Adolescents' Perceptions of Their Peers with Tourette's Syndrome: Does A Brief Anti-Stigma Intervention Help?

Background and aim: Tourette's syndrome is a neurodevelopmental condition characterised by tics. It is a condition that has been stigmatised by the public. School age children and especially adolescents often experience rejection from their typically developing peers due to their symptomology which could hinder school inclusion and social participation. Therefore, there is a need for implementing interventions to target typically developing peers' inaccurate knowledge about TS, and their negative attitudes. There is also a paucity of studies that explore the motivation of peers who stigmatise against people with TS. Understanding stigma and its underlying causes, however, is vital to develop effective interventions that can minimise and help to eventually eradicate stigma.

The aim of the thesis is therefore three-fold: firstly, to understand how individuals with TS were perceived by typically developing adolescents. Secondly, based on these attitudes, to develop a tailor-made anti-stigma intervention; and thirdly to evaluate the effectiveness of the developed intervention within a secondary school classroom setting.

Method: A sequential mixed-method design was used. Qualitative data were collected to capture tic-free adolescents' motives, and reasoning involved in the exclusion of individuals with TS. These findings were then used to design a tailor- made intervention and research measures. A randomised cluster control trial with a mixed-model design was used to determine the impact of the developed intervention on tic-free adolescents' awareness of Tourette's syndrome, attitudes, and behaviours towards individuals with TS. Data were collected at three time points: pre-intervention, post-intervention and 9 weeks after its implementation. This is the first intervention that was specifically designed for adolescents and with an assessment at a follow-up stage.

Results: The qualitative study indicated that adolescents understanding about the condition was construed from misconceptions, unfamiliarity and unanswered questions. Furthermore, people with TS were either perceived as being deprived of agency and strength or as deserving pity, and in need of support. These findings helped design the intervention which was implanted on Year Ten students in a school in the South East. Upon completion of the intervention, positive changes were recorded relating to students' awareness, attitudes and behavioural intentions. Tic-free adolescents were more willing to embrace diversity within the classroom and rejected previously held notions of ableism. However, only changes in awareness were maintained at the 9-weeks follow-up.

Conclusion: Tailor-made interventions can contribute substantially to preventing consolidation of unfavourable attitudes towards individuals with TS. Future research should however place emphasis on how these positive outcomes could be maintained over time. Implications of these findings for school curricula and mental health policy, as well as suggestions for future research, are discussed.