Hi.. It's been awhile since I've been around, but I need your help!!

DS 9 (who is also gifted) was diagnosed with Tourette's 2 years ago - very mild, mostly at home, mainly consists of a slight grunt or moan, sometimes accompanied by an eye blink.. The blinks came first, then the vocalization, but the blinks have mostly disappeared now... Happens most often during dinner, watching TV, lying in bed - at school only usually happens when they start writing (which is his least favorite thing to do...)

At teacher conferences in March, teacher mentioned she'd had the counselor come and observe him a few times because he seemed to be having trouble interacting with other kids and liked to stay buried in his books all the time (reading for pleasure - not sure if he's really into books or it's his "escape mechanism" to get out of whatever is going around that's over- or under-stimulating him at the time...

He's had some temper and emotional outburst issues at home on occasion for years - gets upset if things don't go the way he expects or if he starts to lose a board game, once cried for 10 minutes after his balloon popped and he insisted I needed to fix it, was playing legos with DS5 and when DS5 wanted to go out with me to play in the snow instead DS9 threw the legos across the room and destroyed what they were building - other things like that which aren't age-appropriate reactions any more...I've wondered if he's been depressed or if he's got anxiety issues going along with the Tourette's, or something else..

Since the teacher saw some abnormalities she thought were worth getting observed and I've seen things at home that were disconcerting, we went ahead with the BASC and I've got the report. I'll try to attach images but I'm not sure if it will work - if not, I'll add a summary.

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Quote
summary of results -
x, parents, and teacher completed the BASC to assess their observations of x's behavior and emotional/social functioning in the home and school settings. x also completed the assessment with the guidance counselor to assess his own thoughts, feelings, and behaviors.

In the school setting teacher responses did not yield concerns with externalizing (hyperactivity, aggression, conduct problems) or internalizing (anxiety, depression, somatization) as these areas emerged within the normal limits for an 8-year, 11-month old boy. The attention problem scale emerged in the at-risk range as x can be easily distracted and have difficulty maintaining attention at the clinically significant range. Concerns emerged with the atypicality and withdrawal scales as both fell in the clinically significant range. responses show x engages in odd or unusual behaviors (appears confused, seems unaware of others) and avoids interactions with others (does not join group activities, difficulty making new friends).

At home, parents report more significant concerns with externalizing ehaviors as the aggression scale emerged in the clinically significant range and the hyperactivity and conduct problem scales emerged in the at-risk range. responses also yielded some concer with depression as this scale fell in the at-risk range. At home, Mr and Mrs x observe that x often argues and easily loses his temper. he is very active, demonstrating poor self-control and can become easily upset. Similar to the school setting, Mr and Mrs x responses show the Attention problem scale in the at-risk range."

x's rsopnses on the BASC2 self-report of personality did not yield concerns as all scales emerged within normal limits for an 8-year-old boy. the personal adjustment scale, which assesses positive and desirable behaviors shows typical functioning.

Impressions:
Responses indicate that x demonstrates more significant behavioral concerns at home than are observed at school. It is possible that these behaviors are related to his diagnosis of Tourette's Syndrome, as it is often tiring for children to control/manage their tics throughout the school day. School staff is available to meet with parents at their request to further discuss how the team can best support x. throughout the school day.

At their discretion, Mr. and mrs x may choose to share their concerns and this summary with the medical professional with whom they are currently working to manage x's Tourette's Syndrome and/or with another mental health professional. These professionals will be able to further determine whether x's behaviors are related to his Tourette's or are indicative of a separate mental health diagosis. The school social worker is available to assist parents in connecting with community resources if needed.

He's gifted, has issues summarizing and retelling but remembers little facts and details about what he reads, hates to write and still has horrible handwriting with a very awkward pencil grip (but it would be a beautiful violin bow hold!) and has fallen behind in reading- he came into the year at least at if not above grade level and teacher said if she hadn't given him some extra prompts he would have tested below grade level this last time around...

He'll go for his yearly well-child check in about 2 weeks and I will take the report with me, but I'd like advice on where do we go from here? Neurology, psychology, developmental pediatrician, someplace else? I don't believe the behaviors are related to the Tourette's (which was diagnosed by a pediatrician in our doctor's practice) but I could be wrong.. since it doesn't seem to cause him any issues at school or in life they don't even really follow him for it at all..

I need him to learn some coping skills that at school aren't books and at home aren't emotional outbursts. I fear that as he gets older one of the outbursts could get dangerous and he'll hurt someone (himself or someone else...) we're not there yet, but I don't want things to escalate to that point either...

Thanks for any help or advice you can give!!