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RED FLAGS

There are ‘red flags’ to look for that can assist in determining what supports will be most useful for students with TS. However because symptoms of TS are frequently misunderstood, these 'red flags' are often thought of as being ‘purposeful behaviors’ and not related to the disability. Instead of seeing these difficulties as ‘bad behaviors’, it is more helpful if they are seen as clues to skills deficits or a result of unrecognized symptoms. 

The following is a partial list of some of the more common red flags to be aware of:

• Handwriting problems:   Sloppiness, frequent erasing, time consuming effort at perfectionism, reduced output, inability to get started, difficulty organizing thoughts, slow  handwriting, refusal to write, writing that is difficult to read, etc.
  
  
• Homework difficulties:  Lack of understanding assignment; inconsistency in copying down assignments; struggles to complete; refusal to begin or complete; failure grades due to missing assignments; completed homework never turned in; excessive time required to complete, significant difficulties at home due to homework, etc.
  
  
• Organization problems (Executive Functioning Deficits):  Disorganization that may include problems managing time, tasks, belongings, books, assignments, materials for class, etc.
  
  
• Difficulty with transitions:  Problems when changing tasks or classes; resistant to changes in schedule or difficulties if the routine is changed; difficulties with substitute teachers; chronically inflexible; angered at students not following rules (even though they might not see the need to follow rules themselves), etc.
  
  
• Anxiety:  Explosive behaviors that appear to erupt unexpectedly; increased tics; task avoidance; school avoidance; shutting down when overwhelmed; excessive trips to nurse, bathroom or counselor; emotional outbursts, etc.
  
  
• Sensory Issues:   Sensitivity to light, sound, touch, smells, and/or tastes; need to harm oneself physically; excessive chewing on objects; tapping, hitting objects to make loud noise, slamming objects, spinning in circles, refusal to touch chalk, use pencil or pen, breaking pencils, ripping paper, etc.  (See article on this site: TS and OT)
  
  
• Difficulty following directions:   Slow to respond; overwhelmed by complex directions; need to always have directions repeated; unable to complete tasks with multiple directions (verbal, written or both), etc.
  
  
• Discrepancy between verbal and performance scores: Significant difference between scores on psycho-educational evaluations (ex: high average range for reading comprehension with low average range for written language skills; high scores in verbal and low on performance, etc.)
  
  
• Deliberate misbehavior:  Adults need to ask if the behavior "makes sense” and “why” would the student continue to exhibit this behavior in spite of repeated and consistent consequences (positive or negative).  There very likely may be a symptom that is being overlooked or misunderstood.
  
  
• Sudden academic or social failure:  Swings in performance, abilities, moods, grades
  
  
• Oppositional behaviors:  Refusal to engage in an activity or task  (we must ask why, where, and when does the oppositional behavior occur and see this as a clue for either a symptom or a skills deficit)
  
  
• Difficulty with peers: Social skills deficits and understanding social cues can sometimes be an area of difficulty requiring Pragmatic Language skills training, social skills group support, etc.
  
  
• Impulsivity:   Shouting out answers, making inappropriate statements and exhibiting impulsive behaviors are all areas that can be improved with appropriate positive support that teaches strategies and alternative responses.
  
  
• Behaviors that student knows are wrong:   Able to discuss appropriate behaviors and/or responses but an inconsistent ability to perform while "in the moment"
  
  
• Perfectionism:  Erases constantly; limited risk-taking; must have things just so; hyper-vigilant regarding rules;  insistent regarding rituals; etc.
  
  
• Difficulty attending:  Focusing difficulties that are inconsistent or chronic; doodling; chewing on items;  interfering complex tics or obsession. NOTE:  It is important to know that often suppressing symptoms is more distracting than completing tics. Educators should periodically ask questions to determine the level of attention as many students with TS are capable of paying attention even during complex tics, engaging in a sensory activity or while drawing/doodling
  
  
• Immature behavior as compared to peers:   Responds to stress in a manner that is not age appropriate. May feel more comfortable with younger children and with toys that are geared to a younger child
  
  
• Explosive behaviors only at home:   May be a result of suppressing symptoms while at school as well as being overwhelmed for various reasons

Revised 5/2007

For additional general special education resources visit the IDEA Practices Website: www.ideapractices.org and www.fape.org