Complexities for Assessment and Treatment of Co-Occurring ADHD and Tics

Bidirectional overlap between attention-deficit/hyperactivity disorder (ADHD) and tic disorders has long been described. Twenty percent of individuals with ADHD may meet diagnostic criteria for a tic disorder, and more than 60 % of children ages 6–17 with Tourette’s disorder (TD) in the community had also been diagnosed with ADHD/ADD. While comorbid presentation of ADHD and tic disorders is firmly established, underlying genetic and pathophysiologic mechanisms need additional investigation. Inhibition is a core deficit in both ADHD and tic disorders, and research suggests a diffuse process in the brain involving corticostriatothalamicortical (CSTC) pathways in the basal ganglia, striatum, and frontal lobes. The complex presentation of these patients requires comprehensive evaluation and prioritization of treatment goals. Most studies indicate that ADHD places a greater burden on patients than do tics. Optimal patient outcomes may depend on management of both ADHD symptoms and tics when they co-occur. Research in the past decade has shown that these conditions can be safely treated simultaneously

Tics and Tourette Syndrome

Tourette syndrome is a childhood onset neurodevelopmental disorder characterized by multiple motor and vocal tics. Although many youth experience attenuation or even remission of tics in adolescence and young adulthood, some individuals experience persistent tics, which can be debilitating or disabling. Most patients also have 1 or more psychiatric comorbid disorders, such as attention-deficit/hyperactivity disorder or obsessive-compulsive disorder. Treatment is multimodal, including both pharmacotherapy and cognitive-behavioral treatment, and requires disentanglement of tics and the comorbid symptoms