Tourette's

Our oh-so-lucky middle son, Dubya, has Tourette's, complete with tics, OCD, and ADHD. His neurologist ID'd the tics and ADHD, and the OCD has always been clearly present. He can't take anything for ADHD because of the tics, and the tics aren't bad enough for him to have to suffer the side effects of the meds. He's got two primary tics, a nose/face twitch thing that reminds me of Samantha from "Bewitched," and a huge snort that (obscure literary reference alert!) reminds me of a character from Little Doritt. Not to elaborate too much, but Dickens equates the sound to a tugboat in full tug. Dubya does this prolonged snort sometimes more rapidly than by the second. That drives Mr. DMFP up the wall.

I have to say that his struggles with the ADHD, OCD, and tics are in many ways more difficult for us, as his parents, to witness than are the struggles TH has had with his Asperger's. Dubya gets in "trouble" because he can't sit still, because of his lack of impulse control. Sometimes, when the snorting gets to be too much, we crack and get irritated about it. His OCD tendencies are something we have to watch and monitor. Since he was a toddler and started showing these tendencies, I've done my best to keep him from lapsing into some of the ruts of OCD, but he still has huge problems with it. We've already had one battle with excessive handwashing that led to dry, scabby hands, and he will fixate on guilt over something he perceives as a transgression, usually one that took place in the far past. Luckily, he's comfortable enough to come to me and express his anxieties about this guilt, and we talk about looking at it more realistically. I also work hard to help him learn when perfectionism is useful and when it can be self defeating, and we've actually made some progress in helping him smooth out his mercuriality, swings in temper that are so painful to witness. Every time he has one of his extremes of anger, I can just visualize the stress hormones strafing his little insides, firing up inflammation all over.

He's started this stuff pretty early, well before the average age of onset, which is about age 7 to 10. He doesn't do what some people think is a classic Tourette's sign, the uncontrolled utterance of expletives (which is not really that classic or common). He does have a lot of trouble controlling verbal outbursts, and his lack of control emerges most obviously in movies, when he just cannot seem to whisper what he says but says everything in a loud, prosodically flat voice that telegraphs to anyone around us that things are likely a little "off." Between that and the snorting and my own obsession with not bothering people in movies, a visit to the multiplex can be a little tense, but I try to ameliorate it all by sitting next to him and issuing many many whispered reminders and nose pats, our nonverbal indicator to be more aware of one's nose noises.

It's going to be tough for him in class when students--especially those who might be a bit more aurally sensitive--start to notice this tic more. Tourette's is so misunderstood that probably even teachers won't recognize these facial and noise tics for what they are, since he's not barking out bad words involuntarily (something I tend to myself, but not in a tic-y way). I don't know if Dubya will ever need a circle of friends-type intervention to educate his classmates, but I came across this story today on CNN (you know, what folks in Texas call the "Communist News Network"). The now-grown counselor with Tourette's in the story, on the advice of an obviously compassionate, insightful, and prescient school principal, presented a sort of proto-circle of friends to his classmates, to great positive effect. The effects weren't just on his behalf--he has paid it forward as a teacher and now as director of a camp for kids with Tourette's, where they can twitch and tic with impunity.

We can't predict where this will go, but I'm relieved to read that after a peak in adolescence (yikes), the tics can fade, not necessarily completely but considerably. We've got a smart, extremely creative and interesting little fella on our hands, and I don't want this dopamine imbalance that we all suffer from as a family in one way or another to act as a barrier to his full success. His luck on the draw was not so great, pulling the dopamine-imbalance trifecta, but at least we're aware and knowledgeable and sympathetic.

TH will have a different opinion. Dubya's difference is named after a French neurologist, Dr. Georges Gilles de la Tourette, which is a far more mellifluous and less derrierre-conjuring appellation than Asperger's. I'm pretty sure this is going to make TH jealous.