tic vs. ocd

[smartyjones]

for about a year after ds was diagnosed, i claimed he had no tics or movements. i saw rapid eye blinking one time for about 2 seconds at onset.

 

after i learned more, i now think he didn't/doesn't have overt tics but does have some things that a neurologist or someone skilled would consider tics. he used to do a mouth noise thing.

 

he's had on and off hand/arm mouth wiping. i don't believe it's a tic but more some type of ocd. i don't think it''s a residual ocd but rather an exacerbation thing.

 

with something like that, how do you determine tic vs. ocd? does it matter to distinguish if we know that it's a infection-based neurological issue that we are working on?

[norcalmom]

my son has a thing - we call it a "compuls-tic" its very hard to distinguish it if is a tic or a compulsion. He looks very quickly into the sun. if you were watching him, you would think he was just ticcing. Its only because he told me he's looking into the sun, that I now am aware that when he is making that movement - he looks at the sun, which seems more compulsion than tic...but in the end, doesn't seem to matter what it is categorized as. He had both a type of OCD (intrusive thoughts) and tics...and then compulsions.

[MomWithOCDSon]

I'm not sure, and perhaps with conditions like PANDAS and tourettic OCD, the lines are blurred even further.

 

"Straight tics," though, strike me as relatively simplistic movements . . . a jerk, a blink, a flex, etc. A movement that really could be involuntary or autonomic (like breathing) because the conscious mind doesn't have to get very involved, if involved at all, for the movement to occur.

 

Whereas a compulsion, I think, requires more consciousness for the person undertaking it. So maybe it's a jerk PLUS a blink. Or a flex with a twist. Some more complicated (and, I'm guessing,typically lengthier) movement or strings of movements/gestures?

 

My DS is pretty much only OCD in terms of his behaviors, but in full-out exacerbation, he'll do this thing where he'll walk, dragging one leg behind him the whole time. At first I thought, maybe that's a tic. But like norcalmom said, I found out he realized he was doing it, and he was compelled to do it because it soothed him somehow sensorily. Plus, again, it was anything but quick, and it took some real coordination (and thought) for him to motor around that way.

 

I'm not sure that kids with "straight tics" get any sensations of relief from the tic. As fleeting as most of them are, you'd think that would be hard to achieve. But, then again, I've heard some folks (adults and kids) with tics articulate that sometimes they just have to let the tic out . . . that they feel compelled to, say, stick their tongue out, but maybe they hold it in for a while because they're in a public place or something. But as soon as they get the chance, where it won't be seen or offend anyone, they follow through with the tic. Now, is THAT a tic or a compulsion?!?!

 

Certainly someone here with tics, or who have kids with tics, can explain it better to us.

[EAMom]

Have you seen this video by a lady with tourettes?

 

http://www.youtube.com/watch?v=eaZf2GzFsqw

 

Btw, my dd has some movements which some docs (showed them all the same video) have called a tic, others have called a compulsion, others have called chorea!

Edited February 11, 2011 by EAMom

[smartyjones]

interesting EA mom -- thank you.

 

interesting concept that she makes about a differentiation of compulsions -- autistic type -- about maintaining predictibility and familarity and feeling safe and ocd type -- neutralizing fear and getting rid of thoughts. i have always struggled with that b/c with exception of short severe contamination ocd likely a herx-like reaction, ds does not seem to have a web of thoughts. the autistic type would describe him more accurately.

 

has anyone heard of this distiction in compulsions or is it just this woman's thoughts?

Edited February 11, 2011 by smartyjones

[Phasmid]

This question comes back around quite often. It is indeed a difficult thing to distinguish. I know a psychiatrist would give textbook descriptions that probably would still be difficult to make sense of. I think I understood my son's "tics" to be uncontrollable muscular contractions, such as shoulder shrugging, facial muscle movements, etc. Also, repetitive vocalizations to me are "tics." The OCD stuff incuded his 'retracing' steps as he walked, where he would take five steps forward but then one step back. This is compulsion, not tic. Also, the lining up of plate, glass, fork, etc., before he could start eating, and making the chair line up with table in the exact way, having the pillow square with the bed, the sheets pulled up to a certain place and laying in just the right way (usually the sheet had to come off after 15 minutes of dealing with). My son had a complex thing that I wish I had recognized as OCD (never knew) where he had to touch body parts in a certain order- elbow, elbow, shoulder, shoulder, then resume what he was doing. Crazy. He also had a compulsion to look at the sun (like Norcalmom's son) which meant going outdoors was hazardous. Another compulsion to jump off the sidwalk in front of cars moving in a parking lot. The vocalizations included screams, kissing sounds, and coprolalia which is think are OCD. The shorter, repetitive (same tone, frequency) noises I called tics. All noises went away with antibiotics and time.

[jdude]

I've often wondered about this as well. When my son had what we called tics, it seemed more of a compulsion. I say this because most had a specific pattern, head turn, arm movement, mouth movement. It was always the same pattern. I'm not sure it makes a difference except perhaps that could be a way to eliminate other possible diagnosis's (e.g. Tourette's).

[TexasDad]

Great question and we've had the same with our son. I agree with the other posts and our doc concurs. As we all know, OCD is very complex and manifests itself in a thousand different ways. He was diagnosed with tics, yet they are somewhat complex verbal and motor expressions; much more like Tourettes vs. simple grunting, twitching, etc. I got to the point that, because of their complexity, I considered them a form of OCD. Asked Dr. Zinser and he explained that in PANDAS there is a significant clinical overlap among tics, OCD, and ADHD. Sometimes it is difficult to draw the line. After examining ds yesterday, he said they are "compulsive tics". If you ask him, he is responding to something specific in his head (thoughts). Fortunately, they are much reduced and very manageable for him.

 

Is the difference between the two really all that important? I don't think it matters much. In PANDAS, the same treatment that addresses the one, helps with the other as well. They remit differently, although I think OCD tends to hang around longer. As I've read, the meds used to treat the non-PANDAS version of each are not effective in PANDAS children.

Edited February 12, 2011 by TexasDad