Coprophenomena in the classroom
Dr Seonaid Anderson explains how educational professionals can help their students with Tourette Syndrome (TS) who have coprolalia.
There are many misunderstandings about TS, its symptoms and its prevalence.
People with TS experience both vocal (sound) and motor (movement) tics, which can affect their wellbeing and learning. It is a genetic, inherited neurological condition and is one of a number of tic disorders. The clinical pathways and treatments are exactly the same in terms of medications and behavioural therapy for tics and tic disorders. Previously, TS was regarded as rare, whereas now it is estimated that it affects 1 in a 100 school children. Therefore, many teaching professionals will have come into contact and taught students with TS. Prevalence rates of TS are similar to Autism Spectrum Condition (ASC), however ASC is better known and receives more research and support funding than TS.
The recognition that TS is a common neurological condition is increasing but there are still misunderstandings about it and more work required in terms of awareness and acceptance. People often assume that all people with TS swear, when research has found that only about 15–20% people have a ‘swearing’ tic. This is often how TS has been portrayed on TV and in the media. Some people make assumptions that TS is an excuse for someone behaving badly. This is untrue as tics are involuntary, and people with TS are not just ‘saying what is in their heads’. TS can interfere with major domains of daily life of both children and adults, such as at school, work and in forming or maintaining relationships and this can be especially so when coprolalia is present. However, a really important message is that although we need to maintain the idea that Tourette Syndrome is not a “swearing disease” we need to be careful that at the same time we are not excluding those who do have coprolalia. Symptoms of people with Tourette Syndrome vary greatly from person to person in terms of their tics and the co-occurring conditions that are associated with the tics such as Attention deficit hyperactivity disorder (ADHD) and Obsessive compulsive disorder (OCD).
What are Coprophenomena?
The label Coprophenomena includes obscene gestures (copropraxia) and obscene vocalisations which might be a single word or can be complex phrases (coprolalia. There are a great deal of stigma and challenges facing someone with coprolalia. The general public may not understand how to react when they encounter someone with TS who has coprolalia. They may see them as behaving badly, as being strange or aggressive and be shocked by witnessing or feeling as if the coprolalia is directed at them. In public settings, such as in school, it can be excruciating for the person with coprolalia especially when the coprolalia tics are racist or sexual in nature. A very important step is for people around the person to understand that these tics do not reflect the thoughts, beliefs or feelings of the person.
Why do people have it?
Coprolalic tics are present in some people who have Tourette Syndrome. TS is neurodevelopmental with genetic origins. Often circuitry of the inhibitory mechanism of the brain doesn’t work as well to suppress unwanted movements and unconscious thoughts. TS is involuntary and there are some people who can control their tics for short periods some of the time but the urge to tic, swear or shout will mean eventually tics will come out and are generally something that can’t be controlled.
How teachers can help
Good communication with the young person and their family can help schools to better support the student and manage their TS in a classroom environment. Teachers can find out how coprolalia affects a student and what suggestions they have as to how it could be handled when in a classroom or space within the school. Teachers should understand that being anxious causes tics to get worse, so speaking to the student and understanding how their TS effects them is crucial. Anxiety can often trigger coprolalia, making the person more anxious which can result in au unhelpful cycle. Education professionals are advised to actively ignore coprophenomena and treat it as just another type of tic. In some cases, the student may wish to advocate for themselves and explain that after having a tic that involves obscene language nothing bad was meant, tics like these ones are involuntary and they may wish to apologise or explain what happened and having something prepared ready to say might be helpful. However it cannot be assumed that the student with coprolalia will be comfortable with such a strategy and it should be discussed with the student outside of class. Explaining to others can often be tiring and stigmatising for the person. Instead some people use TS awareness cards to give to others to explain why they might be swearing or making gestures. This can be helpful in public situations where there might be misunderstandings and also helps raise awareness around this issue.
Suppressing or ‘holding in’ tics can impact on a students’ attention in the classroom. Children shouldn’t be told to stop their tics or be punished for them. Drawing attention to the tics should be avoided as this can increase embarrassment, anxiety and shame. Strategies such as allowing the student time out of lessons and a safe place to release tics may be useful. The student may also have anxiety about ticcing in front of peers and may be more susceptible to mimicking, teasing and bullying. Its important for a teacher to educate the other students in the class in terms of modelling kindness and understanding and that coprolalia is not something that the student can control. The other students in a classroom situation will be looking to the teacher in terms of how they should respond to coprophenomena.
Strategies to help
Knowing what strategies someone with coprolalia could use and what might trigger their tics is very useful. Some strategies are to treat coprolalia like any other vocal tic and employ a competing response (often explained by a clinician or therapist in behavioural therapy treatment) such as pressing the tongue to the roof of the mouth when the urge is strong. Behavioural therapy is a skills-based treatment approach which can help some people with tics understand and accept tics as well as providing techniques which can help them manage their tics better. Some people find benefits from using breathing techniques for example diaphragmatic breathing to control breath and perhaps help manage stress and anxiety therefore helping to reduce tics. Relaxation techniques can be helpful for some people but medication may be offered for people who’s tics are really affecting their daily living and/or causing them pain and distress.
Often people with TS use a range of self-help strategies to manage their coprolalia for example only saying part of an offensive word, substituting a word for another less offensive one or sometimes people suggest covering their mouths or mumbling the offensive language as an alternative. Instead of saying obscene language out loud people with coprolalia might find it helpful to say the words inside their head. Another useful strategy might be tracing with their finger on their hand the words instead of saying them out loud. However, it should be recognised that coprolalia and copropraxia can be incredibly hard to manage. A multi-faceted approach can really help support students with coprophenomena. If school and educational professionals can offer accommodations to these students and raise awareness in terms of TS and coprophenomena amongst staff and the student population this would be helpful. Having a knowledge of strategies which could be used will be useful to discuss with the student with ‘active ignoring’ viewed as one of the best approaches.
As part of the rich spectrum of neurodiversity Tourette Syndrome and its co-occurring conditions can be seen as an opportunity to raise awareness in the whole school community about diversity in general and create a supportive environment for everyone to reach their learning goals.
Author: Seonaid Anderson
Seonaid Anderson
Dr Seonaid Anderson is a research psychologist and neurodiversity consultant at www.neuro-diverse.org
