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Tourette's syndrome, tics, ADHD, and psychostimulants
(Ritalin, concerta, methylphenidate, etc.)
Research shows that ADHD can often be a bigger issue than tics.
Here is a summary of journal-documented studies about tics, ADHD, and
stimulants (Ritalin, Concerta, adderall, etcetera).
Updated information on tics, AD/HD and medication.
Tourette's Syndrome: are stimulants safe? Curr Neurol Neurosci Rep. 2003 Jul;3(4):285-8.
A study published in the Feb 2002 issue of Neurology, 2002;58:527-536, concluded that, "prior recommendations to avoid methylphenidate in these children because of concerns of worsening tics are unsupported by this trial."
The 2/27/2002, MedScape summary of this study at medscape.com/viewarticle/429050?srcmp=neur-030102 stated that:
Stimulants May Treat ADHD, Tic Disorders NEW YORK (MedscapeWire) Feb 27 — Children who have attention deficit hyperactivity disorder (ADHD) and suffer from uncontrolled tics or Tourette's syndrome may find relief from stimulants. New research shows that stimulant drugs, such as Ritalin (methylphenidate), may actually minimize the unwanted movements rather than make them worse. ...Researchers studied 136 children aged 7 to 14 years with ADHD and a chronic tic disorder and examined the effects of treating them with either of the drugs alone, both drugs, or no treatment. Throughout the 4-month study, researchers found improvement in all of the children who received medication. ...
"Not only did tics not worsen during treatment with [Ritalin], the severity of tics actually decreased in all treatment groups," writes study author Roger Kurlan, MD, of the University of Rochester Medical Center in New York.
The authors say these findings dispute the notion that children with tics and ADHD should not take stimulants such as Ritalin, which has already been shown effective in treating about 85% of children with ADHD.
"Our study indicates that prior concerns that [Ritalin] worsens tics and that the drug should be avoided in patients with tics may be unwarranted," write the authors. ...
This data suggests that stimulants can be cautiously tried when tics are
present.
Further research on the importance of treating ADHD
first:
The 4-Year Course of Tic Disorders in Boys With Attention-Deficit/Hyperactivity Disorder,
Archives of General Psychiatry, 1999 Sep, Vol. 56, No. 9, Thomas Spencer, MD;
Joseph Biederman, MD; Barbara Coffey, MD; Daniel Geller, MD; Timothy Wilens, MD;
Stephen Faraone, PhD.
Social Functioning, ADHD and
Tourette's syndrome, J Child Psychol Psychiatry 2000 Feb; 41(2):215-23,
Social and emotional adjustment in children affected with Gilles de la
Tourette's syndrome: associations with ADHD and family functioning. Attention
Deficit Hyperactivity Disorder. Carter
AS, O'Donnell DA, Schultz RT, Scahill L, Leckman JF, Pauls DL. PMID:
10750547, UI: 20212585
Disentangling the overlap between Tourette's disorder and ADHD, Spencer T, Biederman J, Harding M, O'Donnell D, Wilens T, Faraone S, Coffey B, Geller DJ. Child Psychol Psychiatry, 1998 Oct;39(7):1037-44. PMID: 9804036, UI: 99019181
DG DISPATCH - AACAP: AD/HD A Major Factor In Tic Disorder
http://www.pslgroup.com/dg/13ee6e.htm
Impact of tic disorders on ADHD outcome across the life cycle: findings from a large group of adults with and without ADHD.
Spencer TJ, Biederman J, Faraone S, Mick E, Coffey B, Geller D, Kagan J, Bearman SK, Wilens T.
Am J Psychiatry 2001 Apr;158(4):611-7 PMID: 11282697
More journal-published articles indicating that stimulants
may be cautiously used in persons with tic disorders:
A study of Stimulant Medication Withdrawal During Long-term Therapy in
Children With Comorbid Attention-Deficit Hyperactivity Disorder and
Chronic Multiple Tic Disorder, Edith E. Nolan, Kenneth D. Gadow, and Joyce Sprafkin,
PEDIATRICS Vol. 103 No. 4 April 1999, pp. 730-737. PMID: 10103294, UI: 99205281
Long-term methylphenidate therapy in children with comorbid attention-deficit hyperactivity disorder and chronic multiple tic disorder.
Gadow KD, Sverd J, Sprafkin J, Nolan EE, Grossman S., Arch Gen Psychiatry 1999 Apr;56(4):330-6,
PMID: 10197827
Another study which showed that Ritalin did not increase tics any more than placebo did in the small research
sample (From J Am Acad Child Adolesc Psychiatry 1999; Aug 38 (8):944-951, Do
typical clinical doses of methylphenidate cause tics in children treated for
attention-deficit hyperactivity disorder? Law SF, Schachar RJ)
PMID: 10434485, UI: 99363329, CONCLUSIONS: Doses of MPH
based on the typical clinical titration procedure did not produce significantly
more tics than the placebo in children with or without preexisting (mild to
moderate) tics.
Methylphenidate Does Not Induce Tics in Children Treated For ADHD, WESTPORT, Jul 29 (Reuters Health)
"Children with attention-deficit hyperactivity disorder treated with methylphenidate (MPH) are no more likely to develop tics than children who receive a placebo, according to the results of a study published in the August Journal of the American Academy of Child and Adolescent Psychiatry.
... The investigators found that of children who had pre-existing tics and received MPH, 33.3% showed worse tics than they did at baseline, and 66% experienced no change or improved. Similarly, of the six children in the placebo group who had pre-existing tics, symptoms worsened in two children but completely disappeared in four.
"Our results are consistent with those studies...that found no evidence that MPH altered the severity of tics or Tourette's disorder among children with ADHD," the researchers write. "Until the effect of MPH on tics in larger samples has been studied with more exacting measures of tics, it would be wise to monitor for tics--especially if high doses of MPH are required--before and during treatment."
On a separate note, parents are advised to be alert in case their child responds poorly to psychostimulants (Ritalin, etc.), as this can be one indication of the possible presence of bipolar (manic-depressive) disorder. There is increasing evidence that bipolar is often misdiagnosed as ADHD. A poor response to stimulants or anti-depressants -- sometimes indicated by an increase in hyperactivity, manic symptoms, or tics -- could be an indication that an investigation into the possibility of bipolar is warranted.
From NAMI, When ADHD is Not ADHD
From Dr. Charles Popper, Diagnosing Bipolar vs. ADHD -- a discussion of the similarities and differences between bipolar and ADHD (Childhood Onset Bipolar is often misdiagnosed as ADHD)
From NAMI, Childhood Onset Bipolar Disorder
From The Bipolar Child, the extreme importance of a correct diagnosis before initiating treatment with stimulants (Ritalin, Concerta, Adderall) or anti-depressants in a child who may be bipolar, since Ritalin, other stimulants, and anti-depressants can cause a severe manic reaction in a child with undetected bipolar disorder. Early diagnosis is key in this condition.
The Child and
Adolescent Bipolar Foundation, with message boards, chats, and mailing
lists.
Back to Other Links
(Just a note: this website was
designed for newcomers to Tourette's syndrome, to be read through in page order.
Growing up with Tourette's
Syndrome: Information for Kids
HBO Documentary on Tourette's Syndrome Tourette
Syndrome Research Article Summary
Tourette's Syndrome - Now What?
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