Stimming vs. Tics - How Can One Tell?

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I have TS and OCD. My wife isn't officially diagnosed, but we're both pretty sure she has ADHD. It's a fun genetic mix. So when my son was diagnosed with ADHD and later with Asperger's, it didn't come as a huge surprise. But up until that point we hadn't done any reading on Asperger's, so now we're playing catch-up in a lot of ways.

For our own sakes, and also because the doctors have asked us to, we've been on the lookout for motor and vocal tics that might also indicate TS. He's had some transient tics that disappear a few months after they come, but nothing that stuck around. So far so good. A pretty high percentage of kids get transient tics that eventually peter out.

But he got one recently that stuck around long enough that I began to wonder: teeth clicking. He'll beat out this staccato rhythm with his teeth almost every time he sits down and focuses on something like a book, Pokemon, or even homework. Until a few minutes ago I had considered it a motor tic. But the recent thread on teeth clicking being a stim changed my mind. Looking back on when and how he's been doing it, it doesn't really fit the tic pattern. At least not the one I've lived with. I'm pretty convinced that one is a case of him stimming.

More recently he's started a loud breathing... tic? stim? I don't know. I'm back in watch and wait mode. It doesn't seem to be causing him distress the way my tics did before I was diagnosed. It could be he's doing it to stim, or it could be that he's simply more relaxed about vocal tics than me. Who's to say?

So how can you tell if something is a motor or vocal tic, or if it's stimming? I'd throw up my hands and say, "Who cares? It's just how he is," except that it can affect what medications he should avoid in the future, if he ever goes that route. I know first-hand some stimulant meds can make my tics go off the wall nuts. (Heck, too much coffee and my tics go nuts!) If he's actually experiencing motor and vocal tics, I'd rather that we all know it.

Thanks

Heres the rule: if it's voluntary and pleasurable, it's a stim, if it's involuntary it's a tic.

i'm not sure if you can call a stim voluntary actually, although the difference you gave does hold true.
i'd prefer to call the stim 'surpressable', my stims are not voluntary in the strictest sense, far from it actually; although i can feel them coming and are capable of surpressing them, i prefer not to...

and yes, i know the difference to tics, i also have a few of those; when i'm very stressed out...

Stims always happen or my body starts to position itself to stim at least a moment before I'm aware of an impulse or movement at all, and I've read that that's normal for stims, so they're involuntarily initiated, and if you fail to notice that you're stimming for some time, they'll be involuntarily sustained, however when you're aware of them they can be voluntarily stopped. Very often this causes stress and/or another kind of stim automatically being initiated.

From what I've heard about tics, you feel the urge building up before it comes out, and eventually it can come out despite any maintained efforts to hold it back, like a sneeze. A stim doesn't come with any warning sensation beforehand as I said, you don't know it's coming until your body is already moving to do it and can go minutes without awareness of it but once you notice it happening you know that you're more comfortable doing it than stopping it, and if it does come out once you've noticed it and begun suppressing it, it's not like a sneeze that bursts free despite your maintained conscious suppression, instead it came out because for a moment you forgot about it. It takes enormous concentration to keep the relevant muscles still and you can't think about anything else for even an instant or it will start again.

Plus, I've seen TSers describe needing to let particular tics out that they've been suppressing for too long, all at once when they get the chance, and more violently because of the build up. I don't think there's much equivalent for that with stimming. One stim might be preferred over another at a particular time, but if you suppress one, another will come out and take its place automatically or deliberately as long as you have another to fall back on. It's not the case that that one specific urge has to be acted on now or later; you can replace it with another, not even on purpose, and later you'll only need to stim if the situation or your feelings are still making you want to, not because you suppressed it earlier and it's hung around waiting.

I am really not 100% sure about this, but I don't think all people with tics have Tourette's, do they? Someone please correct (or agree) with that! I have one tic that I know of, but I never was diagnosed with Tourette's, and I do not feel I have it. Do some people with ASD have a few minor tics without actually having a separate condition, or are those tics ALWAYS a part of a separate condition?

Tics are quite common for people with ASDs. No you don't have Tourettes if you tic necessarily, only if you fit the criteria (a certain amount of motor tics and a certain amount of vocal).

The thing is, tics aren't exactly involuntary. They generally are suppressable. An example to give that others can understand is blinking your eyelids. You can hold your eyelids open (suppress the blink reflex) and as soon as you stop trying to hold them open, they go back to blinking, at first more rapid than normal.

I think the line between tics and stims is a very blurry line.

Tics are more like sudden twitches or random bodily movements that happen fast and periodically. Stimming looks more like it's done on purpose, and appear as more controlled and almost ritualistic body movements. My stimming is slowly pacing in circles when I'm bored.

We had a friend with a tic - it was a clearing of his throat/grunt sort of thing. He was unaware he did it, denied it and was powerless to stop it once he finally did realize he did it. The things I would call my 'stims' are all involuntary but once I realize I'm doing them, I can stop. When I'm hypervigilant about my outward appearance in social situations I can usually catch myself doing them or just before - I can identify the urge when I'm concentrating on looking for it. Sometimes the trigger is nervousness but, more often than not, they happen when I'm fully engaged in something I love.

Not when you have severe Tourettes they aren't I can barely suppress any of mine.

Thanks for the info! I doubt I fit the TS criteria then. The only tic I am aware of is one I do frequently with my eyes. Just the one thing.

Hey, thanks for all the excellent feedback! This really helps.

Unless the latest rev of the DSM changed it, the core criteria for TS are multiple motor and one or more vocal tics, though they don't necessarily need to be experienced concurrently. Tics need to be present for at least one year, with tic-free periods lasting no more than three consecutive months (ha!) during that year. They need to occur multiple times in a given day, or otherwise be a regular occurrence for that year. Age of onset is before the age of 18, and the tics cannot otherwise be attributed to a general medical condition (head trauma, Huntington's disease, etc) or the physiological effect of a substance or medication.

So yeah, people can have tics and not have TS. There are a number of conditions in the DSM in which tics are listed as possible symptoms. Which, of course, complicates the question I'm trying to answer.

But from what everyone has said, it really looks like he's been stimming up to this point. Hey, that's cool by me! Not that I'd have a problem with it if he did have TS, but it's good to have a better understanding.

Thanks again!

This is probably the only difference clear to an outside observer, and I forgot to mention it at all somehow. Motor stims look very different to most tics, because they're continuous, not a series of isolated actions with pauses in between. There are lots of videos on Youtube showing examples of stereotypic movements (motor stimming), and as diverse as they are, it all looks very different to motor ticking, which there are also videos of. It might not be obvious in every case, but in most cases you could probably tell by looking, if you had seen enough examples of both.

I can see that difference with the teeth clicking, but not with his breathing one. Not because it's not there. I'm just not seeing it. The times I've had breathing tics, they've pretty much been non-stop, so it's hard for me to see that difference on that one.

I might have to check out the Youtube videos. Thanks for the pointer.