Hi, I was wondering what would tourettes look like in someone as young as 3?

My son is 6 now and has been showing vocal and motor tics for over a year. He tics every day and at times it is worse. He also tics more during certain times of the day. When he was 3 he showed echolalia, ecopraxia, pronoun reversal and was obsessive about running his hand in certain patterns (touching the wall at a certain height) or would lick things like the iron board. He still has some echopraxia and echolalia at times. He tends to script alot. He shows eye blinking, mouth stretching, skin picking, picking at crouch, squating, acts like a driven motor where he can't sit still, nose stretching, likes activities to be structured, spins objects, whole upper body movements, bouncing in chair over and over like a ritual, shirt stretching, looking out the corners of his eyes, easily irratated and tantrums, throat clearing, humming, repeating words.

These are not all at once and he seems to have 3 or 4 and then they change over a period of time to something else like he rotates them. It gets worse over high allergy times.

His father has always neck stretched. I watched him the other day and saw a few more his father did. I didn't know that is what it was (motor tics) after 20 years of marriage.


I showed a 15 second clip to a Neurologist and he did say they were motor tics.

He is very bright and has a musical gift (perfect pitch). At 3 he was diagnosed PDD-NOS because of social (doesn't understand social rules but loves to be around other kids - example...greeted friend by humming Mozart) and communication difficulties (has trouble in conversations, pronoun reversal, answering questions). He also will watch the same video every night for months, has sensory issues, selective eating, limited imagination. I am wondering if it is tourettes all along or PDD with tourettes or PDD with a chronic motor tic disorder?

M&m

Hi M&m great to see you here

although we didnt get a dx of TS for my son till he was 10, yet I realise now that many of the things that were happening almost since birth (as an infant he made continuous clucking sounds) were actually manifestations of his TS.
Although my son disnt exhibit all of what you describe, still he did show quite a lot of similar "tics" and behaviours from a young age.

As I know next to nothing about PDD-NOS I cant address that aspect of your question, but I am sure there will be someone here or on the other forums here who may be able to shed some light

I was thinking the same thing... My son wasn't "officially" diagnosed until he was 7, but i saw ALOT of his tics when he was very young. Eye blinking was the worse. I had to chuckle when you said your son greeted a friend by humming Motzart, Scott use to walk around humming stuff from Vivaldi. He is very talented with vocal music as well. I too know nothing about PDD-NOS. I hope you get a positive diagnosis soon so you can know exactly, what it is you are dealing with.
Vicky

Well, PDD-NOS is on the Autism Spectrum. I know that some kids on the spectrum also have motor tics. It is a communication/social disorder.

According to the Tourettes DSM it doesn't talk about severity just that they have at least one vocal tic and several motor tics that wax and wane and be present for a year. Is that right or is there more to it?

The most different motor tic (if that is what it was) was the echopraxia. He will even copy someones voice and influcuation. Last year he had a Forest Gump voice because he was copying one of his classmates on the spectrum. He copied a kid from preschool with a speech articulation problem and you would have thought he had one too. He copied a little girl in preschool with Angelman's syndrome.

I believe you are correct, and those are the formal criteria for a TS dx. It doesnt matter whether severe or mild. Only that BOTH motor and vocal are present for at least one year, with characteristic waxing and waning

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/

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

Thanks everyone for answering my post. Luckily, I have had him in various interventions since 2 1/2. He started out in Early Intervention for a speech delay and then in the school system under the Autism umbrella. He gets OT and Speech and pulled out for resource. They noticed the tics last year when he started excessively blinking his eyes. He also pulled his shirt all the time - still does but I thought that was related to sensory needs. He also did the skin picking and actually picked a mole off of his face. He had chapped lips for 2 years and he picked at his fingers. Most people don't realize he is on the spectrum because he is social but it is not appropriate all the time. He is very visual and learns best that way. They also saw the echopraxia last year in school.

I have learned to advocate over the past 3 years in a positive way and he basically has everything he needs for school. I am just trying to figure him out myself so I know what makes him "tick" (not tic) .

I don't know if because of his obsessions and phobias (weather and tornadoes - and we live in a tornado zone) and agressive behavior towards me at times if he needs to be on medicine. I have been a non-medicine person till now because we have been handling it. But as he gets older it gets harder. I can't change him but only teach him positive ways to handle everything. He has been on Lamictal for seizure reasons but any other meds we will have a hard time getting in him with his selective eating. We hid the Lamictal in custard style yogurt which he did well with.

This year has been a stressful year at school because we have a 1st grade teacher who has a chip on her shoulder, has never taught 1st grade let alone a kid with a disability. We are trying to get her the support she needs without being offensive. As a result he is tic-ing more.

We have an aide for him and he is pretty successfull in school.

I will definately have to look at those links you posted Lara. If anyone has any more in depth stuff send it my way. I just want to understand it all.