ADD, High Functioning Autism and tics

[awrightsd]

My son was been diagnosed with ADD (not ADHD), High Functioning Autism, and a semantic pragmatic language processing disorder at the age of 7.  He has been on Adderall XR, 40 mg, in the morning and clonodine at night to help him sleep.  He is now 16 and in 10th grade.  Over the summer, he has developed some tics, tapping his pencil on the paper several times while writing a paragraph.  He is bothered by the tics, but cannot seem to stop them.  His doctor indicates that this often happens in the teens of some ADD kids.  

In school, he is in regular classrooms and he does well controlling his ADD and stimming (autism) behaviors.  However, the tapping tic is bothering him.  I have to be careful what medications to bring in as some of them make the autism issues come out more.

Thank you,

Andie

[Rebecca Resnik, PsyD]

Hello,
   you will want to have him sit down with a doctor and the decision will be made based on observation and asking you specifics about when it happens. Tics are involuntary, and can be suppressed only for short periods of time (after which the person usually experiences a 'burst' of tics). They tend to occur across settings and contexts, and can be vocal or motor. They have a jerky look to them and last only part of a second. Repetitive behaviors can be controlled by the person, though it often causes them stress to not to do them. They last longer and happen at more predictable times (e.g. only while writing, only when bored, when feeling strong emotions etc). Spinning is a common example, as is tapping, flapping or pacing.

Best Wishes
Rebecca Resnik

[awrightsd]

How is it determined if it is a tic or a repetitive behavior?  He started the tapping behavior in the past few months.  

His 'usual' stimming behavor has to do with circular movements or spinning.

Thank you,

Andie

[Rebecca Resnik, PsyD]

Hello,
   the first question would be if this is truly a tic or if it is a repetitive behavior as is commonly seen among children/adolescents with autistic spectrum disorders (ASDs). Many children exhibit such purposeless repetitive behaviors (and tapping is a common one). They arise most frequently when individuals are bored or anxious. The good news is that if this is not in fact a tic, then behavioral therapy and sometimes anti-anxiety medications can help. A psychologist can determine if this truly a tic or repetitive behavior, and make treatment recommendations. The psychologist can teach him how to reduce and eventually stop tapping. I would certainly not ignore these symptoms, as they are likely to be noticeable to your son's classmates.

I recently attended a research presentation by a scientist from NIH, who presented study results showing that stimulants do not necessarily produce or exacerbate tics as a side effect. Your psychiatrist can make recommendations to you about determining if the behavior could be linked to his medications.

Best Wishes
Rebecca Resnik