Can we talk "tics"? (ASD related)

[AimeeM]

Can we talk "tics"? Our almost-9 year old (Level 2 ASD; a few other health related dx's, congenital in nature) has, in the past few months, started to repeat phrases or words to himself, several times over. He will also repeatedly ask the same question (of us), back to back -- we understand that this is his anxiety coming to a head and he is looking for reassurance.

However, I don't really understand the repeating words.

 

An example would be a couple hours ago. He brought me a cup I asked him to get from another room for his younger brother.

Me: "Thank you!"

Him: "You said thank you?"

Me: "Yes."

Him: "Thank you? (pause) You're welcome."

Me: "Okay, buddy."

Him: (walking out of the room, speaking to himself) "Thank you. Okay. Thank you. Okay. Okay. Thank you. Okay. I will say it only two more times -- Thank you. Okay."

 

There is typically a pause before he says to himself, "I will say it only x more times."

 

This happens dozens of times every day. Every time he has a conversation with anyone in the house. Literally.

 

And it's only in the past few months has he has done this -- and become almost ritualistic. Before bed, after saying his prayers with him, I'll stand to leave and he must say the same thing, every night, in the same order, and we have to repeat each after he says it -- otherwise he starts over.

 

Sweet Dreams.

Pleasant Dreams.

Good night.

Love you.

Bye.

Okay.

Alright.

Yep.

 

This particular kiddo also has anxiety. He sees his Developmental Pediatrician next week. I'm not sure exactly what to ask her about -- these are entirely new behaviors for him. He's always, always been highly emotional and anxious -- but the rigidity regarding rituals specifically, and the repeating, and new for him. 

 

 

I'm kind of wondering if we're hitting puberty a bit early, honestly. He's tiny (38 lbs; he'll be nine in June) due to his other medical issues, so it's hard to imagine on my end, and he seems (emotionally) much younger than his actual age -- but I noticed some dark hair suddenly above his lip and what appears to be actual acne on his chin (as opposed to another skin condition he has on his arms), and a general... er... smell that takes over my previously sweet-smelling boy about 24 hours after his last bath.

 

I know puberty can bring up new difficulties for ASD kids -- or am I way off base and should I ask for a separate eval to tease out something separate from the ASD? 

[maize]

This sounds like OCD. I've had a couple of kids go through similar phases.

 

If he has been sick recently you can look into PANDAS/PANS.

 

The workbook "What to do when your brain gets stuck" can be a good starting point for discussing/addressing OCD in a child.

Edited February 17, 2018 by maize

[Crimson Wife]

 

Of he has been sick recently you can look into PANDAS/PANS.

 

:iagree: :iagree: :iagree:

 

My daughter has suspected PANS. Antibiotics helps but we did wind up having to add anxiety medication.

[AimeeM]

He has actually been pretty healthy all year. 

 

He isn't reading yet (suspected dyslexia, like our DD16), and writing is very difficult for him, so workbooks can be tricky. Is the workbook something I could read through and take something away from?

 

I'm not opposed to anxiety mediation at this point. However, I do know that it will take more consideration for him to get it -- if the dentist is any indication (he needed oral sedation), I know his developmental ped will want to speak to a couple of his medical specialists before prescribing much of anything.

 

[sbgrace]

I'll be another one that says this sounds like OCD.

 

That's important, because the treatment for that is a different kind of CBT, and you'd want someone specialized. 

 

It doesn't deal this that exact kind of compulsion, but the book What to do When Your Brain Gets Stuck is really great. It's written to kids, but I find it very helpful as a parent. https://www.amazon.com/What-When-Brain-Stuck-What/dp/1591478057

 

You can have other sorts of anxiety and OCD as well. My son has "regular" anxiety, generalized anxiety, and OCD. The OCD can really take over life. I hate it. 

 

 

[AimeeM]

I'll be another one that says this sounds like OCD.

 

That's important, because the treatment for that is a different kind of CBT, and you'd want someone specialized. 

 

It doesn't deal this that exact kind of compulsion, but the book What to do When Your Brain Gets Stuck is really great. It's written to kids, but I find it very helpful as a parent. https://www.amazon.com/What-When-Brain-Stuck-What/dp/1591478057

 

You can have other sorts of anxiety and OCD as well. My son has "regular" anxiety, generalized anxiety, and OCD. The OCD can really take over life. I hate it. 

 

I've been looking for CBT for him. The tricky part seems to be finding somebody who works with kids as young as him -- and who have experience with autism and OCD or other anxious tendencies. As in, I've completely struck out. When I was looking for a therapist for a different kid of mine (older; no autism in the mix), I had dozens of options. I've asked that therapist for recommendations, and I'm not getting far. Our insurance will cover pretty much anything I want -- but I can't seem to find jack in this arena.

 

It's frustrating. And, yeah, it's taking over life. He even does it in his sleep -- no joke. 

[Crimson Wife]

I've been looking for CBT for him. The tricky part seems to be finding somebody who works with kids as young as him -- and who have experience with autism and OCD or other anxious tendencies. As in, I've completely struck out. When I was looking for a therapist for a different kid of mine (older; no autism in the mix), I had dozens of options. I've asked that therapist for recommendations, and I'm not getting far. Our insurance will cover pretty much anything I want -- but I can't seem to find jack in this arena.

 

It's frustrating. And, yeah, it's taking over life. He even does it in his sleep -- no joke.

CBT requires a level of spoken language that may be above where your child is right now. I am a fan of the approach but my daughter is not verbal enough for it yet

 

 

Sent from my iPhone using Tapatalk

[sbgrace]

I've been looking for CBT for him. The tricky part seems to be finding somebody who works with kids as young as him -- and who have experience with autism and OCD or other anxious tendencies. As in, I've completely struck out. When I was looking for a therapist for a different kid of mine (older; no autism in the mix), I had dozens of options. I've asked that therapist for recommendations, and I'm not getting far. Our insurance will cover pretty much anything I want -- but I can't seem to find jack in this arena.

 

It's frustrating. And, yeah, it's taking over life. He even does it in his sleep -- no joke. 

 

We've run into similar issues. Therapists who specialize in OCD are reluctant to take someone with autism. I am now meeting with an OCD specialist to get input and instruction as I coach my own son. I would expect most therapists to work with parent involvement at young ages. But you can try to teach yourself. I'm sorry he's dealing with this. 

[AimeeM]

CBT requires a level of spoken language that may be above where your child is right now. I am a fan of the approach but my daughter is not verbal enough for it yet

 

 

Sent from my iPhone using Tapatalk

He's got excellent language skills, actually. His official ASD evaluation noted that he used language considered "too formal", but ST was only recommended to articulation issues. (DS5, this DS' younger brother, had the more serious speech problems.)

 

He loves talking to people -- which is why I was going to try CBT for him. Of all my kids, he is the one who prefers to be talked through things. I do not think he is one who would prefer play-based therapies -- at least not solely. Is there another kind of talk-based therapy for children that I can consider for him?

 

I did actually just stumble on a psychologist in our area who specializes in children with anxiety and OCD... and uses a mix of play-based and "cognitive behavioral interventions" (which I assume is CBT). I would really like somebody who could see him and I together, because I would like to know how to help him at home, too. And he does not like to be separated for us (me, DH, or Big Sis), at least not until he gets to know whoever he is left with. 

[maize]

This book is aimed at parents of children with OCD. I have a copy and have actually been wanting to read through it again but it is loaned out to a friend right now.

 

 

https://www.amazon.com/Freeing-Your-Child-Obsessive-Compulsive-Disorder-ebook/dp/B004QWZO4U

Edited February 17, 2018 by maize

[Storygirl]

DS has a tic disorder (Tourettes). What you describe does not sound similar, to me. DS's verbal tics are more like a weird statement out of context, and he doesn't think about what he is saying. For example, recently, he has been saying, "I ain't no whiz kid," which has zero meaning. It's more about the sound of the phrase for him, than the meaning of the phrase. Your description sounds more like ruminating on a thought. Hopefully the developmental pediatrician will have some ideas about where you can seek help.

 

[Crimson Wife]

Tony Attwood has a book on CBT for autism. I haven't read it because my child is nowhere near ready for CBT. But you might find it useful.

[geodob]

As it only began a few months ago, it could be well worth considering PANS or PANDAS as the possible cause?

These are caused by various types of bacteria.

A simple way to identify this, is to take a course of broad spectrum anti-biotics.

If this is the cause, then you will see the verbal tic go away.

[WoolC]

My ASD level 2 son asks the same questions repeatedly as well. For instance when he takes a shower I will tell him before he gets in, "you need to wash your hair." He calls out within 2 minutes of getting in the shower, "Do I need to wash my hair?" He will repeat this until I say, "Yes, you need to wash your hair." He has these little rituals for all kinds of daily routines. At times, I think it could be OCD but it could just be the anxiety component of autism. We've tried the What to Do When Your Brain Gets Stuck book, but honestly it was just another thing he fixated on in an unhealthy way. I think this might be why CBT therapists are hesitant to work with spectrum kids. The Aspergers Experts page says that CBT type therapies won't work for kids with autism when they're in defense mode and I've definitely seen that with my son in trying to work through these issues.

 

I don't have much to add in the way of advice, apart from what others have said about pursuing an opinion on whether this is OCD or autism related. Teasing out the differences could be helpful in how to handle it. Just wanted to say you're not alone; we have similar issues with our son.

 

Oh, he developed a clearing his throat tic that lasted for a couple of years but it disappeared when I started him on a magnesium supplement. Might be worth looking into to see if it will lessen severity for you if you haven't tried it before.

[WoolC]

Tony Attwood has a book on CBT for autism. I haven't read it because my child is nowhere near ready for CBT. But you might find it useful.

Thanks, I will check this out.

[kristin0713]

Sudden tics, OCD, and anxiety symptoms, even if the child has a history of some anxiety, is a huge red flag for PANS/PANDAS.  Please look into it, even if you can't remember a specific illness link. Be aware that psych meds can make children with PANS/PANDAS worse so the correct diagnosis is crucial.  Also keep in mind that anyone can get PANS/PANDAS even if they already have ASD or another diagnosis.  The symptoms can mimic so many other things and overlap other conditions that many, many children are undiagnosed.

 

https://kids.iocdf.org/what-is-ocd/pandas/

 

https://kids.iocdf.org/professionals/md/ocd-or-pandas/

[Noreen Claire]

Sudden tics, OCD, and anxiety symptoms, even if the child has a history of some anxiety, is a huge red flag for PANS/PANDAS. Please look into it, even if you can't remember a specific illness link. Be aware that psych meds can make children with PANS/PANDAS worse so the correct diagnosis is crucial. Also keep in mind that anyone can get PANS/PANDAS even if they already have ASD or another diagnosis. The symptoms can mimic so many other things and overlap other conditions that many, many children are undiagnosed.

 

https://kids.iocdf.org/what-is-ocd/pandas/

 

https://kids.iocdf.org/professionals/md/ocd-or-pandas/

I second this. Also, realize that the child doesn't need to have been sick recently - my son tested positive for strep even though he never had a fever or sore throat. Antibiotics helped immensely.