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I am wondering if it is tourettes all along or PDD with tourettes or PDD with a chronic motor tic disorder?
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Hi M&mikey,
It seems to me and I'm no expert though, that some of what you've written wouldn't necessarily be part of a TS diagnosis alone. Your son sounds a little like mine used to, although mine is now almost 20 and his actual tics are very few and far between these days. It was a very different story when he was young. He also many of the behaviours that you've described in your message including the echopraxia and echolalia, sensory stuff, spinning things etc.. Some of his repetitive behaviours were autism qualities/stereotypies, some were part of his TS/tics and some were part of his OC stuff/compulsions.
He actually has diagnosis of Asperger's Syndrome as well as the TS and other things although everything for him has changed over time. He is obviously on autism spectrum still but I would see no need for any diagnoses at all now at his age. He's almost 20. However, he wasn't correctly diagnosed on Autism spectrum until he was around 14. His AS specialist diagnosed Asperger's Syndrome and tic disorder. Whereas his TS specialist and the Neurlogist both had used the term TS for years and years as an umbrella term to encompass many different conditions and behaviours... this was so confusing and not at all helpful to say the least! He certainly fitted diagnostic criteria for TS but it was his autism qualities that needed the real support and guidance more than anything especially when he was a young boy and teen in school and he didn't get that because everything was lumped into the TS basket. Unfortunately!
The earlier it's sorted out the better for your son and yourself. Then you will know how to approach different behaviours. We certainly had our share of incorrect diagnoses. The thing about the term tic disorders is that it encompasses several diagnostic catagories, but it seems to me that the underlying cause/or causes might turn out to be the same in the long run.
Tourette Syndrome Diagnostic Criteria.
from DSM-IV-TR
I think I posted a link to an article by Jankovic and Mejia regarding secondary causes of tics and tourettism. It should be up in the useful websites section at top of forum. It's tedious reading but worthwhile I think if you're trying to figure out what's what.
There is a section on Dr. Freeman's site about stereotypic movement disorder.
Tourette syndrome: minimizing confusion
http://www.tourette-confusion.blogspot.com/
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Stereotypic Movement Disorder can be confused with tics and TS. SMD is an official DSM-IV diagnosis, but it's rarely made. There are only 2 case series of children published (Tan et al., 1998; Mahone et al., 2004) . Repetitive movements usually start before age 2, and consist of intense patterns (like hand-flapping, pacing, running, bouncing, with or without vocalizations and facial grimacing) in longer runs than tics (can be up to 10-30 minutes). This can be stimulated by excitement or less often boredom. When older, they often say they like it, it's fun, they have to do it before they do something else, and that it stimulates their fantasies, yet they can usually be easily called out of it. It often looks very odd. They typically shape their patterns later so that the movements are done in private or within the family. The main problem is that if you're not familiar with it, you're likely to think it's an autistic spectrum disorder or Tourette's. The pattern itself can look indistinguishable from autistic stereotypies, but is much more prolonged than tics. Comorbidity (other disorders) are common, including tics, just to confuse everyone...
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Good luck to you with finding a helpful physician to sort it all it. It's not always easy for them either, esp. if there are overlapping conditions. Let us know how you're getting on.
take care,
Lara