General examination revealed a barrel-chested appearance, a short neck with low posterior hairline, abnormal scapulae, and webbing of toes. At age of 12 years, weight was 36.6 kg (75%ile), height was 126.4 cm (<5%ile), body mass index was 34 (>95%ile), and head circumference was 50.5 cm. Palate and cardiac exams were normal. Neurologic exam was notable for normal language and gregarious social interactions. Occasional tics and the stereotypy were observed. Cranial nerve exam was normal. Distal strength was diminished in both hands and thumb abductors. Reflexes were 2+ and symmetric. Fine movements of the hands were clumsy and slow. Sensation was diminished to light touch in the hands. Current clinical ratings showed Yale Global Tic Severity Scale (YGTSS) total tic score of 6 (mild), Child Yale-Brown Obsessive Compulsive Scale (CY-BOCS) score of 16 (mild/moderate), and the DuPaul ADHD Rating Scale (ADHDRS) score of 17 (subthreshold).
