What a Difference a School Nurse Can Make! A Tourette Syndrome Guide for School Nurses

Presenter: Graham Hartke, Psy.D.

View the webinar’s corresponding slides here

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School Nurses play an essential and invaluable role in the lives of children with and their families. Serving as onsite medical practitioners, counselors, and mediators between school personnel, health professionals and families, school nurses are in a unique position to make a lasting positive impact on students. In this webinar, Dr. Hartke will provide an overview of TS and associated disorders along with specific tips and strategies for school nurses, families, and educators to best help students living with TS.


  1. Dr. G. Hartke says:

    What roll does anxiety play in TS?

    Anxiety commonly impacts individuals with TS in several ways. First, for many individuals with TS anxiety and stress can exacerbate symptoms and lead to them experiencing an increase in tics. Second, for others, just having tics can be a source of anxiety, particularly if individuals are worried about how they are perceived by others. Last, many individuals with tics have comorbid anxiety based disorders such as OCD and generalized anxiety which for some can present more challenges than the tics themselves.

  2. Dr. G. Hartke says:

    My son is in 7th grade and his tics get worse when we are planning to go somewhere. I would hate to keep pleasurable experiences a secret from him, but not telling him until the last minute seems easier on all of us. Appreciate your comments.

    Thanks for sharing your experience. What you describe happening with your son is common for many individuals with tics. Anticipatory anxiety (whether it be worry or excitement based) about upcoming events and transitions (examples: vacations, school year start/end) can exacerbate symptoms and lead to an increase of tic activity. Each family needs to weight the cost and benefits of different options of how to navigate these situations. It could be that making a trip a surprise is easier and appreciated by the child. It could also be the case that the child might be upset because he/she was left out of the loop. Regardless of what a family opts to do, in the long run it will be important for a child to focus on managing stress and anxiety when travel plans are announced. This could be done by working with an outside therapist, a school counselor, creating a behavior plan for these situations, and/or practicing some at home relaxation activities such as slow breathing.

  3. Dr. G. Hartke says:

    What do you think about not telling the school about a TS diagnosis?

    I believe it is a family’s decision to make based on what they think is best for their child. In most cases, I do recommend letting the school know, particularly if tic symptoms impact a child’s academic, social, emotional, and/or physical experience at school. Letting the school know and educating the school staff about TS can help ensure a child is in a supportive and empathic school environment. It is also important to do this if you think your child might be eligible for 504 accommodations or IEP services. In many cases children feel better about having TS when they know the adults working with them at school are aware of their situation.

  4. Dr. G. Hartke says:

    My son in 5th grade has echolalia and the teacher thinks he’s doing it on purpose. Everyone in the class laughs when he repeats something the teacher says and it disrupts the class. I also think he enjoys the spotlight a bit. I’m not sure how to handle it.

    Thanks for sharing. This is a common, and frustrating situation that happens with children who have tics, particularly echolalia. In this case I would want to have a meeting with the teacher, and possibly the school counselor and principal to discuss what is going on in class. This is a good example of “Don’t be a tic detective.” I would try to educate the teacher about tics, and discuss what classroom management strategies have and can be employed to manage this situation (example: Ignore the tic, focus on the task at hand, modeling for the other students how to respond to it). If the tic is highly disruptive to the class, then it is sometimes helpful to have planned breaks scheduled for the TS child, particularly if he/she is going through a period of time of increased tic activity.

  5. Dr. G. Hartke says:

    My in-laws think we are too permissive with our son and are spoiling him when we “allow” him to make noises. That he needs more discipline. Their comments are causing problems in the family. They don’t seem interested in learning about TS and they don’t want to take him anywhere because he embarrasses them.

    Thanks for sharing. This sounds like a difficult situation for your family. It is common for family members to have different views, levels of understanding, and acceptance of a child with TS. It might be helpful to involve a psychologist or other professional in problem solving this situation with the family. This might involve the professional providing some education for your family members, and a safe place for concerns to be addressed.

  6. Dr. G. Hartke says:

    As a school nurse, what is the most helpful thing I can do for a student with TS?

    The most helpful thing you can do is be supportive, understanding and empathic to the student with TS.

  7. Dr. G. Hartke says:

    Our doctor said that statistically the tics will diminish over time, but the ADHD and OCD will probably be lifelong. So that would require her to be on meds for those disorders for the rest of her life?

    Good question. Every individual is different with regard to their need for medication and other therapeutic treatments. Some people who used medications in childhood for ADHD and OCD continue to treat those conditions with medication in adulthood, other do not. It would be an individual based decision, and your doctor would be the best person to discuss this with. Many adults utilize psychological treatment, such as cognitive behavioral therapy, in adulthood to help treat and manage TS, OCD, and ADHD. Some do this in conjunction with medication, others do not.

  8. Dr. G. Hartke says:

    If I think a student in my school has tics, how would I approach this with a parent?

    Great question. You could call the parents, describe to them the behaviors you are observing, and if you feel that it is appropriate in the situation, you can recommend they speak to their pediatrician about it. I would stay away from suggesting a diagnosis (Its TS), and describe the observed behaviors (movements, vocalizations) including the frequency, intensity, duration and nature (what they look like) of the behaviors.