Knowledge and Awareness of Tourette’s Syndrome among Teachers in Eastern Region, Saudi Arabia

Evidence before this study

Tourette’s Syndrome (TS) is a complex neurodevelopmental disorder that commonly co-occurs with ADHD and OCD, potentially affecting a student’s academic performance and social development. While international studies have examined the clinical aspects of TS and teacher awareness in Western countries, there has been a lack of empirical data from Saudi Arabia, particularly in the Eastern Province. Prior local studies, such as one in Riyadh, focused primarily on medical students and physicians, not educators. No published studies have systematically evaluated the level of TS-related knowledge among schoolteachers, despite their pivotal role in identifying symptoms, implementing classroom accommodations, and reducing stigma. This study addresses a significant knowledge gap in understanding how well-prepared Saudi teachers are to support students with TS.

Added value of this study

This is the first large-scale cross-sectional study to assess knowledge, awareness, and attitudes about Tourette’s Syndrome among teachers in the Eastern Province of Saudi Arabia. Surveying 305 teachers across various school levels and regions, the study found that 57% had poor overall knowledge of TS, while only 5.9% demonstrated good knowledge. Teachers were more familiar with motor and vocal tics (65%), but had limited understanding of associated conditions like OCD (29%) and ADHD (51%), as well as appropriate classroom interventions. The most common source of information was the internet and social media (35%), with minimal reliance on formal training programs. A statistically significant relationship was found between prior experience with TS and higher knowledge scores (p < 0.05), highlighting the importance of practical exposure in improving awareness.

Implications of all the available evidence

The results demonstrate a pressing need for structured and targeted training programs for educators regarding TS and related neurodevelopmental disorders. Given the high percentage of teachers lacking sufficient knowledge and relying on informal sources, educational authorities should integrate evidence-based TS content into teacher training curricula, workshops, and ongoing professional development. Moreover, cross-sector collaboration between educational institutions and healthcare providers could facilitate school-based awareness campaigns and teacher support systems. Improving teacher preparedness will be key to reducing stigma, enabling effective classroom management, and fostering inclusive educational environments for students with TS across Saudi Arabia.

Study Design

A cross-sectional study was conducted between January 2024 and May 2024. A self-administered structured questionnaire was used to assess teachers’ knowledge and perception of TS in the Eastern Province of Saudi Arabia.

Study Area

This study was conducted in the Eastern Province of Saudi Arabia, in both urban and rural areas such as Al-Hasa, Dammam, and Al-Khobar. These regions were selected due to their diverse demographics and the presence of both governmental and private schools, ensuring a broad representation of teachers.

Study Population

The study targeted school teachers working in primary, intermediate, and high schools within the Eastern Province. The inclusion of a wide range of educational levels ensured a comprehensive understanding of the teaching population’s knowledge and perceptions of TS.

Sample Size and Sampling Technique

The sample size was calculated based on the following parameters: a 95% confidence interval, a 5% margin of error, and an estimated population of teachers in the region. A final sample size of 305 participants was determined to ensure statistical power and precision. A stratified random sampling technique was employed, dividing the population into strata based on school type (governmental vs. private), gender, and teaching experience. Random selection within each stratum minimized sampling bias and ensured proportional representation.

Data Collection Tools

Data were collected using a pre-validated, structured questionnaire administered via Google Forms. The questionnaire was developed based on a comprehensive literature review and refined through expert consultation to ensure content validity. It comprised four sections:

• Demographics: Age, gender, education level, teaching speciality, years of teaching experience, and personal experience with TS students.

• Knowledge Assessment: 23 items assessing knowledge of TS symptoms, diagnostic criteria, and comorbid conditions (e.g., OCD and ADHD).

• Classroom Interventions: Questions evaluating teachers’ familiarity with and confidence in implementing modifications for TS students, such as seating arrangements, test accommodations, and peer education.

• Treatment Options: Items assessing awareness of medical and behavioural management strategies for TS.

Knowledge was assessed using 23 items. Each correct response was scored as 1 and incorrect or ‘don’t know’ as 0, yielding a total score range of 0–23. The total score was converted to a percentage (score/23 × 100) and categorised using modified Bloom’s cut-off points: poor (<60%), moderate (60–79%), and good (80–100%) [8].

Pilot Study

A pilot study was conducted with 30 randomly selected teachers to evaluate the reliability and clarity of the questionnaire. Cronbach’s alpha was calculated to assess internal consistency, yielding a value of 0.87, indicating high reliability. Feedback from participants was incorporated to refine ambiguous questions, ensuring the instrument’s validity and feasibility for large-scale application.

Statistical Analysis

All statistical analyses were performed using IBM SPSS Statistics (Version 27.0). Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize the demographic characteristics of the participants and their knowledge scores. Inferential analyses were conducted to examine relationships and differences among variables. Associations between categorical variables, such as knowledge levels and demographic characteristics, were evaluated using Chi-square tests. Comparisons of mean knowledge scores across different demographic groups were performed using independent t-tests and one-way Analysis of Variance (ANOVA). A p-value of less than 0.05 was considered statistically significant for all tests. Furthermore, a post-hoc power analysis was conducted, confirming that the achieved sample size provided 80% power to detect meaningful differences at a 5% significance level, thereby ensuring the robustness of the statistical interpretations.

Ethical Considerations

Ethical approval was obtained from the King Faisal University Research Ethics Committee (IRB Approval: ETHICS182). All participants provided informed consent electronically before completing the questionnaire. Data confidentiality and anonymity were strictly maintained throughout the study, and participants were informed of their right to withdraw at any stage without consequences. The study adhered to the ethical principles outlined in the Declaration of Helsinki.

Baseline Characteristics of Participants

The sample consisted of 43.93% males (n = 134) and 56.07% females (n = 171). Most participants were Saudi (94.75%, n = 289), with 93.75% (n = 285) holding a bachelor’s degree. The majority of teachers specialised in mathematics (19.34%, n = 59), science (24.59%, n = 75), or English language (13.77%, n = 42).

Regarding teaching experience, 41.31% (n = 126) had 17+ years, and 64.26% (n = 196) worked in large districts (more than 300 students). Participants taught across various grade levels: elementary (36.39%, n = 111), junior high (21.64%, n = 66), and high school (37.38%, n = 114). In terms of knowledge of TS, 64.26% (n = 196) had little or no knowledge. Most learned about the disorder through the internet (35.08%, n = 107), and 84.92% (n = 259) had no personal experience with children with TS. Regarding intervention techniques, 47.90% (n = 146) felt competent in parent consultation, and 60.30% (n = 184) in teacher education (Table 1).

General Knowledge about Tourette’s Syndrome

A majority of teachers correctly identified that both motor and vocal tics are associated with TS (65.90%, n = 201). However, 40.98% (n = 125) were unsure about the ability to suppress tics for varying lengths of time, and 46.56% (n = 142) were unsure of the onset of symptoms before age 18. Regarding the need for symptoms to be present continuously for one year, 43.61% (n = 133) did not know, while 24.26% (n = 74) believed the statement to be false. Teachers’ views on the nature of TS included 46.56% (n = 142) agreeing that it is a neurological and genetic disorder. However, 39.02% (n = 119) did not know that children with Tourette’s often have obsessive-compulsive disorder, and 40.66% (n = 124) believed that stimulant medications were most effective for treatment. A majority (50.82%, n = 155) agreed that children with TS often have ADHD (Table 2).

Figure 1 shows the general knowledge of TS among teachers in the eastern region. 57% of them have poor knowledge, and a small number by 5.9% have good knowledge Figure 2 shows the knowledge about symptoms and treatment of TS among teachers in the eastern region. 47% of them have poor knowledge, and a small number, by 10% have good knowledge.

Figure 1

Figure 2

Knowledge about Appropriate Response to Children with Tourette’s Syndrome

In Table 3, teachers showed varying levels of knowledge regarding appropriate responses to children with TS. A significant proportion of teachers (42.30%, n = 129) deemed it inappropriate to allow a child to periodically leave the classroom, while 20.98% (n = 64) thought it was appropriate. Regarding the establishment of a separate test-taking room, 27.54% (n = 84) found it appropriate, and 14.75% (n = 45) considered it inappropriate. Most teachers (53.77%, n = 164) agreed that educating classmates about TS is appropriate, while 13.77% (n = 42) considered it inappropriate.

In terms of classroom management, 29.51% (n = 90) agreed with gently reminding a child to control their tics, while 29.51% (n = 90) deemed it appropriate to seat the child near the front of the classroom. Time limits for assignments and tests were viewed as appropriate by 30.16% (n = 92), with 17.38% (n = 53) finding them inappropriate.

Concerning treatment, 45.25% (n = 138) disagreed with the idea that children with TS sometimes need no treatment, while 59.02% (n = 180) agreed that drugs can sometimes be used. Teachers largely agreed that surgery is not needed for children with Tourette’s (43.28%, n = 132), while 45.25% (n = 138) disagreed with the belief that all children with Tourette’s will improve as they age.

Factors Influencing Participants’ Knowledge

Table 4 assesses the overall knowledge categorized with regard to related factors in the study. By using the Chi-Square test and Wilcoxon sample t-test, the table shows there are differences between knowledge categories and the previous experience of working with children with the disease or with other movement disabilities. This difference is statistically significant.

Table 5 assesses the knowledge of symptoms and treatment of TS, categorized according to related factors in the study. Using the Chi-Square test and Wilcoxon sample t-test, the table shows differences between knowledge categories and previous experience working with children with the disease or with other movement disabilities. This difference is statistically significant.

Summary of Results

The demographic profile of the 305 participating teachers revealed a predominance of female Saudi nationals holding a bachelor’s degree, with specializations primarily in mathematics, science, and English. Teaching experience varied widely, with a substantial proportion working in large school districts and across elementary, junior high, and high school levels.

Assessment of TS-related knowledge identified significant gaps among educators. The majority of teachers reported little to no prior knowledge of TS, with most indicating the internet as their primary information source. While a majority correctly identified the presence of both motor and vocal tics as core symptoms of TS, understanding of other critical aspects was limited. Notably, teachers demonstrated uncertainty regarding the suppressibility of tics, the diagnostic requirement of symptom persistence for one year, and the frequent co-occurrence of obsessive-compulsive disorder (OCD). However, approximately half of the participants recognized the association between TS and attention-deficit/hyperactivity disorder (ADHD). Overall, 57% of teachers were categorized as having poor general knowledge of TS, with only 5.9% demonstrating good knowledge.

Regarding classroom management and intervention strategies, perspectives were mixed. Most teachers supported educating classmates about TS to foster an inclusive environment. However, there was considerable division and uncertainty about practical accommodations, such as allowing periodic classroom exits, providing separate testing environments, or modifying seating arrangements. In terms of treatment, a common misconception was that stimulant medications are the most effective approach for TS.

Finally, analysis of influencing factors revealed that prior personal or professional experience with students with TS or other movement disorders was significantly associated with higher knowledge scores. This correlation underscores the value of direct exposure in improving awareness and understanding. The findings collectively address the study’s core aim of evaluating the current state of awareness, attitudes, and perceptions of TS among schoolteachers in the region.

The study found a statistically significant correlation between previous experience with children with TS or other movement disorders and higher knowledge scores (p < 0.05). In conclusion, the study highlighted a lack of adequate knowledge about TS among teachers in the Eastern region. Limited exposure and training were significant contributing factors.