Tourette's Support: Practical Help With Tics at School and Work

If you or your child has tics, the most useful support is usually not about stopping them. It is about understanding what makes them worse, taking away the pressure to hide them, and getting a few sensible arrangements in place at school or work. Tics are sudden, repeated movements or sounds that a person does not choose to make. When someone has had both movement tics and vocal tics for more than a year, usually starting in childhood, it is called Tourette's syndrome.

Many people with tics never need specialist treatment, and for a lot of children tics ease by the late teens. But "it may get better" is not much help on a Monday morning when your child has been told off for making noises in maths. This guide covers what tics are, what helps day to day, what to ask for at school and at work, and when a GP, a specialist or an occupational therapist is the right person to see.

What tics are, in plain terms

Tics come in two broad types.

• Motor tics are movements: blinking, eye rolling, grimacing, shrugging, head jerking, jumping, touching things or people, or tapping.
• Vocal tics are sounds: sniffing, throat clearing, coughing, grunting, squeaking, words or phrases, or repeating what someone else has just said.

Some tics are simple and brief, like a blink. Others are complex, such as a sequence of movements or a whole phrase. Tics tend to come and go, change over months, and have good and bad patches. A tic that dominated last term may vanish and be replaced by a new one.

Many people describe a feeling just before a tic, a bit like the build-up to a sneeze or an itch that has to be scratched. Doing the tic relieves it, for a while. That is why tics are not deliberate, not bad behaviour and not attention-seeking, even though they can look that way to someone who does not know.

One myth worth clearing up: involuntary swearing, which gets most of the attention on television, affects only a minority of people with Tourette's. Tics are also often found alongside other conditions such as ADHD, anxiety, obsessive-compulsive disorder or autism, and sometimes those cause more day-to-day difficulty than the tics themselves.

What makes tics worse

Tics are not random. Most people find they increase with:

• Stress and anxiety - exams, new situations, conflict, being watched.
• Tiredness - the end of the school day, the end of the week, a late night.
• Excitement - birthdays, Christmas, a big match, a trip out. Good stress counts too.
• Illness - colds and other infections can bring a flare.
• Attention on the tics - comments, questions, being told to stop.

Many people also notice their tics settle when they are absorbed in something they enjoy, such as sport, music, drawing or a game. It is not universal, but it is worth noticing what calms things for you or your child.

A simple tic diary for two or three weeks can be surprisingly useful. Note roughly when tics are worse and what was going on: time of day, place, what came before. It does not need to be scientific. It gives you something concrete to show a teacher, a manager or a GP, and it often reveals patterns, such as tics rising sharply in the last lesson before lunch.

Why holding tics in is so tiring

Many people can hold back their tics for a while. That does not mean they should have to. Suppressing tics takes real effort and concentration. A child spending a lesson holding in tics has less attention left for the actual lesson, and an adult doing it through a long meeting is exhausted by the end.

The urge does not go away while you hold it in. Often it builds and comes out later, all at once. This is why so many parents say their child is "fine at school" according to teachers, then has a burst of tics the moment they get through the front door. That is not a sign that home is the problem. It usually means home is the safe place to let go.

How family can help at home

• Try not to comment on tics. Reacting, even kindly, tends to draw attention and increase them.
• Never copy or tease, and ask brothers, sisters and relatives not to either.
• Build in downtime after school before homework or questions about the day.
• Protect sleep. A steady bedtime routine helps more than most people expect.
• Plan for exciting events. Quiet breaks during a party or a long day out can stop the evening tipping over.
• Talk about tics openly when your child wants to, using their words for them.

Support at school

Schools in England have duties to support pupils with special educational needs, and a child whose tics have a substantial, long-term effect on daily life may also be protected under the Equality Act 2010. You do not need a formal diagnosis to start a conversation. Ask for a meeting with the class teacher or form tutor and the SENCo, bring your tic diary, and bring your child's views if they are old enough to give them. Our guide to SEN support in school explains how that process should work.

The aim is a short, written plan that every adult who teaches your child knows about, including supply teachers and lunchtime staff. These are the things families most often find helpful.

A time-out pass

A discreet card your child can show to leave the room for a few minutes, no questions asked, to release tics somewhere private. Agree in advance where they go and who knows. The pass only works if it is honoured every time, including by a teacher meeting your child for the first time.

Seating

Many children prefer a seat near the door, so they can leave quietly, or at the side or back, so they do not feel watched from behind. Others focus better near the front. Ask your child rather than guessing. Avoid seating next to a pupil who has teased them.

Telling classmates, if your child wants to

Some children want their class to understand. Others would rather nobody mentioned it. Both are reasonable, and the choice should be theirs. If they do want classmates told, options include the child explaining it themselves, a teacher giving a short talk, or using child-friendly materials from Tourettes Action. Agree the exact words beforehand. A simple message works: tics are not on purpose, do not copy them, and do not make a fuss.

Behaviour policies and staff awareness

Tics should never be treated as misbehaviour. It is reasonable to ask that the school notes this in your child's plan so they are not sanctioned for sounds or movements they cannot control. If tics sometimes involve words that could cause offence, agree how staff will respond calmly.

Writing and practical work

Hand, arm and head tics can make handwriting slow, messy or painful, and tiring tics leave less energy for written work. Ideas include using a laptop, printed notes instead of copying from the board, reduced written output, and extra time for tasks.

Exams

Pupils with tics may be eligible for access arrangements in exams, such as a separate room, supervised rest breaks or extra time, depending on the evidence of need. These follow national rules, and the school applies on the pupil's behalf, so raise it early rather than a few weeks before. Our guide to exam access arrangements explains how this works.

Tics at work: reasonable adjustments

Under the Equality Act 2010, you are likely to count as disabled if a condition has a substantial and long-term negative effect on your ability to do normal daily activities. Tourette's often meets that test, but not automatically, so check the current guidance on GOV.UK or with Acas. If it applies, your employer must make reasonable adjustments so you are not at a disadvantage.

You do not have to tell your employer about tics. But an employer can only make adjustments if they know, and many people find that explaining once removes a great deal of daily strain. Adjustments that people with tics commonly find useful include:

• A desk position away from busy walkways, or access to a quiet room for focused work and phone calls.
• Agreed short breaks to release tics, without having to explain each one.
• Some home or hybrid working, especially on high-tic days.
• Flexible start and finish times to avoid crowded commutes.
• Changes to phone or video call duties, or a headset that makes calls easier.
• Voice recognition software or an adapted keyboard if hand tics affect typing.
• A short explanation for colleagues, with your agreement and in your words.
• Telling interview panels in advance, so tics are not misread.

If your job involves the public, some people find a single prepared sentence helps, something like "I have Tourette's, so I make some sounds I cannot control. Carry on." Our guide to reasonable adjustments at work covers how to ask in writing. In Great Britain, Access to Work may help pay for support or equipment that goes beyond what an employer is expected to provide.

Pain, injury and looking after yourself

Tics are not only tiring. Repeated forceful movements can cause sore muscles, neck and back pain, headaches, a sore jaw or aching joints. Some tics involve hitting, biting or pressing, which can bruise or injure. Long periods of suppressing tics can leave people drained by evening.

Things that often help:

• Warmth and gentle stretching for muscles that are worked hard by a particular tic.
• Pacing your day, with breaks before you reach exhaustion rather than after.
• Good sleep habits, because tiredness feeds tics and tics disturb sleep.
• Protecting against hitting tics, for example by padding a hard surface the tic often strikes, or keeping hot drinks out of reach during a bad spell.

See your GP if tic-related pain does not settle, if a tic is causing injury, or if tics are affecting mood, sleep or confidence. A physiotherapist is often the right person for persistent muscle or joint pain. If a forceful neck tic is followed by numbness, tingling or weakness in the arms or legs, get medical advice the same day through NHS 111, and call 999 if the symptoms are sudden or severe.

It is also worth seeing the GP if tic-like movements start suddenly in a teenager or adult, or become severe very quickly. These are sometimes a different condition that needs a different approach, so a proper assessment matters.

Behavioural treatments a specialist may offer

If tics are causing pain, distress or real disruption, your GP can refer you or your child to a specialist, often a paediatrician, neurologist, psychiatrist or psychologist. Not everyone wants or needs treatment, and that is a perfectly valid choice.

The main behavioural treatments are:

• Habit reversal training and CBIT (comprehensive behavioural intervention for tics). You learn to notice the urge before a tic and do a different, less noticeable movement that makes the tic hard to do at the same time. CBIT also looks at the situations that tend to trigger tics and what can be changed around them.
• Exposure and response prevention, which involves gradually learning to tolerate the urge without acting on it.

These are skills, not cures, and they take practice. They are usually delivered by psychologists or specially trained therapists, and NHS availability varies by area. A specialist may also talk about other options for severe tics, and that is a conversation to have with them.

Where an occupational therapist fits

An occupational therapist does not diagnose Tourette's and is not usually the person who delivers CBIT. The GP is the first stop for assessment and referral, a psychologist or trained therapist leads on behavioural treatment, a physiotherapist helps with persistent pain, and the school SENCo coordinates support in class.

Where an occupational therapist can help is everyday life. That might mean:

• Looking at handwriting, typing and other practical tasks affected by hand or arm tics, and suggesting tools or alternatives.
• Exploring sensory needs, as some people with tics are also sensitive to noise, clothing, touch or busy environments, and these can feed stress and tiredness.
• Planning routines that balance energy across the day, including after-school recovery time.
• Helping with self-care, sleep routines and organisation, particularly where ADHD or anxiety is also part of the picture.
• Writing a report with practical recommendations for school, or assessing a workstation and job demands for work.

A private occupational therapist visiting at home sees how things actually go in your space, which can be more useful than a clinic. See our children's occupational therapy and sensory needs pages for more on what that involves.

Frequently asked questions

Can my child be punished at school for their tics?

Tics are involuntary, so they should not be treated as misbehaviour. If this is happening, ask for a meeting with the SENCo and request that your child's support plan makes clear how staff should respond. If it continues, use the school's complaints process.

Is Tourette's classed as a disability?

It can be. Under the Equality Act 2010, a condition counts if it has a substantial and long-term negative effect on normal daily activities. Many people with Tourette's meet that test, but it depends on the individual. GOV.UK and Acas have current guidance.

Do tics go away?

For many children, tics are at their most noticeable in the years before and around the early teens and then ease, sometimes a great deal, by adulthood. Some people continue to have tics as adults. There is no reliable way to predict which, so it makes sense to put support in place now.

Can someone stop their tics if they try hard enough?

Some people can hold tics back for short periods, but it is tiring and the urge often comes out later. Asking someone to stop usually makes things worse. Behavioural treatments teach a different, more controlled skill, and only for people who choose to try them.

Should I tell my employer I have tics?

It is your choice. Telling your employer means they can make reasonable adjustments, and many people find it eases daily pressure. You can decide how much to share and who else is told.

Does Tourette's mean swearing?

No. Involuntary swearing affects only a minority of people with Tourette's. Most tics are movements or sounds such as blinking, sniffing or throat clearing.

Next steps

If tics are affecting school, work or daily routines, an occupational therapist can help with the practical side. See our children's occupational therapy or work and ergonomics page, or current guide prices, and choose your area below.