Have you looked at the diagnostic criteria for Tourette's? Verbal impulsiveness could be a tic behavior that's being missed as such. Keep in mind that tics don't have to be complex or bad to meet the criteria.
Tourette's and ADHD often overlap (along with OCD). Stimulant medication for ADHD can make Tourette's worse, which would explain why moderate doses don't help your DS with the verbal stuff.
Does he have any other behaviors that could be mild physical tics (ie shoulder shrugs, lip licking, facial expressions, subtle hand movements, etc.). With Tourette's the uninitiated look for the "big things" like flapping arms, but many Tourette's sufferers never have exaggerated tics such as those... instead they're mild and get overlooked and categorized as small fidgets.
Fyi my daughter (12) was recently diagnosed, and it came out of left field for me. She fits in the ADHD/OCD sub-type. I called the OCD years ago, and ADHD fits too, but Tourette's was not even on my radar until the psychiatrist brought it up... then all the pieces fell together and it made sense.
Anyway... just something to think about.
Also... what kind of side effects does your DS have to the meds when the dose is high enough to calm down the verbal stuff?
He doesn't have tics, but I understand why you mention that (eldest does--we are a neuro ABC soup around here). Intolerable side effects are loss of appetite, insomnia, and mood lability. All pretty extreme. He didn't have these issues to the same degree until last year. Puberty seemed to really upset the apple cart. He'd come home from school "starving" but couldn't eat (and hadn't eaten lunch). Would be shaky and miserable--still couldn't eat. Made up for it by eating like a horse on the weekends (no med). Couldn't get to sleep, even with melatonin. Depressive, irritability, withdrawn. The doctor doesn't care as long as he's growing (he is) but it's a miserable existence. He did not seem med sensitive until this year.
Eco, do you have a Children's hospital anywhere in the region? You need an expert prescriber.
Some people find that Intuniv can be combined with lower doses of stimulants. But you need an expert to help you with this.
DeeDee--The closest is 300 miles away. We did go this route with eldest, but a lot of circumstances have changed since then and not sure it's realistic. It seems to be quite difficult to get information from a distance.
When you say expert prescriber, do you mean developmental MD (pediatrician/psychiatrist)? Are there med issues specific to developmental disorders? How do I learn more about those?
I wish we had access to more specialists. FWIW, when eldest DS had uncontrolled seizures, we went to Children's because of pure desperation and terrible local pediatric neurologist. With epilepsy medication (and I know this sounds unlikely, but it's true) mostly it's just a crap shoot. Mechanism of action is "unknown" for neuro meds and basically you read the side effect profile, decide which is least-worst, and roll the dice. Then you balance seizure control (or lack thereof) against side effects and QOL. I actually think most brain meds are like this. People hypothesize but nobody knows for sure why they work or don't work.
If we can't find an expert prescriber, what is the least-worst option?
