All his tics are back... - Mothering Forums
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#1 of 9 Old 04-02-2012, 12:10 AM - Thread Starter
 
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Ds, age 10, going on 11, has a diagnosis of SPD/motor planning issues and number of tics/stims/habits.. one at a time, they're not too bad and he doesn't stick out too much. But they seem to be getting worse in the last few months.

 

  • He holds his  hands up in front of his eyes very briefly and then back down. He'll do this multiple times a minute when he can. If he can't he seems to move his neck in a way to change his vision field and it looks odd. It sort of looks like a pigeon walking.
  • He pulls on his hair/twists it. Sometimes he pulls his hair out. He'll go months without doing this, and then start up again. He's started again. Mostly he does this while reading.
  • In the last few months he's been washing his hands a lot, when any dirt (imagined or real) gets on them.
  • In the last 6 months of so, he holds his hands at a funny angle (parallel to the floor or even higher) and seems to be reluctant to touch things, or he'll try to do things with one hand only.
  • He refuses to eat anything that's fallen off his plate (even onto the table) or heaven forbid, touched the floor. He used to be OK with this.
  • He refuses to wipe his mouth off  even when he gets food on his face in public, even if I ask him to. He will take a washcloth at home and do it. He gets really angry with me if I try to get his face clean for him with a napkin or something.

 

The combination of these things is starting to make me wonder if something is going on that we need to get looked at.

 

Here's what we know:

He's not on the autism spectrum (really he's not, his social cognition is excellent). He had some mild anxiety when he was younger (~7) but that's resolved. He doesn't have Tourette's (no vocal tics ever).

 

His tics have always been worse in spring/summer. He's probably entering the beginning stages of puberty (his feet have grown enormously, I saw a small pimple on his face the other day, he's constantly hungry and his legs hurt). School is going fine academically, and socially as far as I know. He's got a couple of friends who he plays well with most of the time (they seek him out, they have occasional spats, but nothing major). He tells me who he's played basketball with at school other little things that make me think he's fine. He's physically very active and is becoming more coordinated. He still has to think sometimes before his body will do something, so he's not a natural athlete. But he works hard and is quite average in terms of performance.

 

I sort of feel like we're on the verge of OCD, but it's not interfering with his life. He's a quiet introvert, and has never, ever discussed his feelings. When I ask him what's up with his hands, he can't tell me, not even to say that he is/is not able to stop washing them.  He's quite sensitive emotionally, though you'd only know that if you were his parent. I'm afraid to push too hard or he'll shut down.

 

He's starting middle school next fall where they mix kids from a number of different schools, and I'd like him not to be a target for being weird. I'm feeling like something is up, but I don't know where to start. Back to his old OT? Somewhere else? Wait and see?

 

 

 


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#2 of 9 Old 04-02-2012, 05:55 AM
 
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Sounds like there may be some OCD going on or maybe something neurological.  I think a trip to see either a developmental pediatrician or, preferably, a pediatric neurologist is in order.  


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#3 of 9 Old 04-03-2012, 09:02 AM
 
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Strep popped into my mind for some reason. Like PANDAS... has he had a virus or sore throat lately?

My son is the same age as yours, and I do notice that certain behaviors are amped up through hormonal shifts. My son has stims that are similar to what you are describing... his sensory sensitivities really amp up through these periods as well.


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#4 of 9 Old 04-03-2012, 07:05 PM
 
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Sounds similar to my ds.  He seems worse (anxiety/lack of coping/tics/etc) in spring summer due to allergies and the transition of a school year ending/ moving to the next grade.  We did recently test for strep as that was also a concern.

 

Has your ds been tested for allergies and strep? Also vision testing comes to mind (depth perception/ light sensitivity)?

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#5 of 9 Old 04-04-2012, 05:27 AM
 
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These are pretty familiar tics to me, my 11 year old (ASD, OCD, anxiety) has had all of these at some point.  Transient tics from anxiety are pretty common in this age group if there have been any increases in stress.  I second looking into PANDAS, although seeing as you have had difficulties with tics and sensory issues in the past and not a sudden onset, it may not be as likely.  In your shoes, I'd probably want a total re-evaluation by a neuro-pediatrician or developmental pediatrician.  It would give you an idea if you are dealing with anything new or if you are just dealing with new stresses it upcoming puberty changes affecting what difficulties he already has.

 

Just in response to the ASD and social cognition.  While your gut is probably right, I wanted to point out that some kids on the spectrum have pretty good social cognition.  My son has had very thorough testing in this arena (we had quite a time sorting out OCD from if he could be on the spectrum or if he had some sort of Tourette's).  He tests above average on making social inferences and theoretically handling social situations.  He also tests above average on interpreting facial expressions and many other non verbals.  The reason he scored on the spectrum was eye contact (previously interpreted as introversion and anxiety), having a different emotional range even though he recognized others were not the same, and not particularly caring about social contact or making an impression.  He has a friend (one) and many acquaintances, participates in sports, volunteers and runs a small baking business over the summer.  My point is that things aren't always obvious, and while your son most likely isn't in the spectrum, keep an open mind when (or if) he is re-evaluated.  I got very frustrated when ASD was suggested, thought everyone was barking up the wrong tree and that it couldn't possibly be my kid.  But when he actually had the ADOS, I got it.  He was diagnosed only this year and was evaluated (full psych assessment) three times previously, I work with special needs kids, my husband is a nurse, we were well informed.  It didn't change that things were different than we thought.  Diddo with Tourette's still being possible.  Especially since for some people, Tourette's can intensify with puberty changes.  I'm not saying your son has any of these disorders, but I am just putting it out there that unless you had recent and thorough assessments, you don't really know if he doesn't have any of these disorders.  My apologies if I've come off strong, but it's just that I've been in the difficult to diagnose situation, and in some cases even the professionals have a very hard time sorting things out.

 

 


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#6 of 9 Old 04-04-2012, 03:15 PM - Thread Starter
 
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Thanks,

 

I'm 98% sure it's not PANDAS as we've seen most of these before. And it wasn't a sudden onset, it was more like a slow ramping up of things over the last several months. They also wax and wane by day. They were quite bad on Monday when I posted, and I didn't notice much of anything yesterday.

 

I'm aware that he might be on the autism spectrum, especially since we've got relatives on both sides of the family that have Asperger's (one originally had classic autism and was 'graduated' to Asperger's, one was diagnosed with Asperger's at age 8 1/2). At the same time, ds' social development appears to be on track, for an introvert. Ds does care about what others think and about social contact. For example, last night he was telling me that one of the younger neighbor kids was a "menace" because the neighbor had thrown a pine cone and hit ds in the eye. I asked a few more details (why was the neighbor upset and whether ds was hurt). The first thing ds said after I asked my questions was "please don't get involved!" He was much more worried about being embarrassed in front of his friends than the pine cone incident. He keeps his emotions very close to the vest, but he's got a range and the appropriate range for the situations he's in. He's got fine eye contact and we will often share amusement about something his little sister is doing just with a glance and a smile.

 

We had a pretty thorough evaluation with a developmental psychologist 3 years ago, and that's when Asperger's was ruled out. He's taking part in an ADHD study ( as a control) and they've done some pretty intense testing (3+ hour sessions) and he's come out neurotypical on those too.

 

I'm afraid I've got the classic quirky kid. I don't really care about a label, I do care that he's got the skills he needs, and I don't know how to get him those without a label.

 


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#7 of 9 Old 04-04-2012, 06:27 PM
 
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You might be able to get some specific help with tics even if it's under an anxiety label (you did identify that he had past trouble with anxiety before age 7).  We're in a different country, so services may not be the same, but personally a diagnoses of GAD was enough to access services for tics as transient tics are common (especially with boys) if they have an anxiety disorder.  Further looking into the possibility of OCD would help, too.

 

Three years ago for testing could change a lot.  We had testing by a developmental psychologist 3 years before the diagnoses we now have and his current diagnoses were not on the radar because what is the norm for age 7 can allow for more quirkiness than what's the norm for age 10.  That would go for any disorder.  Also, we had a very different experience only using a developmental psychologist compared to also working with a pediatric neurologist.  The best circumstance is if you have a developmental team (OT, developmental psychologist, pediatrician) working together.  If there is an honest and helpful label a multidisciplinary group might be more likely to find it as they will be collectively thinking outside of their individual specialties.  For example, our OT saw SPD, the educational psychologist saw NVLD, the psychiatrist he was seeing for anxiety thought ADHD (inattentive type)was a contributing factor to anxiety, the neurologist thought it was just plain Tourette's with no other conditions, the developmental psychologist thought he was on the autistic spectrum but very high functioning (and by the way, your examples with your son are still within the range of what both my son and some kids I work with can do/express/feel).  It took a whole team to sort that out.  When a kid is quirky and complicated, and a label is needed, it might take a team to find it.

 

Do you have some coping suggestions from the OT?  Many kids can find a replacement activity or a sensory outlet for tics.  As to the food stuff (food falling off plate, or in my son's case, possibly touched) and hand washing, gradual exposure to the obsession causing activity with increasingly stricter rules to avoid the compulsion is often part of the treatment, just as with anxiety gradually taking on more anxiety producing situation helps.  Kind of an emotional/behavioral scaffolding.  Say, with the hand washing, you would start with allowing a certain frequency and duration of hand washing similar to what's current and gradually decrease the frequency and duration involved.  Actually record it, and have a tangible (but not necessarily material way) that your son can rewqrd himself for getting through it.  Both psychiatrists and psychologists familiar with CBT could help you come up with a plan.  It helps with some tics, too, and even without a formal OCD diagnoses, if the behaviors are there it's probably enough for a therapist to warrant treatment.


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#8 of 9 Old 04-04-2012, 07:23 PM
 
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Wow! This sounds just like my son. We have heard everything from autism (psychiatrist), Aspergers (psychologist), dyspraxia (developmental pediatrician), ADD (psychologist), SPD (OT), Tourettes (neurologist), PANDAS-like infection (neuro-psych)...you name it! Even within the same practice, we have had different opinions. One neurologist said Tourettes, the other said no, probably just tics associated with developmental delays or autism, etc. and the other is taking a wait and see approach.

 

My son is 9 and his tics come and go in severity....and he doesn't have any obvious OCDs yet besides just facial tics and occasionally breathing tics or tics involving larger muscle groups.

 

I have a cousin who has a son with Tourettes and it gets pretty severe at times (without the vocals) so I think there may be a genetic factor. That side of the family has had a few quirky tics here and there, but not as severe as my cousin's child with Tourettes. I worry because this boy is about 20 now, and his tics are still pretty bad.

 

When my son was about 3 he started with noises. They would wax and wane. They eventually subsided around age 5 as far as I could tell, and the motor tics started very suddenly at age 7.

 

My son is very sensitive at times and I know he worries about how others see him. I have gone to school to have lunch with him during some of his tics, and he can usually suppress it pretty well...but when he gets home he tics like crazy and is exhausted from holding it in all day.

 

I think my son is super sensitive to certain foods. I notice him immediately start to tic after starting a meal. His teachers even said that after lunch his tics get bad, but it could be that he is tired...but he has a very early lunch time. I wouldn't call it a food allergy, but he just has a "lower tic threshold" and certain things he ingests will instantly set off tics. I am almost tempted to try a strict diet like a gluten/casein free diet, but he has such a restricted diet already due to being such a picky eater (from sensory issues??). I hate to take away the two things that he likes....dairy and wheat! Especially since those things don't seem to give an immediate reaction....it's other things that set him off like artificial colors, corn syrup, preservatives, and salycates (found in natural stuff like fruits and veggies, spices and aspirin but I can't figure out the spelling!). 

 

For us, vitamin B seems to help sometimes. I got a children's B complex with vitamin C made by Superior Source at the health food store. 
 

Quote:
Originally Posted by FarmerBeth View Post

You might be able to get some specific help with tics even if it's under an anxiety label (you did identify that he had past trouble with anxiety before age 7).  We're in a different country, so services may not be the same, but personally a diagnoses of GAD was enough to access services for tics as transient tics are common (especially with boys) if they have an anxiety disorder.  Further looking into the possibility of OCD would help, too.

 

Three years ago for testing could change a lot.  We had testing by a developmental psychologist 3 years before the diagnoses we now have and his current diagnoses were not on the radar because what is the norm for age 7 can allow for more quirkiness than what's the norm for age 10.  That would go for any disorder.  Also, we had a very different experience only using a developmental psychologist compared to also working with a pediatric neurologist.  The best circumstance is if you have a developmental team (OT, developmental psychologist, pediatrician) working together.  If there is an honest and helpful label a multidisciplinary group might be more likely to find it as they will be collectively thinking outside of their individual specialties.  For example, our OT saw SPD, the educational psychologist saw NVLD, the psychiatrist he was seeing for anxiety thought ADHD (inattentive type)was a contributing factor to anxiety, the neurologist thought it was just plain Tourette's with no other conditions, the developmental psychologist thought he was on the autistic spectrum but very high functioning (and by the way, your examples with your son are still within the range of what both my son and some kids I work with can do/express/feel).  It took a whole team to sort that out.  When a kid is quirky and complicated, and a label is needed, it might take a team to find it.

 

Do you have some coping suggestions from the OT?  Many kids can find a replacement activity or a sensory outlet for tics.  As to the food stuff (food falling off plate, or in my son's case, possibly touched) and hand washing, gradual exposure to the obsession causing activity with increasingly stricter rules to avoid the compulsion is often part of the treatment, just as with anxiety gradually taking on more anxiety producing situation helps.  Kind of an emotional/behavioral scaffolding.  Say, with the hand washing, you would start with allowing a certain frequency and duration of hand washing similar to what's current and gradually decrease the frequency and duration involved.  Actually record it, and have a tangible (but not necessarily material way) that your son can rewqrd himself for getting through it.  Both psychiatrists and psychologists familiar with CBT could help you come up with a plan.  It helps with some tics, too, and even without a formal OCD diagnoses, if the behaviors are there it's probably enough for a therapist to warrant treatment.



 

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#9 of 9 Old 04-04-2012, 07:29 PM
 
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I'd recommend some type of CBT because as he gets older it will interfere socially.

I had many transient tics as a child, and all my mom did was scold me. As I got older, they continued to become more apparent socially.

It wasn't until I became a behavior therapist myself that I learned about this type of therapy, and began my own regimen of replacing the "old habits' with "new habits". I did this in my early twenties but the replacement behaviors I used would have been easy for a child to do as well, provided he was motivated.

That's where I think you might have to wait a bit since you think that his tics aren't inhibiting him at all yet.

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