What are the doctor's missing?

[beverly]

My 4 1/2 year old son has been diagnosed with Tourette Syndrome, Obsessive Compulsive Disorder, and ADHD.  The treatment for these include only behavior mods with "Sean Bucks" and the medication Tenex.  The Tenex doesn't work for the tics very well, but, it virtually eliminates his hyperactivity.  Now that he has calmed down to a more "normal" activity level, he is displaying some very bizarre behaviors... actually, these behaviors have always been present, but, more masked because of the hyperactivity.  Let me briefly describe some of the most "odd" behaviors...  He is VERY clumsy (can not hop or stand on one foot, was unable to jump until nearly 3 years old, but, walked at 8 months), he is many times way off subject (kids are talking about slides, he says, "The Thrust 2 is the fastest car in the world, it goes 634 mph."), during church he memorizes the pastor's sermon and repeats is acurately word for word in the car on the way home, he has a calculator brain (he is fascinated with reading the dates on coins and saying how old they are... example, "This coin was made in 1972, it is 27 years old."  He does this without hesitation), he taught himself to read and now reads books from the end to the beginning reading all the words backward (example: The animals came from... he says, "morf emac slamina eht."),  he "zones" out while building with is lego's (he will sit for literally hours and build with Lego's, nothing else exists, you have to remove the Lego's before he can even hear you)... now the most "odd" behavior... he can not read non-verbal cues (can not tell that someone is annoyed with him until they snap at him.  He can not read body language or facial expressions).  

So, my question is... what are the doctor's missing?  Is there some type of neurological, biological, or mental problem that looks like TS, OCD, and ADHD all combined?  He has 10 motor tics and 9 vocal tics at the current time, he has many rituals and repetitive behaviors (must watch Batman at 6 and Rugrats at 7:30, must line his toys up in certain orders, must have his socks "just right", no tags on anything, only will eat sandwiches mashed potatoes and fruit), he is hyperactive and impulsive... sometimes he is distactible (I call it "overload", he is only distractible in busy or loud places... like pre-kindergarten, daycare, restaurants, stores, basketball games), mainly he pays too much attention to what he is involved with and he is in his "own little world."

What are the doctor's missing?  It seems his diagnoses all fit to a certain extent, but, they don't explain the behaviors that set him apart from other children.

Thank You...

Beverly

[Kevin Kennedy, Ph.D.]

Dear Beverly,

The conditions your son is displaying are often found to co-exist, though he may require more than Tenex to address them. Phrmacological treatment of these conditions, particularly the Tourette Disorder and OCD, is not a simple, straightforward matter. Generally, combinations of medicines are required.

You are probably correct in thinking that there may be more to your son's diagnoses than the conditions already identified. He may aslo display a type of Pervasive Develpmental Disorder, though in terms of his medication plan this may not alter the picture to any significant degree.

Have you detailed the behaviors you described in your note to your son's clinicians? It's not out of the question that such behaviors could be subsumed under the conditions already diagnosed, but my sense is that he displays some manifestation of PDD as well.

[MG]

Has the doctor ever done a karyotype?  Some of the symptoms you describe have been reported in boys with 47xxy--they often go undiagnosed because professionals often diagnose them with PDD, adhd, asperger, etc.  Not to say that some of these things don't coexist with 47xxy, but ruling out or find 47xxy would be helpful.