R saw the psychiatrist again y'day. The one we see is completing her fellowship in pediatric/adolescent psychiatry and she said y'day that she had taken R's case file to her supervisor for further review. Her opinion is that he's overdiagnosed and that the bottom-line problem is Obsessive Compulsive Disorder (OCD). Her supervisor suggested removing the Zoloft and replacing it with Celexa. He feels if we can get the Obsessive Compulsive Disorder (OCD) under control then the ADHD and tic disorder, along with all the other issues, will at the very least fade into the background significantly if not disappear altogether. She wrote a letter to the school recommending an IEP to address difficulties with his behavior or learning in the classroom and was not in the least bit amused that the wicked witch teacher more often than not has him sitting at a desk in the hall alone. The only bad news from y'day's appointment was that he's lost another 3 pounds. We can't increase the appetite stimulant anymore and he's refusing to eat almost everything. She highly recommended nutritional supplement drinks and this morning he was gagging to the point of almost vomiting on them. I advised the school staff this am of the change from Zoloft to Celexa and am now working on a cover letter to send with the psychiatrist's letter requesting the IEP evaluation.