Today's Ask Experts Questions is about impulsivity.
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Dear Dr. Barnhill,
I am a grade 4 teacher. One of my students has very recently been diagnosed with Tourettes Syndrome.
The tics are very minor, almost un-noticeable.
But the impulsivity is extreme.
I have never met a child in my 25 years of teaching with less impulse control (impulsivity). It is starting to affect him socially, as none of his classmates want to sit beside him or be in a work group with him.
He drives them crazy with his impulsivity.
He is a nice boy, and quite bright. After the fact, he can articulate quite well what he did wrong and what he should have done differently. He does demonstrate remorse about his impulsivity actions.
However, he cannot explain why he did or said what he did.
He honestly cannot seem to control his impulsivity.
This boy has also started to lie; small things really, but things to make him look better in his classmates eyes, or to make him come out first.
Do you have any suggestions for IEP accommodations for a child with impulsivity control issues?
From Frank Barnhill, M.D. (this answer is not to be construed as medical advice and the child should be seen by his own physician).
With that disclaimer, here is Dr. Barnhill's reply:
This is a very good description of a Tourette's child with ADHD behavior traits.
While tourettes and impulsivity behavior control issues are often seen in Tourette's, most affected kids will have learned or been taught some ways to control or at least diminish their poorly controlled behavior-habits by the time of school entry.
For the IEP, first of all I recommend that this child needs to be evaluated for co-morbid (coexisting) ADHD and treated appropriately if his doctor agrees.
Placing him on a very low-dose ADHD drug may decrease his impulsivity, but might produce tics...so his parents need to understand the risks of therapy.
Secondly, he needs a behavior therapy team to help him learn ways to either delay or prevent impulsivity and disruptive behaviors and what to do once they have started.
This type of training includes teaching the person what triggers specific behaviors (impulsivity triggers) and how to use other thoughts and behaviors to either stop the progression of the impulsivity behavior or funnel their nervous energy into a more acceptable behavior.
And thirdly, others students in the class should be educated about what Tourette's and impulsivity are and more importantly what they are not - he is not brain damaged!
That way, the other students will often become willing therapeutic partners and a kind of social monitor for your student who appears to have tourettes and impulsivity (even though he should be evaluated for tourettes and ADHD behavior as well).
This will give your Tourette's student a built in support group that will provide security, on-going behavior training, and social skills training that is often not made available to others.
Tourette's kids are indeed often very likeable, intelligent, can teach others, be good friends and as you pointed out....very often feel as if they either can't control their behavior or don't even realize it has occurred.
Until there is more work-up done, the IEP needs to be modified to add this information on impulsivity and other possibilities from his physician.
Thank you for your question Mary Jo and you are free to send others at any time.
Dr. Frank Barnhill is HowToLearn.com's Official Expert on ADHD and conditions which are mistaken for ADHD. You can read more on his blog or in his book, Mistaken For ADHD.
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Our thanks to both Mary Jo and Dr. Frank Barnhill for this information on impulsivity.
Posted by +Pat Wyman, author and founder of HowToLearn.com