2. A Primary Child with Undiagnosed Tourette Syndrome

Background A P5 child, diagnosed as dyspraxic, was enrolled in a new school, having been excluded from his previous placement because of unacceptable behaviour which included regularly shouting out. Solution Focused Approach The School Support team believed the child suffered from Tourette syndrome. However, this was not confirmed by Mental Health practitioners. Nevertheless, experienced staff used approaches which acknowledged and successfully addressed ‘Tourette-type’ behaviours. Strategies Key success factors included the following: • an experienced teacher took the P5 class and observed the child carefully; • on the basis of observations, the Headteacher helped the child’s mother to write on explanatory letter to her Genera/ Practitioner requesting a referral to Mental Health services; • a lengthy assessment by the Speech & language Therapist, during which the child divulged that he could ‘feel’ the noises he was making; • on agreement that when the child realised he was about to shout out, he used his time­ out cord to leave the class and ‘let out’ his noises; • an agreement that the child did not line up for class as this was frequently a time when his noises were significant. Range of Strategies to Promote Positive Behaviour and Improve Learning The school had a good history of supporting a range of children with additional support needs. Several members of staff had wide experience in identifying specific needs and clarifying the way forward. The school’s ethos was positive, accepting and supportive. Individualised Planning and a Flexible Curriculum in Line with Curriculum for Excellence The child had very good ability to learn. However, his disability was in danger of ‘labelling’ him as a difficult pupil. Once he and others were clear about the nature of his Tourette-type presentation and he could take responsibility for managing it, he required no special planning or curriculum. Partnership Working • The in-school team worked closely with the child’s parents to problem solve this child’s difficulties and meet his needs. • The child’s doctor co-operated on the basis of a convincing case made by the Headteacher and parent, by ‘fast tracking’ him to Mental Health services. • Despite the initial non-diagnosis by Mental Health services, the school team along with the Speech & language Therapist and the Educational Psychologist, agreed the way forward. • The child was subsequently diagnosed by Tourette’s Scotland and re-referred to Mental Health services.

Successful Outcomes included:

• acceptance rather than exclusion for a child with undiagnosed disability;
• support for an unconfident mother to seek specialist help;
• best use of specialist staff such as the Speech & Language Therapist to confirm professional judgement;
• positive action taken based on presenting barriers to learning, irrespective of a lack of diagnosis;
• simple but successful strategies to enable the child to take responsibility for his presenting behaviour;
• successful learning for this child who also gained in confidence;
• increased confidence within the School Support team in relation to identifying (sometimes less obvious) additional support needs.