Tourette Syndrome

Tics are sudden, repetitive, non-rhythmic movements or sounds. They tend to wax and wane in severity, peak between ages 10 and 12, and reduce in most young people by late adolescence. The diagnostic route in England is via a paediatric neurologist or community paediatrician with a tic clinic: Great Ormond Street's Tic Clinic, Evelina, and the Manchester service take regional referrals. Tics are involuntary in the sense that suppressing them takes effort and builds discomfort, similar to suppressing a sneeze.

In a Year 5 classroom, the picture is rarely the swearing tic (coprolalia affects under 10% of people with Tourette's). More commonly it is the eye-blink that the teacher reads as defiance, the throat-clearing tic that triggers attendance complaints from neighbouring classrooms, or the explosive vocalisation in an assembly that is then disciplined as disruption. The child masks at school all day, then releases the held-back tics in a 90-minute rebound at home, known as the after-school tic release.

What helps: staff training so tics are recognised as involuntary, environmental adjustment (a seat near the door so the child can step out without explanation), and access to Comprehensive Behavioural Intervention for Tics (CBIT), the NICE-evidence-supported behavioural therapy delivered by trained CAMHS or specialist clinics. Medication (clonidine or aripiprazole) is reserved for severe cases. Exam access arrangements under JCQ commonly include rest breaks, a separate room, and 25% extra time.

Tourette's engages the Equality Act 2010 from the day school knows about it. A school disciplining a child for a tic faces a disability discrimination claim.