I'm pretty sure SMILE has a tic disorder. It's much too early to say it's Tourette Syndrome, it takes 6-12 months of observation to get that diagnosis, but I know what I see. SMILE's quirky movements from the summer, a lot of hand waving in front of his face, have morphed into head jerks, neck twists, shoulder shrugs, and grimaces. He also makes little grunting sounds, although he's done that for years. At first, I thought he was stimming, and the hand waving could still have been a stim, but the rest is too pervasive and unpleasant in my opinion to be based on anxiety or a need to stimulate or calm himself.
Look at it this way. Most people stim from time to time. Right now, I'm sitting here with my legs crossed and I'm waving my top leg without thinking about it. It's soothing. Ever since I first held a microphone at my grandparents' 50th wedding anniversary, I've discreetly cleared my throat before speaking publicly. It's just what I do. Other people twist their hair, smell their hands (or whatever is soapy), hum a mantra, or do any number of things to calm- or energize- themselves. But they are pleasant, at least to the person doing them, and within the person's control. There's no way possible that SMILE enjoys some of what I see happening. The neck twists and grimaces alone interrupt him while he answers questions or tells a story sometimes. The shoulder shrugs have hit during games at home, and we've had to pause until they've passed. Much of the time, SMILE is neither stressed nor lacking in stimulation when his body "gets flappy" (as he puts it). To me, this all means he's having tics. Add to this the facts that SMILE is just about the right age for symptoms to start (it's 7), it's a common co-morbid issue for spectrum kids, and it's linked to OCD, and I'm pretty certain a diagnosis is in our futures.
I've done some preliminary research on line and I've spoken to his developmental pediatrician. So far, it seems like my only three options for SMILE are: 1) Pray he outgrows this as he gets older (some children do); 2) Medicate him; 3) Do both. I'm not crazy about any of them. I'm all for praying, but not as a form of treatment. I hate seeing SMILE's little body and face contort. I'm afraid that he'll be a bigger target for bullying. But, medicate him? I'm not ready. I don't think there's such a thing as a medication that is side-effect free, or one that will work on any body chemistry. Most parents I've spoken to talk about a trial and error period that was horrible to go through because it caused all sorts of problems (depression, rages, weight gain, more tics, anxiety, etc) until they found the right drug or dosage. My little SMILE has gone through so much already. He's fought so hard in the past year to learn better behavior and to regulate himself, that I can't stand the idea of putting something in his system that can throw him so out of whack.
Is medication necessary in some cases? No doubt, in my opinion. A child who can't function or sleep because of his high anxiety, a child who is miserable because of his condition, a child whose present symptoms are more severe or dangerous than the side effects of medication, should probably have medication. But the purpose is to calm or eliminate symptoms of a disease. But what if there is no dis-ease ("dis" means "without")? What if SMILE isn't bothered by his tics? They don't hurt him. They're not dangerous to him or anyone else. He doesn't seem anxious, reserved, or depressed about them. They're not interfering with school. As a matter of fact, I think he's delighted by his tics and the possibility that, some day, they might get him out of trouble (he's tried with me-but no such luck).
So, unless his tics become a problem for him- physically or emotionally- or others are put at risk by his tics, I think I'll take my little SMILE the way he is. No matter how shaken or stirred it makes me.
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