Tics and Stimulants

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Last Update 10/08/07

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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. 
You can browse the pages in the order you desire, but if you're new to Tourette syndrome,
you may get a better overview by reading through the pages in order, by clicking on the Next Page links throughout.)

  Strengths and advantages associated with Tourette's syndrome
Medical literature supports the common lore that children with Tourette syndrome have uncommon gifts.

Growing up with Tourette's Syndrome:  Information for Kids
A new website about Tourette syndrome, with information targeted to ages 5–8, ages 9–13, and a section for parents.

HBO Documentary on Tourette's Syndrome   
I Have Tourette's but Tourette's Doesn't Have Me
Video clips of Tourette's syndrome HBO Documentary

First Five Things to Do After Your Child Is Diagnosed with Tourette Syndrome
I may not agree with all of them, but # 1 is interesting.

 Tourette Syndrome Research Article Summary

  Controversy, myth, and inaccurate information about Tourette syndrome
 Dr. Phil on Tourette's syndrome and Asperger's syndrome:  "Extreme Disorders" and brain imaging 
  Dr. Laura Schlessinger on Tourette's  
David Comings, M.D. - Hope Press - The Gene Bomb

Inaccurate definition of Tourette's Syndrome by Joseph Jankovic, M.D. in the New England Journal of Medicine
Deep Brain Stimulation, Tourette's Syndrome, and "Miracle Workers"
Disclaimer - Just a Mom !
I am not a medical person and am not qualified to give medical advice.
Please discuss your treatment with your personal physician.
PLEASE NOTE:  I am NOT affiliated with another Tourette's website which uses the tourettenowwhat name!
(Imitation is the sincerest form of flattery?  Or another webmaster trick to derive traffic from my name?)

A word about spelling

The official name of the condition, according to the DSM-IV-TR, 307.23, is Tourette's disorder. 
Tourette's is also referred to as TS, Tourette Syndrome, Tourette's syndrome, GTS, and Gilles de la Tourette's Syndrome.
Common misspellings are tourettes syndrome, tourretts, tourrettes, touretts, terrets, terets, turettes, turetts, turets, turetes and turrets syndrom.
Tourette's disease is a common misnomer (it's not a disease).
Tick is a common misspelling:  ticks are nasty critters that suck blood from dogs and people.  People with Tourette's disorder have tics.

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Tourette's Syndrome Research articles   |   Other Tourette Syndrome Links    |   International Links - Síndrome de Tourette en español – castellano
Dr. Laura on Tourette's Syndrome    |   David E. Comings, Tourette's and Hope Press     |    NEJM - Jankovic article on Tourette's Syndrome

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