That neurotransmitter information has proved useful in many children with tic disorder. Most commonly seen as you would suppose, an increase in excitatory neurotransmitters and significant immune dysfunction – casein is an antigen often associated, as is gluten. If you don’t look you can’t see.
cp

Other contributory, mitigating circumstances might be picky eating, poor breakfasts, immune system dysfunction [bowel issues], depression and possibly genetic predisposition.

Re intervention possibilities:
1. Neurotransmitter precursor measurement and targeted treatment – not a med, amino acids, I would jump on this right away because of the safety factor and some reports that severe tics have responded after years of poor response.
2. Tenex [guanfacine] and the new drug coming out by Shire: Intuniv, [a time release Tenex] has been helpful in tic disorder with some people – [more than simply for oppositional folks - doesn't sound like he is oppositional]. Intuniv is indicated for treatment of ADHD in children and will likely be launched this fall. Tenex is available now.
3. Neurofeedback: Exceedingly good outcomes – in our office we have regularly seen complete resolution of tic disorder with NFB.

In complex presentations I would expect to use all three of these interventions.
This problem is highly likely to be resolved, – just a matter of getting on it.
cp

My son was put on Vyvanse by our pediatrician, which we are considering leaving, after having discussions with her, to get her advice with input I was getting from teachers at school on my son who was in the 4/5 grade. His grades were honor roll grades, always, but I was told continuously that he was distracted, couldn’t concentrate, and was distracting other student due to him not sitting still and wanting to chat. My pediatrician prescribed Vyvanse without any suggestion of seeing any other for a diagnosis. We’ve seen her for years and I had a significant amount of trust in this doctor. My son seemed to be much “calmer” on the medicine, but also seemed to go into a “dark” place after being on this medicine for 4 months or so. We went from the 30 mg. to 20 mg. Shortly after switching, SUDDENLY, he developed a motor tic and then some facial tics. NEVER, in is 11 years had there been any signs of any tics at all. NOTHING! He was a great athlete, full of energy, and literally, one night, I hear him upstairs in his room saying a cursing over and over. I was beside myself. I had not heard from school, I assumed nothing was happening. Turns out, that same day, his teacher said he yelled out in class. Something he had never done. Needless to say, he has been taken off the medication, and has been off of it for some 5 months now. Most all tics FINALLY went away. However, now he has a motor tic that has resurfaced as well as a motor tic, no cursing this time, just repeating things over. Our pediatrician indicated that it was likely caused by Vyvanse and that it “should” go away. Any thoughts on how long we can expect these tics to continue? It has not effected his grades at all, but his has effected is confidence and also his athletic ability as he is unable to adequately focus due to his head tic, which often times causes SEVERE headaches.

Thanks so much for your thoughts.