Tic question

[wintak]

So difficult child has tics...and I use that word loosely because there is no other word to describe it. Pre-medications he would hum CONSTANTLY and tap CONSTANTLY and you could tell some of the time he'd do it on purpose.

After diagnosis of ADHD the humming has subsided as the tapping to some extent BUT...now he makes this grunt kind of noise with his throat, he hits his hip CONSTANTLY, last week he started with a "puh" sound at random times and last night it was some nasal noise.

He's also had a stutter but that has disappeared after about 2 weeks.

Now, when you ASK him nicely to stop and he's in a good mood, he can and he will. His math teacher says he does make noises in math but even SHE'S pretty sure it's to **** off his table mates.

The MD said that some of these drugs bring out the tics that he's already had. In other words the medications aren't CAUSING the tics, he probably always had them but the medications just make them way more apparent.

I am convinced that they are done on purpose. He's that kind of kid. If he can find something that really gets under my skin, he will. If he knows there is a reward for being quiet during book time, he can keep all of that under control. However this gets ridiculous because the other two are quiet during book time with NO motivators but don't see it as fair that difficult child gets rewards for being quiet and truthfully I can understand that.

So here's the question...(oh and he's on Concerta 27mg and risperdal 1 mg daily) do you all have any experience with tics becoming more apparent with certain medications? How do you deal with the tics? How do I know if they are medication related or just to get under everyone's skin (even the younger two get irritated with him at book time cuz sometimes he does it so loud it's hard to hear me reading to them).

we see his psychiatrist on Wednesday so I'll be taking this up with her. Personally, I don't see any difference in the ADHD or the mood but school does so that's what the docs are kind of going on. He has stopped hitting and kicking me, but I'm not sure if that's the drugs or the threat of going to the hospital as a psychiatric emergency which I have been told by the psychiatrist to do.

Thanks all

 

[BusynMember]

Sounds like a stimulant to me, not a tic. A stimulant is common in autistic spesctrum disorder. The kids hum or make weird mouth noises or tap or blink or smack their lips, etc. It is comforting in Autism Spectrum Disorders (ASD). MY son used to also suck his shirt from the neck down and make growling noises.

Has he ever seen a neuropsychologist? Who diagnosed him? NEITHER TICS OR STIMS ARE TO GET ON ANYONE'S NERVES. Whew! There If he is doing this on purpose, it is neither a tick nor a stimulant. If you feel it's tics, you should take him to a pediatric neurologist to see if he has Tourette's Syndrome, but I'd be careful about thinking he is only doing this to get on your nerves...

My son is almost eighteen and he is MUCH better, but he still has stims. One is he licks the skin around his lips until it is sore and we need to get him a special cream, which he applies. And he sings in his room all the time (he has a very nice voice too!). He has learned how to keep his stims under control in public usually, but is still fidgety when he thinks people are looking at him, like when he had to sing in choir. He would pick at his clothes on stage then look up then look down, you get the picture. He was not trying to misbehave. This is how he deals with stress.

 

[Marguerite]

OK, I have a slightly more complex view, thanks to long conversations with both boys about their stims. I agree, this sounds like stimming. And yes, there can be a connection with medications but not necessarily the connection you think.

First, there is SOME voluntary control, but it is variable. It also takes a lot of effort. The stimming is actually a coping strategy at some level - it soothes and calms the individual. However, especially as they get older and more socially aware, and especially as they get pressured to not make the noises, they try to mask it. This removes a coping strategy and can increase anxiety. And as we found, you stop one type of stimulant, another one will emerge. Also over time, perhaps due to social pressure, the stims tend to become less obtrusive.

When they're concentrating on other things (such as in class doing worksheets) there is likely to be a considerable increase in unconscious stims. teachers often see this as deliberate, but it generally is not. If their attention is brought to it, they will make an effort to stop but as they slip back into focussing on their work, the stimulant comes back. This leaves the teacher with a difficult choice - either block the stimulant (and the student can't concentrate on work) or put up with it and the distraction in order to get some output from the kid.

There is also some level of deliberate involvement in stims. Not a lot, though. For example, difficult child 1 (like a lot of Aspies) is a mimic. he likes to try and imitate noises, actions etc. It is part of his attempts to learn to fit in - first observe, then imitate. So, he got a volunteer job in a local Aussie zoo. He is especially fascinated with birds, so it was bird behaviour and bird noises he began to observe and imitate. The large male emus were especially fascinating to him. They make a sort of quiet booming noise, sounds like the noise you would get if you tapped the end of a long open drainpipe. Which I guess is what their long throat resembles! So at first, difficult child 1 worked hard to get the sound just right. But what then happened, was he couldn't stop. He was about 20 at the time, old enough to know what was NOT socially acceptable.

Let's go back to when he was 6 years old. We have this on tape, because we were travelling in Europe at the time. difficult child 1 was sitting in the back of the car making what I called WWII noises. To a casual observer, it sounded like he was in his own world mentally replaying every dogfight Snoopy ever fought against the Red Baron. But I realise now, he couldn't stop these noises. Being away from his comfort zone pushed his anxiety up and increased the need for the stims for him. So the more we pressured him to shut up, the more he couldn't. He tried, but as soon as he stopped concentrating on "shutting up" the noises would start up again.

Does this help you understand? it is a bit more complicated than "they can't help it" but that is basically what it boils down to. See if you can share this with your son's teacher, and see if you can work with her to find other strategies to reduce his anxiety and need to stimulant. Also work with him to find more socially acceptable stims. But that is a lot trickier!

Acceptance will work wonders, especially with the apparent ODD side of things.

Marg

 

[tictoc]

I agree that neither a tic nor a stimulant would be a deliberate attempt to annoy you. In the case of either tics or stims, a child can suppress them temporarily, such as when a parent or teacher tells the child to stop.

My son has Tourette Syndrome. Our one trial with a stimulant (before his BiPolar (BP) diagnosis) lasted two doses. His tics became so bad that we stopped immediately. So, yes, your son is taking medications that could worsen tics.

I'm not sure whether you are describing tics or stims. Could be both.

 

[shellyd67]

While my difficult child was on Strattera 25mg (which is not a stimulant) he snapped his fingers constantly for over 2weeks and with gentle reminders it stopped.

When he began taking Concerta he bit his shirt at the shoulder until it was soaked. This went on for several months and then also subsided.

How long has he been taking Concerta ?

 

[smallworld]

If the movements are tics, Concerta can make them worse (in other words, bring out a tendency to have them). However, Risperdal actually treats tics.

 

[Marguerite]

Whether you call them tics or stims, anxiety can make them worse. If the medications are making the anxiety worse or in other ways making them need (or able) to concentrate more, this can also make the stims or tics more prominent. But it is not necessarily due directly to the medications. Just an indication of the medications perhaps causing stresses in other areas of the child's functioning.

Sometimes these things are an indicator, not the main problem.

So if a medication makes them suddenly a lot worse, it is not necessarily that the medication is causing the stimulant or tic. But it is doing SOMETHING not good, and an increase in stimulant or tic is one measurable outcome.

Sorry to nitpick, but it is important to get the distinction right. And yes, some medications can directly cause a problem with stims or tics, but I think this is far less common than simply a medication reducing the child's ability to cope, and the child ramping up stims or tics as a result of that.

WHichever reason - an increase, especially a big increase, indicates a problem that needs to be identified and addressed.

But the stimulant is not the problem. It's just a symptom, as well as a facet of the condition you need to accept, for now. It will change.

Marg

 

[smallworld]

Marg, that's not entirely true. Stimulants like Concerta and Adderall can bring out tics like gangbusters. It's happened with my son. He has already tics, but when he takes certain stimulants, the tics suddenly worsen. When he stops the stimulants, the tics lessen. There is a cause and effect relationship.

 

[wintak]

wow...never thought about a stimulant. He TELLS me (and let's remember this kid lies about everything) that he LIKES to hear the noises and he LIKES how his fist on his hip feels and that's why he does it, but after reading these responses, that's what a stimulant is. Do I have that right? It feels good to them, like a comfort thing?
I don't believe he's seen a neuropsychologist. He sees the head of the peds psychiatric at the childrens hospital and she diagnosis him with mood disorder and severe ADHD

He's been on concerta for 5 mos and it was upped at 3 weeks because the ADHD was so bad. risperdal has been also 5 mos but has been upped 4x believe. She started VERY low because he's a small kid (he's 8 and not 4' tall yet and just 50lbs).

SHe told me risperdal would make him sleepy and after trials of when to give it to him, we found it does not. There is a question of whether his metabolism is eating the medications up so very quickly. I gave him ritalin one night at 6pm against dr orders because as a family we were going somewhere where I needed the ADHD to chill and I was willing to take the chance that he wouldn't go to sleep 2 hours later cuz the ritalin was still in full swing. But alas, that kid fell asleep like a rock even with the ritalin in him..but I digress.

so if I'm getting this right, the stims or tics might be a way for him to cope with some sort of anxiety or stress. And if that's the issue, then we need to find out the anxiety or the stressor? That oughta be fun since he lies about everything, everything is fine and he does this 100% of the time. My original post said he even did this at book time at night...to a typical child (which he's not, I get) this is nothing to get anxious about. So why would this make difficult child anxious?

You guys are great...I have appts with his therapist and his psychiatric this week and I feel like I can go in with some info to pose careful questions.

But this is like pandora's box now...holy cow. So I have a mood disorder, severe ADHD kid who may or may not have tics or stims because he may or may not have some anxiety in his life (he says he doesn't, he tells the therapists and dr's that he feels things are getting BETTER at home) who lies constantly (saw him limping the other day, asked why he was limping what was wrong is he ok etc...I'm fine, nothing hurts etc. I get frustrated and I raise my voice..BUT YOU'RE LIMPING...about an hour later he admits that his foot hurts), acts like a 2-3 year old, has the emotional capacity of that same age, the intellectual ability of his stated age and drives everyone in the family crazy. Oh and possible Reactive Attachment Disorder (RAD)????

I don't know how you all with teens made it this far. He's only 8 and I'm ready to check out, I'm so frustrated. Kudos to you all!

 

[BusynMember]

Stims are closely associated with autistic spectrum disorder.

He probably has more than one issue going on. It is unlikely in my opinion to only be ADHD and it is also in my opinion unlikely that he is doing those "irritating" things to bug you or to bug anyone. He probably NEEDS to do them.

I still think a neuropsychologist is better than a psychiatrist for diagnosing. Also, a neurologist to see if he has tics or if they are stims is also in my opinion a good idea. He could also have Tourettes. Tourettes causes all sorts of mental health and neurological issues. The first go-to diagnosis, it seems, for most kids is ADHD/ODD. It is VERY RARELY the last and final diagnosis. Stimulants make a lot of k ids worse. My son got mean and aggressive on stims.

If your son's birthmother did not get the proper prenatal care when she was pregnant that could cause all sorts of issues with the baby/now a child. You have a lot of things going on here. Everyone with an adopted kid, unless he/she knows the birthparents very well, has a blank slate and that makes it much harder for diagnosticians to diagnose...there is no real history. I took all my adopted kids to NeuroPsychs; I felt that was the best way to figure them out. I had better luck with them, diagnosis-wise, than with psychiatrists. Psychiatrists seem pretty clueless about stuff like Aspergers and other neurological conditions. NeuroPsychs test intensively and for both.

Keep us posted!

 

[wintak]

So I just talked to him and he says he IS doing them on purpose. And now that I think back, MOST of the stims/tics have come in the last 4 weeks. One was present 6 weeks ago, I addressed it with the doctor and then it subsided all on it's own, but not before I got a call from the school about THEIR concern about his sudden speech issue (which was the issue I spoke with the doctor about.).
He used to hum and tap....like Chinese water torture to me. And tonight he's got 2 more new ones. I'm calling the docs line (non - emergency line) to see if I can stop the medications until we see her on Monday. I'm going crazy.

He does NOT do this in school except for Math class. I have asked repeatedly and all of his teachers look at me with this "are you HIGH" look. No, they say...one class in the afternoon he loses focus, but no...no noises, no hitting himself etc. So why at home?

And another question...those who do stimulant LOUDLY...how do you deal with it? It drives me crazy. I can't deal with stuff like that. Any ideas?

 

[BusynMember]

Ok.

to me, it sounds like you do have some added problems. He is saying that he does it on purpose. Does he mean he does it on purpose to bother you or does he mean he can't help it...he NEEDS to do it? Is he good at communicating when he speaks?

As for loud stims, I would tell my son to please try to be quieter, but he would listen. He wouldn't stop (maybe couldn't stop), but he would try. You have a different type of child there. I have no idea if he is doing it on purpose or not by your description. Chronic lying is more a Reactive Attachment Disorder (RAD) trait than anything else. I doubt there is only one issue with this child. I would do the neuropsychologist and see. I doubt anyone here can tell you what is going on. We can only maybe guess.

I wish I could be more helpful :<<

 

[BusynMember]

I have one more idea (ta-da) that I just thought of.

Many adopted kids do not live in the best conditions before we adopt them and have high lead levels. This is very significant and can cause all sorts of really strange behaviors and learning issues. You may want to have the psychiatrist test his lead levels. A child at the school I work at had lead poisoning and he acted totally autistic, BOY, DID HE stimulant!!! (and, yes, he was loud). Lead poisining happens when a child eats paint chips with lead in them.

Does your son ever act as if he is daydreaming or in his own world and then at other times seem very "with it" so that you are just baffled?

Good luck!

 

[wintak]

I totally realize we aren't diagnosis'ing my kid...but I am going in to the doctor Wednesday armed with a lot more questions than I usually have, thanks to all the real life info here.

I tried talking to him tonight about what he meant by "he's doing it on purpose" cuz I was thinking today that maybe he was stimming and such. So I ask him if it comforts him and he says it feels good. I try to ask what that means. I have video of him playing soccer with his younger brother today, having a good time and hitting the **** out of his right hip with his right fist, even while running. He says when he's happy the hitting makes him feel happy, and when he's mad the hitting makes him know he did something bad. But truly this kid is a TERRIBLE communicator. He truly is.

He doesn't seem to indicate that it's soothing or comforting to him. I talked to him at length tonight about my "concerns" (docs way of phrasing it so he doesn't get defensive) and how I can help him but he's got to be able to tell me more than "I like it". He tells me he's gonna stop. In fact, at one point we were doing rewards if he could be quiet and still during book time at night. If the reward was something he wanted (A small piece of candy (therapists idea)) he could be quiet and still for LONG periods of time. But then that got old (as it does with him) and he didn't care about the treat anymore so he started in again.

I asked him if he's nervous about stuff and he says no, then TOTALLY uses that word everytime something didn't go his way. Ugh. So I ask him, why does book time make you nervous? He says, it doesn't. Then why do you make all those noises and stuff? Then he gets frustrated but we end it calmly and off to get ready for bed. He does help his little brother out tonight, which was nice, got praised etc.

He walks in the room for books and starts IMMEDIATELY with the noises and physical beating of himself. I burst into tears right then and there in front of the kids. I couldn't take it anymore. I"m sure some of you reading are thinking what a horrible person I am that I can't be open enough to handle the tics/stims but they are CONSTANT and LOUD and all recent. I was thinking back...his recent repetoire is in the last 4-6 weeks. And then because I'm bawling, my sensitive easy child 1 and easy child 2 start crying and easy child 1 starts going on about how she's going to lose me when I die. HOLY ****...where did THIS come from? Anyway, another story, another time.

And again, he does NOT do these in school except for math class, which is blissfully easy for him. Any ideas on how you all deal with the constant stimulant/tic? Or do kids who stimulant/tic only do them when certain triggers happen? I'm so confused and I'm thinking this is going to be another summer spent at dr offices. Heavy sigh

 

[Marguerite]

it's not always anxiety. And smallworld, what I was trying to say was that yes, medications are sometimes a trigger, but I feel it is important to consider that there can be other factors in there so even if it does look like the medications, there may be more to it. For example, a medication that heightens muscle tension in a child or makes them feel different, could lead to an increase in stimming because the child at some level feels a greater need to stimulant, to cope with other unwanted side effects of the medication. End result is the same as if the medication was directly the cause. All I am saying, is that this can be more complex that it seems. But of course, for some kids, some medications make stimming or tics worse more directly. Although I would be interested to understand the brain biochemistry associated with this.

Wintak, he sounds like he's not a good communicator. HE's probably also not as plugged in to his own mind and body as most other kids his age. For example, difficult child 3 would insist that he did not feel anxious, even when we could see him having a full-blown panic attack. The classic example I've quoted here before - we were on holiday in New Zealand, visiting hot springs and boiling mud pools in Rotarua. difficult child 3 had expressed his fears before we went to NZ, that we could be caught up in an earthquake or some other hazard due to the high level of vulcanism in the country. He was so concerned, we had a fight getting him to agree to come. Although we weren't going to take no for an answer, there was no way he could stay behind for a month on his own.

In general he was okay, but the day in Rotarua was interesting. The smell of sulfur was not too unpleasant but was pervasive. Not rotten egg gas, more like egg sandwiches on the other side of the room. He was able to eat his lunch but was increasingly complaining of feeling a bit nauseous. When we went to the geysers and boiling mud place, he was really complaining not only of feeling sick, but convinced something bad was about to happen. He looked listless, he felt feverish, he was clingy and telling me we had to leave, he was dying. We stayed the course, I said to him, "You're okay, you're not sick, you're not dying, this is anxiety."
He said, "Anxiety isn't this bad. If this is anxiety, why do I feel so terrible?"
He had great difficulty accepting that anxiety COULD be this bad. However, as we left and drove south away from Rotarua, he began to improve. By the time we got back to our rented apartment on the shores of Lake Taupo, he was feeling fine. I reminded him again tat this was another clear indication that the problem had been anxiety. Not "just" anxiety, because for him it really was dire.

An interesting follow-on point - a few days later we visited the Volcano Centre in Taupo; it's a science museum, really well done, explaining about the vulcanism in the area. It had an earthquake simulation which he even had a go in (a room that shakes) with husband. But there was a really good display showing the areas of New Zealand's North Island and how seismically active various places are. We had been telling difficult child 3 that Taupo was not so active as Rotarua (we believed it at the time) and at this place difficult child 3 discovered for himself - Taupo is HOT! It leaves Rotarua in the shade. He looked at me with a wry expression on his face and said glumly, "It figures. So much for us being somewhere SAFE!" and he glared at me again. But by that stage we had been there almost a week and hadn't been blown sky high...

Look up Lake Taupo on Wikipedia. The whole lake is an active volcanic caldera. If you look at NZ on a map, there is a spot in the centre of North Island, about the size of a glass-headed pin holding the map on the wall. That is Lake Taupo. One large crater lake. We could walk to a spot on the shore where steam was rising. I waded out and nearly scalded my feet. The experience helped difficult child 3 learn a little bit more, to recognise his own anxiety. he still needs help with it. He was about 14 at the time we were there, your son is still only 8.

As for the noises - all you an do is keep asking him to find something quieter. But what he describes, even if he says he is doing it on purpose - they're stims. And like difficult child 1 with his emu noises, they may seem to the individual that they are under voluntary control, but there is less control than they realise. I've also known them to make the noise when they are relaxed and happy, like a kid rocking in a rocking chair while reading a book. In fact, rocking in a chair is very similar. it is under voluntary control, but it is also a habit you can get into. it is very difficult for some people to sit in a rocking chair and NOT rock.

Think about those mothers with young children who ride in strollers. Have you seen these mothers in the supermarket, rocking their shopping trolley? It's a habit you get into and you do it without thinking. Stims have a component of "It makes me feel good, or feel better," plus these kids form habits really easily, and there is a habit component. A kid who has been feeling criticised constantly for being disruptive, will also take on board and accept as valid, the accusation that they're doing it on purpose. Especially if a person in authority tells them so.

His level of communication and self-awareness - increasingly, he sounds Aspie or high-functioning autistic to me. This is not necessarily bad news.

Good luck with the appointment. I hope you get some useful answers.

Marg

 

[ML]

nothing to add except it can definitely be both. Manster has both AS and Tourette's Syndrome. He used to suck on his shirt and had a constant wet spot there. Typical stimulant. Later on he developed tics and went on to meet the criteria for Tourette's. His tics include: humming, throat clearing and eye blinking. Tourette's Syndrome is diagnosis when there are both vocal and movement tics. As Marg said, they can control them if they concentrate on it but it removes their coping mechanism and often they tic or stimulant more later. Stuff that tends to "travel" with Tourette's Syndrome is ADHD and Obsessive Compulsive Disorder (OCD).

 

[ML]

Sorry duplicate message

 

[BusynMember]

With his poor communication skills and the stimming, which he can't explain, I think it sounds a lot like autistic spectrum/Aspergers as well. You need a neuropsychologist for that and it is not a good idea to try to stop him from stimming...he may need it.

 

[hearts and roses]

My difficult child has Tourette's Syndrome. I used to believe, in the early days, that she had certain things she would do because she knew it bugged me, but as I came to understand the disorder better, I realized that while there may be some truth to the original act/behavior being on purpose, at a certain point it does become a tic. For example, my daughter may have been trying to bother me by clicking her tongue, but at some point it becomes a vocal tic that she cannot control. Or, she may be able to stop it in front of me, but then when she's alone, they come out again. She used to get stuck on a particular tune or phrase and it would drive me nuts. Seems the more the knew it bugged me, the more difficult it would become for her to stop that particular behavior.

Later, when ADHD medications were added, even though they were supposed non stimulants, they exacerbated her already present tics. They didn't cause new ones, but I would notice that her cycles would be more frequent and more severe while taking the stims for her ADHD.

When I would complain to her dr about difficult child's tics and the effect of the stims, the dr would explain this all to me. I then researched my butt off. The book Teaching the Tiger, was very helpful. I'm sure it's been updated and it's worth a look. What I finally figured out on my own was that when difficult child was doing these irritating behaviors, it was time for a time out - for me! Remember to take breaks for yourself. You're correct, your difficult child may be able to correct or stop these behaviors at will, but I'm almost certain they will, if they are truly tics, come out in other ways or when he's off by himself. It is important for him to know that home is a safe place for him. Demanding that he be in control of all these behaviors all the time is unfair and may make other behaviors worse. Big hugs, it certainly takes patience-more than some of us have!

 

[keista]

My first thought was stimming as well.

You've repeatedly said that he lies about everything, and from your perspective it is probably true. I'm curious as to the nature of the lies. Stoic "lies"- It doesn't hurt, no, that doesn't bother me - are in my opinion an Autism Spectrum Disorders (ASD) trait. Forgetful "lies" - I forgot to hand it in (he was holding it but put it in the trash or somewhere else instead), I forgot to bring my books, pencil, paper, etc, I don't know why I did/n't do it - are in my opinion Autism Spectrum Disorders (ASD) and ADD traits. If the lies are elaborate - Did you take the cookie? No sister took it and put in in her pockets and ate them in her room. (when the crumbs are clearly on his hands and around his mouth) - then in my opinion Autism Spectrum Disorders (ASD) goes right out the window and you are dealing with mood/personality disorder.

My son has AS and has always stimmed/mimmicked. In about 6th grade he started making this noise that we dubbed the "dying coyote" Fortunately he didn't do it in school very often, but at home it was almost constant, and Holy Hell nerve wracking. I discussed with him that I understood why he was doing it but he just simply was not alowed to drive the family nuts. He tried to stop, but unsuccessfully, so we went into "aversion therapy" Every time he made the "dying coyote" sound we would go "BLAH!!!!!!!!!!!" By we, I mean me, my then house mate, and his younger sisters - whoever was around. Once we started doing that, he came to realise how often he was actually doing it, and how annoying it was. He started to slow down the frequency. Once the frequency was really low 3-4 per evening, we'd allow him one "free" sound but if he repeated it immediately, then we would "BLAH" him. Eventually, he stopped making the noise, but took to swallowing air and belching - this was a much more quiet behavior but not necessarily good since chronically swallowing air and belching could mess up your gastro systems - but I allowed it and eventually that stopped as well as he got older. He's now 15 finishing the 9th grade. He's gone through several different stims, and every time there is a new one we discuss the social acceptance of that particular stimulant and help him find a "public" and "private" stimulant that works for him at that time.

CAUTION. I am not recommending you try my version of "aversion therapy" with your 8yo without professional guidance. It worked for my son because he was already older, always was mature for his age, understood what and why he was doing, and is on mild end of AS. My story is just to show that these behaviors can be changed when they need to be.