"You've got to be kidding! Another spectrum?"

It's almost conclusive. My little SMILE has a tic disorder. According to his neurologist- I can't believe my 6 year old has a neurologist- SMILE's vocal and motor simple tics (grunting and movements that involve one or two muscle groups) suggest Tourette's syndrome.  His complex tics, those involving movements of several muscles at the same time, may be indicative of a secondary issue, however.  Turns out that Tourette's is one tic disorder on, you guessed it, a spectrum of tic disorders. What does that mean? SMILE may have something called chorea disease.  People with chorea experience movements that jump from one muscle group to another (like SMILE's head jerks that lead to shoulder shrugs) so that it loosely resembles a dance ("chorea"= "dance", derived from Greek).

So...now what? Well, blood tests need to be done to rule out infection and toxic levels of copper in his system.  An MRI of his brain with sedation is in SMILE's future to rule out a malformation or physical cause (i.e. benign tumor). Then a sleep-deprived EEG to rule out a seizure disorder. Finally, some genetic testing to see if there are any more surprises waiting to surface. If everything comes back unremarkable, then Tourettes is causing all the movements.    So...if I understand this correctly, SMILE has Tourettes and maybe another movement disorder. Or else, he just has a really bad case of Tourettes.