Gifted Issues Discussion homepage Forums Twice Exceptional tic storm

Hi everyone,

I haven't written for a while but thought I'd ask around for input on something that's going on with my 5, almost 6 year old daughter. Sorry for the long post. Background: DD has not been tested yet, but is clearly gifted. She spoke clearly as a baby (numerous clear words at 6 mos and full sentences before 12 mos). Her vocabulary was/is huge. Her developmental history/milestones and her sense of humor were/are extremely advanced. She's a native Spanish speaker and is currently reading in both English and Spanish at a 3rd grade level, and is equally fluent in both languages. She is finishing up a successful year in K (it had a lot of free play and a loving, flexible teacher). She has some differentiation in language arts and reading, but not near her actual level. DD is very social and has good social skills, makes friends easily, loves her teacher and was a standout in class. She's a confident kid in general with a very intense, very sensitive (but very sunny) personality.

She doesn't express worry about social situations/dynamics (loves free play with friends) but expresses a lot of concern and worry for the environment (cries hard about the trees that monkeys live in getting cut down), the homeless, etc. She saves money and passes it out to the homeless. When she has one of her crying spells, it frequently turns into crying about the family cat who died when she was four and her missing two kittens that we fostered who were adopted by another family. She is heavily existential and talks about death and heaven a lot. She cries when bugs get stepped on. She has been monitored by a pediatric neurologist since she was two for frequent tics (which she has had consistently since she was a toddler) and has an official diagnosis of OCD and Tourette's (Tourette's for throat clearing and grunting vocalizations). Nothing has been done as far as interventions because the tics haven't gotten in the way of much. She hasn't gotten teased yet about them because she's still young and is a popular kid. She's gone through several "tic storms" before where she develops a new tic or tics and then tics very heavily for a period of time. Her tics are worse when she's anxious or tired.

Right now, she is in the middle of the worst tic storm of her life. I've never seen anything like it. Eye tics and rolls, mouth grimaces, shoulder shrugs and jerks, neck movements, arm flapping, etc, all constantly (usually she has just a couple of dominant movements) What I'm most concerned about is that she's injured herself twice because her tics are so extreme-- in the last couple of days she's pinched a nerve in her neck from shrugging upward so hard and has hurt her thigh by repeatedly hitting it with her elbow in the same spot (sore). I'm going to take her back to the pediatric neurologist to be looked at. She also has a history of picking at scabs obsessively so they don't heal and leave a scar. There is nothing causing extra stress in her life right now, and she is a happy kid. I just don't know what is causing this! When I ask her if she can not do the tic, she says it feels too good/ she can't not do it. She doesn't seem especially worried or self-conscious about it, but I wonder if that will change if/when she gets teased.

I thought that maybe folks on this board might have some insights. Anyone else have a kid/situation like this? Is this linked to giftedness in any way? A friend suggested giving her magnesium-- anyone have success with that? I'm very reluctant to try medication with her. Would cognitive behavioral therapy help? Any other recommendations or accommodations to try? Thank you so much!

If you have TS, you can resist OCD (and you should in order to combat it), but you cannot resist the tics. CBIT actually teaches them to do an opposite action to the tic to sort of cancel it out, but the tic *must* come out somehow. I'm not sure if there's a link between tics and giftedness but a lot of kids with Tourettes supposedly have a normal or above average IQ.

From what I've read, they don't recommend CBT before the age of ten, but I would ask her doctor. My DS also does the skin picking thing, to the point where I finally went to medication because both his legs were covered in sores that never healed and I was worried they would get infected. I've read differing accounts with regard to magnesium, some say it works, some say it doesn't. No one knows exactly what causes Tourette's, but they know it has to do with brain chemistry in the area of the basal ganglia part of the brain, and that it has a genetic component. It seems to be that you have a genetic predisposition, and then something in the environment triggers it. Also, they used to think it was rare, but now they think it is fairly common but just not recognized as TS. I used to think maybe it had something to do with overexcitabilities, but now I think that overexcitabilites are not tourettes. Most kids have tics of some kind, but they go away. If your child has TS they will probably grow out of them, so the trick is to figure out a way to manage it til they do. There is a website called Latitudes I think where there is info on natural remedies for TS, but in general it appears to be a chemistry problem where the brain can not shut down certain impulses: OCD is a kind of mental tic where the brain gets stuck in a loop for instance. Go to your Ped Neuro to see what you can do to get her some relief. It's so hard as a parent to watch them go through it - hugs

That must be hard to watch your daughter go through! (((hugs))) to you

My brother had TS when he was young, but he's mostly grown out of it now. I seem to recall he took some medication for it, which helped, but he decided that he didn't like the side effects (it affected his drumming). But this was a long time ago, medications may have improved since then....

Re the scab picking - don't know if this might help, but my DD pulls her hair (eyelashes and eyebrows) - trichotillomania. It is very distressing to see her do this, especially when I discovered she'd completely plucked her eyebrows. It seems to be worse when she's anxious, but sometimes just when she's bored or she does it absentmindedly while reading.

So far the only thing that seems to help is to make sure she _always_ has a fidgit toy in her hands. I've tried a few different things but the only one she likes is a kind of putty that she squishes and pulls on. Probably it's an individual thing and something different may work for each person.

Therapy putty:
http://www.therapyshoppe.com/category/6-therapy-putty

If you look at fidget toys, they also have some neat ones on this site.

She also likes Poster putty (which is way cheaper!) and you can get from any office supply store...

Consider whether there might be an infectious trigger (strep is often cited as one of the most common, but there can be others). Google PANS, aka PANDAS.