4 year old, OCD/Tic’s not sure

[Mummy_of_4]

My son is 4 years old, we live far out of town so medical help is difficult.
He is Breath holding and “getting my breath out” as he says.
It first started while on the toilet, this holding his breath and then blowing into his hand and flicking it away.
Now he is doing it while showering and bathing or even when we are just going to the bathroom at a shopping centre to hand wash.
He has also started to wet himself, bot wanting to use the toilet. He will also now wet through his clothes. And while urinating he will turn his head to the side and breath heavenly over his shoulder, while hand flicking.
The past few days he has even started to tense his face and open his mouth in an unusual way.
I have OCD myself, the thing is though he is only doing these thing in toilet or bathrooms although I have notice for a few minutes after he leaves the toilet / bathroom he will keep the flicking up for about 3mins.
I took him to the only Doctor we have in town and he said our son is playing games for attention. I know it’s not this, he is really embarrassed and trying to hide it when we ask him about it.
I feel really desperate you would have to see this child doing it to fully understand how bad it is. It all seemed to start when he broke his arm. We were went home as they couldn’t find the brake, we drove 3.5hours to a city hospital and his arm was broken but it was all up 48hours till he was out of pain.
What do I do to help him and what are your thoughts on what it is? Am I right thinking OCD or Tic’s?
Thanks hope to hear back soon

[Rachel Thompson, Ph.D., BCBA]

It sounds like a real challenge to get the professional support that you need, given your geographic area. But, there is not substitute for a face-to-face evaluation by a qualified professional. So, I am glad the hear that you are making another attempt to find some help. I encounter a great deal of problematic behavior that is attention seeking. But, given that you are seeing the breath holding primarily during toileting and washing routines, it seems unlikely (though not impossible) that these are attention seeking.

[Sally44]

Couldn't you just throttle doctors sometimes!  If he is embarrassed about it you are right to think he isn't doing it for attention.  Sounds more like tics to me than OCD.  Wherever you are I think you should ask for an assessment through Health, because whether it is tics or OCD it could get worse.
Sometimes hand flicking near the face in the line of vision can be an indication of autism.  But you haven't raised that as a concern so I assume there were no speech delays or communication problems or throwing tantrums or sensory issues?
Does your child have a diagnosis of anything else, or are there any other similar related conditions in the family.

[Mummy_of_4]

Sally thanks so much for your reply, I think you are right about it being more of a Tic, I have been looking around the net heaps and it seems to fit better.
I have OCD myself and just thought it was that.
My older child went through a period of having a vocal tic as well as some odd movements after he had a Bone graft for his Cleft Palate, so I should have realised, but the two are so different and I just didn’t see it.

He doesn’t have any delays at all but does have some difficult behaviours I have spoken to my other son’s (younger than the other two) Early Intervention Teacher some time ago with his other odd behaviour. She feels he has something like Aspergers but isn’t’ qualified to say.  
I was just beside myself with worry when I posted. I think though we can deal with Tic’s and it does seem to be settling down. Well he has adapted them to smaller movements, and the hyperventilating has changed to whistling. Oh it’s so hard for him, but easier I’m feeling like I can deal with it now. So now it’s a matter of getting into Mental health and finding the best way to support him. Can you tell I feel so much better lol
Mental health would like us to see the Pead to rule out any medical reasons for his behaviour.
So I’m off to find another Doctor it’s a 3.5hour drive both ways for us to get to another Doctor so not at all easy
Thanks again for your support

[Sally44]

It is quite possible to have traits of different disorders, but not enough of any of them to get a full diagnosis.  As it sounds like there are a number of things running in your family (as there are with mine), I think it would be wise to get a full evaluation through Health.  The main thing I am thinking is that if he doesn't get a diagnosis because he doesn't have enough symptoms, it might be the case of trying some stress/anxiety reduction or control techniques because alot of what you mention OCD, Tics/Tourettes, Aspergers are all high anxiety disorders that get worse with stress.
Hope all goes well.