Tic...Tic...Tic...Kaboom

Four years.

That’s how long Max has been ticcing.

Had I been asked to guess, I would have said it was only going on for two years. Because they’re intermittent, Max will go many months without a single tic. But soon a new one emerges and becomes part of our everyday life, an unwanted visitor moving in and taking up residence in Max’s small body. Had I not consulted my journal I never would have known he’s been doing it for most of his life.

The tics have always taken a supporting role to the cast of behaviors and issues that are often in the spotlight. The eye blinks, hand movements and head jerks were always of little consequence compared to Max’s impulsivity, sensory issues, inattentiveness and basic lack of control over his executive function. Although they were sometimes distracting—and yes, I’ll dare say sometimes annoying—to us--they were never an issue for Max. It was one small saving grace given that just about everything else was an issue for Max.

But like the ever-evolving tics themselves, this has all changed.

I had picked Max up at school and within a minute after pulling out of the parking lot he was in distress. “My hands are bothering me,” he said, fighting the panic that was rising up. I turned around and saw his hands moving fast and furiously in a movement that looked as if Max was trying to open two imaginary doorknobs. He had never demonstrated this particular tic before; nor had he ever ticced with such intensity.

What was so frightening to me wasn’t just that Max had absolutely no control over his body at that moment—but that it frightened him, too.

“Do you think you can stop?” I asked.

“No,” he said.

“It’s OK Max,” I said, trying in vain to offer reassurance. “We’re going to the doctor right now.”

It was after 4 p.m. on a Friday and I still had to pick up Ari, but somehow the pieces fell into place and we got an appointment with our pediatrician. I gave Dr. N. the rundown and was surprised when she said she wanted to do a throat culture and check for strep. Max had shown no symptoms of strep or any physical illness for that matter, save his twitching hands.

And then Dr. N. reminded me of something I had read about years ago: PANDAS.

PANDAS is an acronym for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection. I know, not nearly as cute as the furry black and white variety. It basically refers to how some kids with OCD or tics can have their symptoms worsened by strep. Treat the strep and things improve.
Dr. N. wrote us a prescription for amoxicillin and suggested we follow up with Max’s neurologist.

I suppose this whole ordeal might have been all the more stressful if we didn’t already have a pediatric neurologist for Max. (Good thing we suspected petit mal seizures back when he was two-and-a-half; save us the trouble of looking for someone now.) Still, it was upsetting to see Max so completely out of control of his body’s movements. It’s overwhelming to try to keep up with the ever-changing neurobiological snafus taking place in Max’s brain. I can’t even imagine what it feels like for Max.

It seems every time we solve one problem, another one emerges. Max’s primary diagnosis may be ADHD, but there are so many related issues—anxiety, compulsions, tics, sensory issues--that you could probably flip to any page in the DSM-IV and find something he’s experienced.

Our goal for so long has been to improve Max’s impulsivity and focus. But with the tics taking center stage, it’s my focus that could use a little help. Which of the many neurological and psychiatric issues do I address first? I feel like I’m doing nothing but researching online and making appointments with mental health professionals. I’m moving as fast as I can to bring Max—and our family—some relief.

Why do I feel in such a rush? Max’s tic, tic, ticcing is not unlike the ticking of a bomb. If I can’t make it stop, you can damn well be sure there will be an explosion.

And it’ll be me who will have to pick up the pieces.