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About Tourette Syndrome
Tourette Syndrome (TS) is a neurological disorder that is characterized by brief, sudden, repetitive, and unusual involuntary movements or unwanted sounds called tics. Symptoms can range from mild to severe to debilitating.
The tics associated with TS are classified as either simple or complex. Simple tics involve a limited number of muscle groups. Some of the more common simple tics include eye blinking, nose twitching, mouth movements, and head / shoulder shrugging or jerking. More complex tics involving several muscle groups and may include facial grimacing combined with a head twist and a shoulder shrug, touching objects, hopping, jumping, bending, or twisting. Simple vocalizations might include repetitive throat-clearing, sniffing, or grunting sounds. More complex vocal tics include repeating words or phrases, sometimes obscene or swear words. More intense symptoms may considerably impede communication, daily functioning and quality of life.
Symptoms of TS usually begin in childhood and can be seen as early as two years of age, but are more likely to occur between the ages of six to seven. Males are three to four times more likely than females to develop TS. In most cases, the severity, frequency, and disruptiveness of the symptoms diminish during adolescence and adulthood. In other cases, the symptoms actually disappear entirely, usually by early adulthood. Rarely will the symptoms worsen in adulthood.
Many individuals with TSexperience additional related conditions such as attention deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), learning disabilities, sleep disorders, and anxiety and mood disorders. JAN's Accommodation Solutions: Executive Functioning Deficits is a publication detailing accommodations for individuals with limitations related to executive functioning. These ideas may be helpful in determining accommodations.
Tourette Syndrome and the Americans with Disabilities Act
The ADA does not contain a definitive list of medical conditions that constitute disabilities. Instead, the ADA defines a person with a disability as someone who (1) has a physical or mental impairment that substantially limits one or more "major life activities," (2) has a record of such an impairment, or (3) is regarded as having such an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act (ADAAA).
Accommodating Employees with Tourette Syndrome
People with Tourette Syndrome may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people who are aging will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.
Questions to Consider:
- What limitations is the employee experiencing?
- How do these limitations affect the employee and the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training?
Situations and Solutions:
The following situations and solutions are real-life examples of accommodations that were made by JAN customers. Because accommodations are made on a case-by-case basis, these examples may not be effective for every workplace but give you an idea about the types of accommodations that are possible.
A library employee who had several fairly severe motor tics very rarely had vocal ones because of Tourette Syndrome.
After demonstrating one of his rare outbursts, his employer requested medical documentation in order to ascertain the nature of the outbursts and whether they would be an issue in the future. The employer was able to determine that the outbursts were rare indeed, that there really was no accommodation to help reduce them, and that they could handle the outbursts as outlined by the employee’s doctor.
A parks and recreation worker with Tourette Syndrome worked for a city and had difficulty controlling his vocal tics when he was under the stress and chaos of working with a crew of more than three people.
He asked for the accommodation of allowing him to work alone, or with just one other co-worker. Although transportation become a little tricky to organize, his employer found no hardship in providing the accommodation for a trial period to see how effective it could be.
An insurance salesman, working in a call center, had Tourette Syndrome that was getting more severe.
No longer able to control his vocal outbursts, it became impossible for him and his coworkers to complete calls. When it was brought to his attention, he shirked it off as his co-workers being too difficult to get along with. He refused to take part in the accommodation process, and refused the move to a more private area with frequent breaks to help him manage the stress that he stated was exacerbating his condition. With no assistance from medical documentation as he refused to cooperate, the employer determined that he was no longer qualified for the position as he was unable to complete the essential functions of his position.
An employer who had just hired a new employee with Tourette Syndrome was shocked when he discovered that the employee was making sexually offensive comments to female coworkers as well as passing around lewd pictures he had drawn.
Meeting immediately with the employee and his job coach, the employer discovered that the employee had Tourette syndrome, had experienced the same issues in previous positions, and was unable to refrain from the comments and the drawings due to his Tourette’s. Since no accommodation had previously been found to be effective, the employer terminated this employee.
Due to Tourette Syndrome an office employee had vocalizations that disturbed his co-workers.
He asked for a stress-free environment in order to reduce the vocalizations. In order for his employer to reduce or eliminate stress, he had to know specifics. The employee was able to explain the day-to-day issues that caused his stress to escalate so the employer could work with him to help reduce it. Effective accommodations included projects with detailed instructions, noise-canceling earbuds to help eliminate conversations/ distractions around him, and the ability to take short flexible breaks.
JAN Publications & Articles Regarding Tourette Syndrome
Consultants' Corner Articles
- Accommodating Social Anxiety Disorder (Social Phobia)
- Accommodations Beyond Job Performance = Compliance and Inclusion
- Cognitive Impairment and the Interactive Process
- Disclosing a Disability Before an Accommodation is Needed
- I Understand You Are Stressed...But Aren’t We All?
- My Disability Made Me Do It! When It Does and Doesn’t Matter