing how to read other signals or understand social hierarchies or social cues. And these kids really have difficulty knowing what’s considered, you know, cool. So knowing hidden social rules like, you know, the popular, placing her back, popular girl, placing her bag on a chair. And then a child sits on that chair can lead to rejection and negative consequences. So kind of not really knowing those social rules. And kids with Tourette syndrome, they tend to self isolate to hide or minimize their peers noticing tics.

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And in the long run, these kids can lose self confidence.

19:25

They can engage in school refusal or a decision where it’s kind of forced to homeschooled children; fear, emotional, upset, and reversion to even being more introverted if they were a child who in early elementary years were considered to be more extroverted and feeling like no, they lose trust in others, and this often persist well into adulthood.

19:48

When children feel accepted by their peers, though, it really leads to better school adjustment, higher quality friendships, they’re more co-operative in their play and social engagement.

19:59

To improve peer relations for children with disabilities, it’s really necessary to understand the context in which kids make inferences or assumptions regarding the personal responsibility that a disabled child bears in regard to his or her challenge. And a child’s cognitive level of understanding this context, as well as a child’s exposure to the disability. So whether that’s through contact with a sibling, or a friend, or a parent, that’s also a big contributing factor in the attribution process. So in psychology, this is known as something called attribution theory. And attribution theory, in essence, assigned some kind of causality and responsibility to someone’s behavior. So it serves, as our minds kind of perception, why a person is acting a certain way.

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And, in children, this is really dependent on their cognitive level and the level or amount of experience with or exposure to that disability. So, for a child who may have a parent with a physical disability, they may be much more likely to approach a peer who has a physical disability compared to a child who has no exposure to it.

21:06

So, I’m looking at some interventions that were designed to improve peer attitudes toward a child with differences.

21:13

Literature is identified something called actual information to be helpful in the positive attitude development toward peers, neurodevelopmental or physical differences. So that translates into providing kids with facts.

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Factual makes sense facts about appear symptoms, and that could look something like Tourette’s syndrome is not something I can control, purely factual, informational. And giving kids facts has been positively associated with improving younger, but not older, children’s perceptions.

21:43

And we’ll talk about that a little bit later, about why that may be.

21:47

The other intervention that’s been considered and used in anti bullying interventions is giving kids examples of ways they are similar to one another.

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So these are kind of descriptive terms that are designed to build sameness.

22:00

So, here, we’re putting kids are really on an even playing field, and finding ways in which they’re similar to bridge that gap in the manner in which they see themselves as different and often more superior in social status than a neuro, atypical peer.

22:13

So, again, these interventions work better among younger than older kids, and the reason for that is because as children progress into the middle school years, they become more aware of the importance of social status.

22:25

They’re less likely to engage with a peer who may be different from them, even though, they know, logically, the child is not engaging in specific behaviors to irritate others or pretension seeking purposes.

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By the time children are under ending elementary school, they’re much more likely to attribute biological and neurological explanations into the way they kind of conceptualize children with autism, Tourette’s, ADHD for examples, as compared to younger children who really attribute symptoms of ADHD, for example, to that individual’s control.

22:57

And what this means is, younger age children, so we’re talking, like, kindergarten to third grade, tend to have more negative associations toward children with differences, largely because they believe there is some purposeful intention of that other child’s behaviors.

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So, the kid with ADHD who can’t sit still, or child who’s sniffing repeatedly, are humming repeatedly, or whatever the tic might be, those kids are more likely to be seen as doing those behaviors on purpose in the younger grades.

23:24

Once kids are really in fifth and sixth grade, they’re much more aware that kids with Tourette’s syndrome or autism are not responsible for those behaviors. And they’re cognitively able to figure out, like, hey, there’s some other factor going on here that’s really not in that child’s control. So it’s really not surprising that giving older kids more information, more of these facts about appears differences. Doesn’t really help increase the likelihood that, you know, Rachel is going to invite Sarah to her Sleepover, or that Zach will invite Michael to see a movie.

23:54

And as parents, really, all we want is for our children to have at least one meaningful relationship, one child with whom they can connect with and feel of social bond. Because that can make it makes all the difference in a child’s day, which can often be riddled with rejection. No one to sit at lunch, or running to the nurse or the bathroom when it’s time to select partnership from, for group projects. So they can avoid that awful feeling of being the one kid who didn’t get picked to be in the group.

24:20

So, now, it hasn’t often been considered, although many of the anti bullying programs do try to incorporate this into their curriculum, is the component of empathy in peer integration programs. And empathy is really different from some sympathy.

24:33

Empathy is the ability to understand and share the feelings of someone else, and emotion researchers generally defined empathy as something, like the ability to sense other people’s emotions, coupled with the ability to imagine what someone else might be thinking or feeling.

24:48

So, really putting yourself in someone else’s shoes, it’s really just perspective taking, and that concept is it’s difficult to teach in younger children because they haven’t quite mastered that part of their brain development.

25:03

So, kids begin to show empathy around age two, but their mastery of emotion and, and cognitive empathy really takes place and practice. It takes experience and practice. And this generally doesn’t emerge until about age seven or so, which is second grade.

25:18

And we know, according to, you know, prominent folks in psychology like Albert Bandura, social psychologists that the importance of observing and modeling the behaviors, attitudes, and emotional reactions of others and that really continues to develop as children’s executive function skills mature. So that frontal lobe development is really critical.

25:39

And they become more capable of managing their own distress and gain that cognitive space that they need to connect with another person’s experience without feeling totally overwhelmed themselves.

25:51

And it’s really not until middle childhood that these advances are seen in children’s developmental skills. And this is the time to intervene.

26:00

So we know that the key components that factor into a child’s positive attitudes toward a peer include their ability to take perspectives of another and their capacity to imagine what others are thinking and feeling.

26:13

And it really isn’t until those middle childhood years. So we’re talking like third grade or so and up 8 to 11, that kids are really advancing in this area and this core developmental skill.

26:28

We also know that there are sex effects of pure preference, particularly in the elementary school years, and across the cancer and obesity literature. It was found that when presented with vignettes are short stories about girls and boys with them without cancer, girls rated girls more favorably than boys, and that boys rated boys more favorably than girls, regardless of whether cancer was present or absent in the vignettes, And we also found this in obesity literature among girls.

26:58

So, the purpose of this study that I conducted was to improve peer acceptance and behavioral intention. So, when I say behavioral intention, that’s the likelihood that a child would ask, appear to sit at his or her lunch table.

27:13

And this in turn, would help inform disability awareness trainings across various settings, including academic settings.

27:21

That was the main goal.

27:24

Some experts in the realm of emotion development have said that empathy is caught, not taught.

27:31

So, of course, these skills and behaviors emerge and unfold differently for different children, and depend on context as well. So, we really can’t sit our children down for formal lessons and empathy, and now you’re going to get your empathy lesson. That’s tough to do in the classroom too. Instead, empathic responses really emerge over time in the context of warm caring relationships, that model appropriate relationship, seen it at home, storytelling communication and planning.

27:59

And understanding whether a specific type of information, or the combined effects of information is most effective, can really help schools and teachers in providing better sensitivity training, and simplify the informational process of helping children in their classrooms understand differences between them, and appear with a disability. So I was particularly interested in Tourette’s syndrome, for a couple of reasons. one, because of my own personal experiences of having a child who struggles with tics. And too, because there really wasn’t much literature in this specific realm that was seeking to understand what it is about Tourette’s syndrome that puts these kids at risk.

28:35

Significant risk for social rejection and negativity.

28:39

The Tourettes prevalence rates are relatively low, but the noticeability of symptoms is really high.

28:45

So this is a condition in which kids likely don’t know much about it.

28:48

And we, we kind of had the luxury in my study of targeting children who were somewhat of a blank slate as far as their prior knowledge or biases that they may have developed over time about Tourette’s.

29:00

So what I did was I looked at which type of information was most successful and improving typically developing children’s attitudes, and positive behavioral intentions, toward a child with Tourette syndrome, and to do that.

29:13

I created three different video intervention, called The Philadelphia Emotion and Social Cognition Videos along with doctor Diana Montague, and these featured a boy and a girl, presenting three different sets of information. So one video presented just knowledge about Tourette’s. one presented just empathy statements, such as, I feel sad when I am left out of a game, or when people don’t pick me to be on their team.

29:34

Then there was one combined video that merge these two pieces of information.

29:39

We targeted third and sixth graders to really target that kind of emerging time when kids are beginning to have that, you know, strong frontal lobe development, empathic skills development. We really want to see which set of information work best in the way these children rated a peer with Tourette syndrome. And now I should mention that the child that was portrayed in each video was a neurotypical child. Who was a trained actor portraying both motor and vocal tics because we really wanted to keep the presentation of symptoms consistent across the three videos.

30:13

So, we targeted seven private parochial schools and the Philadelphia suburbs never submit. They were very demographically consistent.

30:20

We looked at about 200 participants and with little to no prior information about Tourette’s, and these were third and sixth graders, like I mentioned before.

30:29

What we found was that kids learned a lot of information from the video that gave them just factual information. So things like I was born with Tourette’s, I’m not doing these behaviors on purpose, I can’t control them. You can’t catch Tourettes like, you can catch a cold, purely factual information.

30:45

Kids who are presented with a video of a child, just evoking empathy learned the least about Tourette’s. Not terribly surprising.

30:54

The kids to learn the most were the ones who are presented with the video that combine facts and empathy about Tourette. So you see that combined dotted line in the, in the slide. That, the first line, the top one.

31:07

And why is that? Well, because kids do pay more attention, when there’s an emotional component to what you’re learning adults, as well. Did you ever notice that you’re more likely to remember events in which you had some kind of emotional attachment? So a graduation or a new job, or becoming really sick, or where you were when 9/11 happened?

31:27

Interesting, we found that, whether you were in third or sixth grade, the children generally learned about the same amount of information about Tourette’s syndrome. So we didn’t really see any grade if that effects on knowledge learned.

31:41

So again, you can see that.

31:44

After children watch the video, we kind of looked at their knowledge of Tourette syndrome again, and we compared it to before they watch the video of how much knowledge they have.

31:55

So now we examine the beliefs about the child in the video. If kids were provided appropriate knowledge about the child, and beliefs and attitudes are two very different things. So I can believe that the child in the video isn’t doing the tics on purpose, And I can believe that she was born with Tourette.

32:12

But I can still have a very negative attitude toward that child. And that gap is really, really hard to fill. And that’s where kids need help. So the element of something called social desirability really plays a huge role, particularly in the middle school years when kids are much more aware of their social status and how they’re perceived by others.

32:35

So this is just a little cartoon outlining the concept of social desirability. And it really means that it’s a tendency for children and adults for that matter to portray themselves in a positive manner that’s socially acceptable. So particularly for the older children moving into adolescence, they may fully acknowledge and understand logically that kids with neurodevelopmental differences were born with them.

32:57

They don’t do them on purpose, they can’t control them, but there are also acutely aware that their own social status is potentially at stake. So if they decided to sit with that child at the lunch table, well, what are their friends going to say? Or if they, you know, sit with a child who has autism, you know, appears to be having some difficulty, what are their friends going back to the sex effects. But we did see the girls in our study had a much more favorable attitude if they were shown the video depicting a girl with Tourette syndrome. And the same is true for boys and pass literature. Most of these interventions have boys in them. I mean, prevalence of boys, having Tourette syndrome is higher.

33:36

But there haven’t been that many studies looking at sex effects of who is presenting the video, or the information, rather.

33:48

And kids who had empathy incorporated into their video, they were more likely to have improved attitudes toward the child with Tourette syndrome, and kids who are older had a higher level of empathy for the child on the video compared to younger children.

34:02

Going further, kids who had the greater, greater increases and empathy were more likely to interact socially with the child who had Tourette’s syndrome, and that’s really important because it has been a huge struggle for lots of in services. And other interventions and anti bullying campaigns kinda really make that leap.

34:23

And that’s something that we, that we were able to see in this study.

34:30

So, again, children who had the greatest positive change or increase in empathy, they were much more likely to interact socially with the child with Tourette syndrome.

34:38

So, here’s a graphic of how each video changed, the Childs empathy, and which video kinda mattered the most as far as that while it matters to a certain point how much knowledge child is provided about a particular disorder. The key here is to find ways to repeatedly increase a child’s emotional awareness and empathy toward others. And this can happen at school ,at home, and lots of teachable moments throughout the child’s day. This is this, this chart is looking at empathy scores. Look by video, what video you got, whether you are in third and sixth grade, and by gender.

35:16

Your gender by boys and girls.

35:21

So what we, what we see here is kind of the older kids had greater amounts of empathy compared to the younger children overall.

35:32

But there were really and boys had a little bit less empathy than girls as well.

35:41

I just wanted to share a graphic that’s pretty powerful of where empathy kind of resides in our brains. And if you look on the left side, that orangey yellow portions, that’s where we feel and process pain in the brain. And on the right, the same portions of the of that system or it’s called the anterior cingulate cortex they’re activated.

36:03

So, I thought this was interesting, empathy is pain, but sort of.

36:08

So, compared to previous research this study, entered the novel element. Use the novel Element of first-person perspective of Tourette syndrome, knowledge change and empathy. Children had an increase in knowledge over all, but the empathy video group, having the least changes in knowledge. Older children had more empathy than younger kids, and there was a clear relationship between higher knowledge of Tourette syndrome and more positive beliefs.

36:33

But those positive beliefs didn’t always translate into action toward, a peer with Tourette syndrome.

36:43

So there’s a clear relationship between higher knowledge of Tourette.

36:46

more positive beliefs about a peer, with Tourette syndrome, but the leap isn’t made necessarily between a better belief about a child with Tourette syndrome and their likelihood to interact socially with them.

36:58

And that goes back to those social desirability effects we were talking about earlier.

37:04

So regarding some outcome measures of beliefs, attitudes, and behavioral intentions toward a child with Tourette Syndrome empathy was really this novel element and accounted for a considerable portion of participants, positive beliefs, attitudes, and their willingness to engage socially. So do you want to sit and have lunch with me? Do you want to come to my birthday party? Do you want to come for a sleepover, Let’s hang out after school. I mean, these are all things that, as parents we want, for our kids and things, that these, children, as a collective group struggle with every day and long. We talked about earlier, that, that long term struggle in social interactions really has repercussions throughout the lifespan.

37:44

So how can we increase empathy? Well, first off, you know, in my opinion, and some people may disagree- I feel like we need to stop using the term special needs. The term special has really become a euphemism for separate.

37:59

And people may disagree with me but I see kids with neuro developmental differences as a really diverse part of our population: 15 to 20% of individuals worldwide have some kind of difference. And like other forms of diversity, the presence of those that are differently abled, really enriches our humanity in so many ways.

38:18

And it’s nothing to be ashamed of or scared of. Our children’s needs really aren’t special. They all need to access the same things in life. It’s just how they access them. That may be different.

38:30

But the need themselves are not special. And we all have a right to access those needs.

38:34

So, and, if words matter, there have been recent studies at the University of Wisconsin, Madison and University of Kansas on the particular term, Special Needs, and it was found that it was an ineffective euphemism for that. So, when kids don’t meet that narrow definition of what quote, normal is, they continue to be marginalized.

38:54

Um, so, a couple of things that we can do to increase empathy.

39:00

Speaking to two parents and caregivers first-

39:03

So, in addition to, you know, we start with good examples at home, so, in addition to asking your child how they did on an exam, you might want to consider something like, Were you kind to the other children in your class today?

39:16

Paying attention to how you talk about others. You know, even when you don’t think your children are listening, especially, people that are different from you, teaching empathy to kids requires that you model empathy for others. To model really, that you prioritize caring, be your child’s emotion coach, and what that means is just learning to identify and manage your own emotion, that’s really the first step and understanding others.

39:41

I have come home many times, frustrated or tired, or you know, just kind of depleted and openly saying I had a really bad day today or I feel really frustrated because I’m sad because whatever happened during the day. It’s normal to feel emotions and it’s normal to let your kids so you feeling emotions, and see how you’re coping with those in a really positive and adaptive way.

40:10

Encourage compassionate perspective taking, and encourage the compassionate perspective taking. So, children and youth really pay attention to what you say.

40:22

So, you know, your childhood something on Snapchat or Instagram? You know, you could ask something like, how do you think that Chad would, would feel if

40:31

he saw texts like that, motto this awareness in your own language as well. So you may tell your child your, your grandmother might be feeling sad today because grandpas gone. You know, or because he’s sick. I’m going to call her now to see how she’s doing and if there’s anything I can do to help kind of model that behavior expand. Your children’s what I call circle of concern. Many kids are more likely to have to practice empathizing with close friends or family first. So you could use Newspapers, Television, TV, shows community events to really broaden your child’s circle of caring and find compassion for other people’s experiences, as well, And encourage your child to listen carefully to others, even if their perspective is really different.

41:15

And be patient, you know, your child or your teenager doesn’t always respond with compassion, or isn’t readily willing to reflect with you on their feelings. An empathy is not something that you like, pass or fail. And finding an empathic response can be especially challenging when young people are hurt or angry themselves. Kids in adolescence, they practice and develop empathy over years. So, really, just being patient. And lastly, just stop, rest, and reflect. I think last month, Dr. … provided a webinar here on mindfulness, so really prioritizing time for reflection. What happened during your day? How did you feel during your day? What were some of the emotions you felt, mindfulness, and really rest.

42:04

Teachers are our first line of defense during the day.

42:07

And I really believe that wholeheartedly, teachers are with our kids eight hours a day, sometimes more if there’s extracurricular activities.

42:18

So, you know, what teachers can do is, again, model empathy. When you’re frustrated with your students, as I’m sure happens multiple times a day. Let them see you pause. Take a deep breath. Take a minute, close your eyes. Try to see the situation from their perspective or responding. But let them see how you experience emotions and how you adapt to them positively.

42:39

Be aware of students, non-verbal cues, and really follow up on them. So, for example, if you see a student, you know slumping in his or her chair appearing angry, beginning to get dysregulated, say something like, you know, I noticed you’re more quiet today than usual. or I noticed something might be bothering you.

42:55

Kind of saying this, Now, when appropriate within reason, instead of, sit up in your chair and pay attention, which can be perceived as reprimanding to a child, that can often go along with the child.

43:08

Ask for students, input, and feedback when it’s appropriate, and when it’s feasible. So, for example, when establishing classroom roles, or are generating ideas. for group projects, find opportunities to incorporate their feedback when possible.

43:23

Give examples on how to act on empathy, such as helping, showing kindness, rebid, simply listening, and practice empathy. Creating opportunities to practice taking someone else’s perspective, imagine what other people are thinking. You could do role plays. Read and discussing books that are designed to teach and build empathy toward children specific situations. And using kind of a what would you do style vignette? It’s often very helpful. There’s a series of books that are published for specific areas of differences that you can use in the classroom and help increase awareness, and I’ll show you a couple of those in couple of slides.

43:58

Um, that’s pretty clear, ethical expectations, you know, expect your students to care about one another and kind of go through these, have like a, you know, an ethical set of rules in your classroom. Establish guidelines for unacceptable language and behaviors.

44:14

Enlist students and establishing these rules, and really check in with students. So, a couple system, some teachers, up to use. Kids could pick a number at the beginning of the day, like one means students doing really well two, you’re doing OK, three you’re not feeling so great, and four you’re not doing well. So, that can really help teachers clue into the emotional climate of her students. When possible, you know, teachers are, you know, fully engaged throughout their day. Teachers could possibly check indirectly with the students who indicated they are having tough days, or maybe have them visit the Guidance Office for a check in, to help them have a more positive day.

44:55

I know this is done, you know, quite a bit among the school districts, educating the school community. If you have a child in your school community with a specific disorder, such as Tourettes or autism, training school staff is really critical.

45:09

I came across this recent study, I guess it’s about four years old. 70 school-based speech language pathologists, and they found that about 85% viewed bullying of children with autism as serious, or somewhat of a problem. That’s a lot.

45:25

They all agreed. They should intervene in acts of bullying, but not all felt comfortable doing so, Kind of felt that wasn’t necessarily their place. Or might be stepping on someone else’s toes. 78% were in a district with an anti-bullying campaign, but only 20% were in a district where that campaign focused on children who are uniquely at risk.

45:49

Increasing supervision in high risk areas. So, this is kind of having extra eyes in areas like the bathrooms at the school bus line at dismissal. Lunchroom, these are core areas were bullying because it happens because there’s just not enough supervision loud, you know, when kids are able to take advantage of that.

46:12

Teachers really need to have ongoing discussions about what they’re seeing, because what you find, again, and again, as teachers and staff, may be reluctant to take action when they’re not sure what happened. They may have just kind of walked in on this situation, or just gotten one side story, and when teachers can really consult with each other, they can become more clear on a potential toxic situation.

46:35

And, you know, on a positive note, studies are really showing that bullying may be decreasing over time. So, you know, these policy and cultural shifts that really, they can make a difference.

46:47

Know the bullying policy for your school district, you know, become aware as parents, you know, have it, you almost always, on the school district’s website.

46:56

Just understand that these programs, they’re not often evaluated to see if they’re effective, contact the teacher, if there’s a problem, and then kind of go up the line to the principal superintendent And the school board, if necessary, know the state law for your state or policy for your state, really. If all else fails, you can go to the US. Office for Civil rights and make a claim there, because your child’s civil rights if they are repeatedly getting bullied, are being violated, particularly the bullying persist without adequate intervention from the school.

47:27

Couple of resources I wanted to give. These are a couple of storybooks that can be used in the classroom, some of them are a little older, like I can’t stop, and that taking Tourette syndrome to school. That’s a whole series with a number of other disorders taking autism spectrum disorder school, et cetera. And some of them are newer, telly in me is newer. And then there’s this series by Susan …: or can I tell you about ADHD? It’s really a guidebook for kind for friends family to kind of give an overview of that, so that can help build some understanding.

48:04

These are a couple of resources and links that you can use. The first is for the stop bullying and programs that are from the US. Department of Health and Human Services, so you can kind of get a sense of what those programs are. The US. Department of Education, and there, many people who have kids, either on the autism spectrum, or with threats or other disabilities, learning different differences, have an IEP in place for their child. But, if you want to kind of a nice overview and a guide to that IEP process and what it provides, how it works, there’s a link there to that IEP process.

48:46

If you find that your child hasn’t had a full evaluation, and you think that that would be helpful, you can certainly talk to the child study team at your child’s school district, express your concerns at the child’s having, and in, in the classroom, out of the classroom. And see if there’s a way they could offer you innovate, learning, and, or a cognitive evaluation. You could speak to your pediatrician and neurologist. You could you could speak to a licensed provider to inquire about a neuropsychological evaluation. And we here at Neuro Abilities, provide diagnostic and treatment care for individuals with a host of neurodevelopmental and neurological disorders, And I’ve put our website there and our phone number.

49:30

And now, I’d like to open up to questions.

49:36

OK, and I think we’re ready. Great presentation, by the way. Thank you.

49:43

All right. So, I have a question about what the neuropsychological profile looks like in a child with Tourette and how important is that to do?

49:58

Well, let’s, right up my alley. So that’s a great question. Tourette’s is one of those disorders. That’s, it has been studied pretty extensively. In the brain we see dysfunction primarily in the basal, ganglia kind of a sub cortical structure responsible for movement. And there’s been a variety of impairments related to kind of frontal dysfunction that have been observed in individuals with Tourette syndrome and those impairments you see them in various domains founded a neuro psych neuropsychological evaluation. So for example, you see them and attention, memory, executive function. So that’s kind of that planning. The frontal lobe, which I call the blades manager, helps you plan, initiate, organize, and complete tasks, time management.

50:50

It can impact language, functionality, motor, and visual motor functions, among others. So, specifically, it’s been proposed that tics might be caused by this an unexpected activation of specific cells in the brain, this in the striatum, so, which would lead to the production of these unwanted movements. And there’s been pretty robust evidence for individuals to have a lot of impulsivity on certain tasks.

51:20

So, we do see a lot of executive function deficits, deficits in planning. Kids often have difficulties doing the fluency related tasks. So, reading, both, you know, accurately and efficiently or doing math problems quickly. We can see some deficits in some cognitive flexibility. So kinda switching gears quickly is tough for these kids can be tough. And as far as overall intelligence. So, there might be significant variants and intelligence across Tourette syndrome folks. But really, there’s only slight impairments in general until intelligence that are usually reported.

51:59

We know there’s, there’s really no intelligent factor, or in mm. So how long would just addressing that, how long would that kind of evaluation take? I mean, is that spread over a couple of days, or is it will all in one session? Just a little bit of explanation there. Oh, that’s a good question. So, if you go to your child study team at your school, you know, the school psychologist would typically conduct that evaluation or someone kind of, you know, working with the child, working with the school psychologist. So those are done throughout that during the child’s school day. It’s not afterschool or before school, and it’s done, kind of a little bit here and there. If you put in writing that you’re requesting an evaluation of your child, the district typically has about 60 days to complete that evaluation and provide you with the report.

52:52

School evaluations typically include – they’re leaner, and they’re designed to see where your child maybe having difficulty academically responsible for your child’s academics. Really more like an IQ test and some academic measures, and then, some screening measures of emotional, emotional function that the parent will complete the child.

53:13

You have neuropsychological evaluation that goes, you know, much more in-depth beyond just kind of IQ and academic. The child’s language, Memory, attention, et cetera. So, it can take just a couple hours, over several days if you go to the school route, or if you seek a private practice, or another clinician.

53:35

Typically, they’re done over 2, 3 hour session, so two half day sessions, Some folks will do it in one day, six hours.

53:44

But, often in children, the fatigue, it’s not really valid if you have your child, OK, all right, thank you, question about the, the, the empathy were participants regarding, they, were, the child actor was used here.

54:05

So, we’re participants more likely, to actually interact with the child actor or hypothetically say that they would That’s a great question. They were, it was hypothetical. We did not bring the individual directly into the classroom to see, that, would, that would be a much bigger study over kind of a longitudinal period of time. So, yes, so this was hypothetical. This wasn’t, this was kind of how children said they would report how they look, they said they would do. And to minimize the chance that the child would respond positively because somebody’s gonna judge me for what I’m saying. You know, these kids were allowed to conduct the measures, individually they weren’t next to a peer or near peer who could see the responses.

54:52

Everything went right back an envelope, the seal that, you know, nobody could see.

54:56

So, you know, trying to minimize some of those social desirability effects, but yeah, I mean, the next step would be to, kind of try and integrate a child, you know, into the classroom, to do some kind of study in that, in that format.

55:10

OK, thank you, So, in terms of empathy, again, have a number of empathy questions here. Would you say that it’s, if it’s modeled at home, it would have a greater or the greatest impact? Let me put it that way. So that the environment at home, that’s, like, present for the child, all the time, that empathy. And that would be the place where it would be the most effective.

55:38

So, meaning, kind of empathy should begin at home. Is that? Yeah. I would think that’s where we’re going with this question.  I mean, empathy is one of those things that, you know, is built over time and with repetition and practice and experience. So, kind of having these experiences repeatedly so that you kind of can build these skills.

56:05

So, yeah, I think it’s always helpful. I mean, a parent can’t be with their child 24 hours a day, seven days a week, But, you know, trying to demonstrate empathy as much as possible within reason. when it’s and, as it’s appropriate, You don’t want it to be contrived.

56:25

And, like I said, you know, you don’t want it to be kind of this empathy lesson, but it can be taught at home. It can be taught in religious settings. It can be taught in a number of places, kind of, you know, like I said, an empathy is kind of caught not taught, so. It can be through your child’s on a sports team, and somebody gets hurt, kind of, wow. How do you think they really feel, you know, beyond just the fact that maybe their leg is hurt, you think they’re upset that, you know, maybe they can’t play right now, or are they may have to take a break from soccer for a period, OK. All right, another empathy problem. And now this is apparently causing a family situation. So the problem with modeling and so forth, in this particular instance, there is a high school niece who does afterschool care.

57:15

And they’ve tried to it. And so, apparently, this, this high school, afterschool care person is not handling issues well with the, with the child that they’re watching, and says things that don’t reflect the family standards, I guess. And, but she doesn’t seem to understand. They’ve tried talking to this high school student, and she doesn’t seem to get it, and it’s causing problems in the family. So short of finding somebody else to do after school care, could you make some suggestions about maybe, how to handle that?

57:56

Let me just to clarify. Its who is providing afterschool care for a younger child? Yeah. And they’re saying it’s in the family. So, it’s a niece, and so, she’s watching and I would assume from this, that she’s probably doing some babysitting. And there’s just this ineffective way that this girl is behaving around the child. The parents are concerned about. So, she would have just moving on and trying to find somebody else, would you make any suggestions about how to handle that in the family? Well, I would assume this niece is old enough to be able to be, you know babysitting, and providing care for a younger child. So, we would hope, Yes, I would think that, you know, kind of, a calm, delicate, you know, not in the moment conversation, so, not right after they may have caught or heard this, this individual saying something like that. The younger child crying saying, just get over it.

58:52

Maybe not in that moment, but maybe in a moment, kind of separate from that situation to kind of let that high school or defensiveness come down a little bit. Explaining that, you know, this is, you know, this is a young child, and this is your cousin, and I know she’s young, and she may not quite understand, you know, kind of delicately saying, You know, How can we together if you if you allow the individual to kind of feel like they’re having a collaborative discussion? And collaborating on how to, you know, change or do things differently? Maybe not using the language, how to do things better, but how to do things differently. Sometimes that helps to get high schoolers buy in when they started their developmental stage when they think they’re right about everything. Yes. I like the collaborative idea though you’re absolutely right.

59:39

Not in the moment and have it turn into a, you know, a big ruckus and the family are going on. Right. You’re wrong. Yes. OK. thank you.

Do kids with Tourette autism often get diagnosed with learning disorders or is it the other way around?

59:58

That does certainly happen.

1:00:04

So there’s a lot of overlap with kids and learning disorders with kids with development neurodevelopmental disorders and learning disorders. And there’s certain risks risk factors for having a learning disorder among the Tourette syndrome populated, so gender is a big factor. Boys have been shown to have more learning difficulties and girls. An age of symptom onset is also a factor. Started showing the symptoms a little early. You know, if you think about it, if you’re in, if you’re five years old, six years old, when some of the kind of critical early reading, no letter development, letter recognition skills are being taught and you’re having these ticks and the symptoms, it’s, it’s really overwhelming. And it’s scary at first, the child who’s having that experience. So that your attention is away from the lesson  at hand.

1:00:54

Tic severity is another factor. So, it’s tough to parse out what is the function of Tourette’s? And what’s the function of an executive function deficits in the like? But what we do know is kids who have Tourette’s syndrome or to a higher risk for developing a learning disorder.

1:01:06

I think I recently saw statistic where kids with Tourette syndrome, adult learning disorder, you know, 80% of them also had a diagnosis of ADHD.

1:01:22

There’s certainly quite a bit of overlap there.

1:01:26

OK, thank you, um, we have a question about school refusal: There was apparently a bullying situation that the school is ignoring, apparently. So, how, you know, the question is, how do you handle a school refusal because of bullying, that the school is ignoring?

1:01:46

My heart goes out to whomever is experiencing that.

1:01:51

That’s a really difficult thing, and I, you know, I, I’m sorry that the school isn’t doing more than they should be. So, you know, it’s really vicious cycle. Bullying kind of happens over and over and over the child. It’s, it’s not surprising in school refusals a huge issue among the kids.

1:02:13

The victims who are bullying. It really stems from this overall sense of anxiety, just dread that occurs.

1:02:22

I know, my recommendation would be to call an emergency meeting, with school guidance, counselor, and the school psychologist to discuss this, know, if the child is having school refusal, that the school may temporarily send in homebound instruction to encompass a couple of hours a day. So, they’re still able to get instruction really, kind of, building in some behavioral supports, to try and get the child back into the school system.

1:02:53

A school refusal is a difficult thing, and if it goes on, it becomes, it’s a way to avoid an unpleasant experience, and the longer you stay out, the more difficult it is to get back in there, too. So that’s the other side of it. Yeah, very reinforcing. So kind of, you know, in a difficult situation, because you know, you don’t want your child to have to experience that. You feel like you’re throwing them, you know, to the lions every day, but, you know, you know, really there’s kind of like building some supports over time back in. So that the child you know, maybe only goes for 2 hours 3 days a week to slowly begin to go back and re-integrate into the school. But, you know, certainly there has to be plenty of supports in place at the school as well.

1:03:41

OK would you talk a little bit about OCD? And the question is about OCD that is specific to TS. So the question goes on a little bit further that OCD in TS is not like OCD that most people think about. In the you know the example she’s giving here that you know the daughter is the messiest person with OCD that she ever met. Its distinction with the OCD that accompanies TS or is comorbid with TS.

1:04:18

That’s, that’s a little different. Is there any evidence of that? Well, yeah. And you don’t you expect people, or we collect. We know colloquial terms. We think of OCD isn’t really a neat freak or a neat nick, but you know, a lot of times, it’s just really specific to only certain areas. So they kind of a messy room. But you know, have certain obsessions and compulsions that they think they have to do. So OCD and Tourette Syndrome they really, they exist as separate entities in the DSM. OCD is classified as anxiety.  But there is quite a bit of symptoms overlap. So and there’s a lot of evidence that OCD interests overlap in ways that suggest that there’s a pretty close relationship.

1:05:03

You know, because the frequency that those two those two disorders occur is a pretty big clue. I think 60% maybe also of Tourette’s syndrome kids diagnosed with Tourette’s also have OCD syndrome symptoms.

1:05:22

Um so I don’t know if the question is, you know, is there like is it OCD or is it Tourette’s? It’s really tough to parse out. I mean, OCD is kind of a more specific type of compulsion. So, you know, it may be that you know like this. This fear of germs or excessive hand-washing, you know, tapping something repeatedly, that’s, really not a tic, that’s not know, that doesn’t bond under the same umbrella as motor and vocal tics.

1:05:58

I don’t know if I answered that question.

1:06:19

So we had somebody come in and comment that teaching tolerance so much of that begins with family values and attitudes that are modeled so and towards people with differences. And so they just wanted to get that in there.

1:06:43

And doctor Newman says, I think OCD that goes with TS is often about counting and cemetery. And yeah, we do find we do find that, and we find that kids with OCD and Tourette’s syndrome call it ticks of the mind.

1:07:05

So I have a woman who’s got, who teaches in a school that is for behavioral disorders. She says that she has a student with severe verbal tics, noises, throat clearing, which is difficult for other students to handle.

1:07:23

Although she’s talked to her students that this individual can’t help it, some students are better at understanding them than others.

1:07:35

Are there any suggestions to help students tolerate the other one’s noises?

1:07:43

That’s a tough one. You know, because, like you said, the child isn’t doing these things on purpose and yet, you know, that all the kids have a right to learn and direct access to curriculum in a way that’s suitable for them. So now, I would, I think you can.

1:08:08

That’s it. That is a tough one.

1:08:10

No, perhaps try to, you know, position. You know, you don’t want to, you know, move this child with the verbal ticks. You know, in some no other way, but you know, perhaps allowing him or her to kind of, you know, there’s often this for mandatory urged before a student or a child is going to begin engaging. And maybe a bout of ticks, so kind of allowing the child some freedom to, no, excuse him or herself in the classroom, teaching and feel more comfortable to kind of allow that release. And then return to the classroom when they’re feeling.

1:08:42

You know, they’re feeling better, know, and then, you know, the teacher may have to get a little bit creative. You know, just kind of being persistent and patient, No, no just reminding. Just keep reminding the students that, you know, the this isn’t on purpose. You know, maybe building breaks into the the lesson so that, you know, the anxiety level of the classroom can come down a little bit as needed. And just, you know, kind of like, you know.

1:09:14

Hmm.

1:09:15

Yeah. So, it’s a difficult thing. But you know, if it is presenting. I don’t know how many students are in the class, but there may be some other creative options. the learning support team can come up with to kind of help support that student a little bit, you know better and you know, allow for.

1:09:33

No less distraction during that for the rest of the class, OK, so we have one last question to ask at the moment. So, how do you help a child maintain friends? My child seems to be able to initiate friendships, but they tend not to lasts, and she’s around nine.

1:09:53

And she does have Tourette syndrome, OK. Well, it’s great. And it’s really positive that, that she’s able to kind of initiate friends, friendships, and, you know, a couple of things that parents can do to support friends. She’s nine, you said.

1:10:08

No, sometimes parents, adults take this opinion, like little children need to work it out for themselves. And sometimes they do, but you know, rarely do kids at that age group or in that fine art externship without some support or role modeling about healthy relationships.

1:10:22

So, you know, this is a shy child. They may need to learn, you know, to not respond to certain types of peer conflict.

1:10:33

Would, like fear, worry, you, know, find, you know, find your child’s strengths, welcome, your child, tends to your home kind of repeatedly. It may feel like, I’m always the parent having my kid’s friends over and nobody ever invites him or her of where they don’t reciprocate and that’s OK. You know, that that’s a valid concern and frustration but, you know, continuing continue to welcome that child’s friends to your home.

1:11:02

You know, if, you know, kind of, you know, offer some kind of like fun activity for them to do, you know, make it like a place where you know, kids are going to have fun, feel comfortable and enjoy being with that child.

1:11:15

Um, know, if there’s an opportunity for that child to kind of join some clubs or some sports or other events, you know, that, that they can become more involved, consistently. So, maybe not just seeing this child and their friend in the classroom, but also seeing them on the, on the field, are also seeing them in an art club or something like that. And for the parent, you know, I often recommend that parents try and get involved as they can. I know parents are very busy with jobs and many competing priorities. But trying to get involved in your child’s school to kind of, you know, be there and see what’s going on. You’re able to kind of have some eyes and ears on, you know, what’s going on in your child’s day, who they’re hanging out with, you know, what some of those interactions look like.

1:11:57

Um, know, and at night, you know, parents are still kind of scaffolding their child’s social structure and social plan. So, you know, trying to, you know, kind of facilitate some of those playdates or activities or things with other parents, it’s still really helpful at this age. You know, kids don’t usually have phones at nine, although I may be kind of out of the loop on that one.

1:12:20

But, you know, just kind of keep facilitating some of the, know, some of the interactions with, with students and giving them like casting a wide net. Like giving them a wide variety. If they say, You know, boy, I only want to hang out with this person. You know, try inviting something, someone different.

1:12:35

Um, I hope that was helpful.

1:12:40

It was. So, one note, we had a parent type and about the, the loud noises.

1:12:52

When, when his teacher, when he was having verbal ticks, the teacher played some soft background music in the classroom, and she also would give out sugar free candy so that her son could suck on something which helped suppresses techs. So, I hope that makes that helpful for that other question.

1:13:13

Doctor, doctor Theobald, I really appreciate your time, and thank you for doing this webinar. It was quite, quite helpful and quite full of a lot of information. Thank you all for joining us. Our next presentation.

1:13:35

On developmental Consideration for OCD in Kids, teens, and adults will be given by doctor Jacqueline Gola and is scheduled for March 18th, 2020. There is an exit survey, which we need everyone attending to fill out. The webinar blog is open now and available for the next seven days on our website For any additional questions that were not covered in tonight’s presentation, the website is WWW dot N J C T S dot org. Also, an archived recording of tonight’s webinar will be posted to our website. This ends tonight’s webinar. Thank you, doctor Theobald for your presentation. And, thank you, everyone for attending. Goodnight.

Comments(2)

  1. G. Gruenfeld says

    Can empathy which is modeled at home have a greater impact on children?

  2. Laura R says

    How to handle school refusal because of bullying that the school is ignoring, all they say is “we’ll continue to monitor” CST keeps cancelling/rescheduling

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