He was diagnosed by the neurologist at six, and since then the tics and movements have changed shape more than once. These days it’s a synchronized stretching sequence, along with eye-rolling and blinking. I notice these more when he is fully relaxed, usually when it is the two of us, when he is hanging out with his sister, or just relaxing and eating. By the time he was nine, we had a fuller picture forming beyond the tics alone: likely ADHD, “just right” OCD, and on a waitlist for a full neuropsychiatric evaluation. None of these showed up one at a time. They arrived tangled together, and nowhere do they tangle more than at the start of a new school year, with a new teacher, new classmates, new routines, and new rooms.
In clinical literature this has a name: the Tourette’s Triad or clinical triad1 – tics, ADHD, and OCD-type behaviors, colliding hardest in the moments when a child has to shift from one thing to the next. For elementary school age kids especially, transitions aren’t a small hiccup in the day. They are often the hardest part of it.
Why Transitions Are So Hard
It is extremely common for tic disorders, ADHD, and OCD to show up together. We were told from the very beginning the likelihood of co-occurring ADHD, and the neurologist had already noted signs of “just right” OCD behaviors at six. Long-term studies of kids with tic disorders have found that while tics often ease up over time, ADHD and OCD symptoms tend to stick around, and most kids end up with at least one of these conditions alongside their tics.2 Kids who have both tics and OCD tend to have more severe tics and a harder time functioning day to day, while kids with tics and ADHD together often struggle just as much, even when their tics themselves aren’t more severe.3 In other words, it’s rarely the tic alone causing a tough day. It’s everything stacked on top of it.
Here’s the thing I wish someone had explained sooner. Kids only have so much mental energy to spend on holding themselves together. Switching from reading group to math, packing up for recess, changing seats for new activities asks them each time they switch, to let go of what they were doing and adjust to something new. That is the kind of task ADHD makes harder. At the same moment, if a “just right” urge hasn’t been finished such as, a paper that needs to be erased again or a folder that has to be lined up correctly, the brain treats the transition as unresolved and pulls even more from that same limited well of self-control. Once that well runs low, tics that a child normally works hard to hold back start slipping through. A transition demands focus and flexibility, an unfinished compulsion adds more strain, and tics lose their brakes right when the classroom is watching.
Building a Transition Plan That Actually Fits
For elementary school age kids, a 504 or IEP built around transitions can make a real difference. Before the switch happens:
- A short heads-up before transitions, spoken or shown visually, so there's no cold stop and start
- A short private moment between activities to let tics out without an audience
- A simple agreed-upon limit on redo’s. Example: one do-over per worksheet
- Typed work instead of handwritten when possible, to remove the visual trigger of a wrong-looking letter
- A small, private signal the child can use to say “I need a second” without explaining it out loud
- Instructions broken down into one or two steps, instead of a multi-step list all at once
- A visual schedule posted where the child can see what is coming next, so transitions aren’t a surprise
- Built-in functional movement breaks between longer stretches of seated work
The Hidden Cost of Holding it Together
Many parents may hear a version of this at conferences: “He’s one of my easiest students.” Meanwhile, home doesn’t always feel like that.
This gap has a name that's become familiar in some parenting communities: after-school restraint collapse. It describes a child who seems to manage well all day at school, and then falls apart once they finally feel safe enough to let go.4 For a child managing tics, ADHD, and OCD tendencies together, “managing well” often means quietly holding back tics, pushing through distraction, and working through compulsions all day without anyone noticing. That takes an enormous amount of effort for a ten-year-old, and it has to go somewhere. It usually shows up at home, in the form of meltdowns, exhaustion, or a child who suddenly can’t handle small requests.
I see this play out in small, specific ways. Certain tics will show up far more when he is relaxed than they ever do in a classroom full of people. That’s not a coincidence. It’s effort. A room full of eyes is exactly the environment where a child works the hardest to hold a tic back, and home is where that effort finally gets to stop.
The goal of a good support plan isn’t to help a child hide their symptoms better at school. It’s to help them need to hide less in the first place.
Researchers are still working out exactly why Tourette’s, ADHD, and OCD travel together the way that they do, and why the after-school collapse so many of us see at home is better documented in parent experience than in formal studies. But for those of us watching this pattern play out every September, we don’t need to wait for a perfect study to act. Our kids need a team that already understands the cycle, and a plan that meets them before the hard moment, not after it.
References
1. Temporal Course of the Tourette Syndrome Clinical Triad, PMC, pmc.ncbi.nlm.nih.gov
2. Course of Tourette Syndrome and Comorbidities in a Large Prospective Clinical Study, ScienceDirect, sciencedirect.com
3. Tourette syndrome in youth with and without obsessive compulsive disorder and attention deficit hyperactivity disorder, PMC, pmc.ncbi.nlm.nih.gov
4. How to Deal With After-School Restraint Collapse, Undivided, undivided.io
ABOUT THE AUTHOR:
Aimee Tallamy is a late-diagnosed neurodivergent mom raising a ten-year-old son with Tourette’s Triad and an eighteen-year-old daughter headed to college to study psychology. After a career in healthcare and customer success, she turned to writing and advocacy, dedicating time to work with the Prisha Charity Foundation, Light Upon Light, and Systemic Diversity and Inclusion Group. She writes from the intersection of her own ADHD, autism, and OCD traits and her family's daily experience navigating neurodivergence.
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