Frances is 4 years old, and her mom, Melissa, reached out to me because she was feeling conflicted and confused with a recent diagnosis of Tourette's, and she wanted guidance on where to focus her energy. As a side note, I did mention to her that Tourette's is not something I have extensive knowledge in, but she reiterated she just wanted to consult mainly about sensory strategies to keep her active daughter regulated in their small apartment.
Melissa described Frances as a girl who is bright and verbal and deeply attached to the way things are supposed to go. A kid who loves orderly toys and doing things in sequence, just as she likes. She seemed to experience so much joy just watching her classmates play tag or hide and seek, even though she never participated in it once.
Frances also LOVES to move, crash, jump, crawl, squeeze and do just about anything active. She found ways to meet this need at school and on the playground, but it was becoming an issue in their 2 bedroom apartment, especially with a baby brother in the mix.
Frances was on OT waitlists for months, because Melissa already knew that some of these behaviors felt “sensory-ish”. When she finally got in to work with an OT, the sessions focused mostly on handwriting rather than the sensory regulation piece Melissa needed help with most, so they stopped going.
When Melissa brought up some of these behavioral concerns to the pediatrician, he told her some kids are "just like that" and she'd "most likely grow out of it". [Insert eye roll here]
Tourette’s Diagnosis
When you think of Tourette’s, you might only picture vocal tics and motor movements. But there’s also rigidity, emotional intensity, and difficulty with transitions. Sound familiar? These behaviors are also associated with ADHD, OCD, and Autism, but all were ruled out by a developmental pediatrician. For a lot of families, a diagnosis can actually bring some relief; it’s a name for what they've been seeing, and a clear path forward. But for Melissa, receiving this diagnosis was also accompanied with confusion because she didn’t expect it.
The recommended next step was CBT (cognitive behavioral therapy) with a psychologist, but Melissa feared Frances was too young to benefit from this kind of approach.
To top it all off, Melissa was in the process of getting a divorce, and her partner did not support any of these efforts to access diagnoses and professional support for Frances.
My Initial Thoughts
I know just as much as any other average parent about Tourette’s, but I was surprised to learn that Autism and OCD were ruled out. Frances’ rigidity with routines and rituals seemed to be a huge disturbance in their day and I knew we needed to discuss ways to manage the fall out when it didn’t go according to plan.
Frances’ sensory preferences were pretty clear in the way that Melissa described her: she had a high threshold for movement and proprioceptive input, and might have a lower threshold for auditory and tactile input.
I wanted to know more about how Melissa was currently meeting Frances’ high movement needs in her apartment, so I could provide her more applicable, practical tools to support them without being redundant or unrealistic.
Coming Up In This Series:
Over the next three parts of Frances's story, we're going to look at three specific areas:
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How Melissa can try to structure her day and environment to support Frances’ sensory needs. The small apartment space and fragile baby brother were going to have to be considered.
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Her rigid routines and the meltdowns that follow when something goes sideways. When Melissa talked about these, you could sense the stress and tension through the screen. I wanted to talk about a plan that she could rely on when the next meltdown happened.
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And finally, the professional support question. I knew Melissa had already been bounced around from provider to provider and had the complicated layer of trying to convince her soon-to-be ex husband that professional support was necessary.
Hit reply and let me know — who’s looking forward to this case study? Anyone in the same boat?
Thanks for being here!
Disclaimer: These case studies are inspired by real-life clients I have worked with, with permission from their parents to share. Some aspects of the case are authentic, and other details are added to include more variability for our discussions. None of the strategies and advice here substitutes medical advice, diagnosis or intervention with an Occupational Therapist.
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