![]() ![]() The primary objective was the proportion of children reporting tics as a side effect of medication as reported by clinician, participant, parent or teacher. All trials compared methylphenidate or dextroamphetamine derivatives to placebo. 15 The meta-analysis included 22 double blind, randomized, placebo-controlled trials involving 2,385 patients under the age of 18 with an ADHD or hyperkinetic disorder diagnosis. In order to assess the risk associated with psychostimulant use and new onset or worsening of tics, Cohen et al completed a meta-analysis in 2015. The purpose of this FAQ is to provide a summary of that literature. 1,15 Recent literature has brought into question whether psychostimulants cause or worsen tics. Moreover, tic severity increases and decreases depending on stress, excitement, fatigue or anxiety in the child’s life. 15 This makes it difficult to discern whether the tics are a result of psychostimulant initiation or if they were to occur regardless of pharmacotherapy taken by the child. 15 However, when ADHD and tic disorders occur together, ADHD symptoms precede tic symptoms by 2 to 3 years. 3,9,15 Psychostimulants have a biological explanation for aggravating tics in that they can increase dopamine in the synaptic cleft whereas most medications used to treat tic disorders antagonize dopamine. 8-14 As a result of a case series in 1982, which included 15 children who developed tics after initiation of psychostimulants, the Food and Drug Administration (FDA) mandated that the labeling for psychostimulants list tics and/or family history of tic disorders as a contraindication or as a significant adverse reaction. 5-7 Additionally, in the 1970s and 1980s, there were several case reports and case series published about pediatric patients who either experienced worsening of tics or new onset tic disorders after the use of psychostimulants for ADHD. In animal studies, methylphenidate and dextroamphetamine have demonstrated dose-dependent tic-like movements. Historically, clinicians have been hesitant to use stimulants for the treatment of children with ADHD and tic disorders for fear of worsening tics. 3 For these reasons, treatment for ADHD is a greater priority than treatment for tics. Conversely, the impact of tic disorders on ADHD symptoms is limited. 3 Additionally, the greatest predictor of psychosocial quality of life in the pediatric population with a tic disorder is the severity of ADHD symptoms. 1,3 When ADHD and tic disorders are present in a child, the ADHD symptoms have a more prominent impact on the child’s social relationships and academic achievements in comparison to the tics. 3 The relationship between ADHD and tic disorders is thought to be attributed to abnormalities in noradrenergic and dopaminergic transmission within corticostriatal circuits causing failure of inhibition of intrusive thoughts, sensory inputs and motor responses. ![]() 1,3 Up to 50% of children with tic disorders also have ADHD. 4ĪDHD commonly co-occurs with tic disorders. Overall, management includes behavior therapy and pharmacotherapy including psychostimulants methylphenidate and amphetamine non-stimulants, such as atomoxetine alpha agonists, such as extended-release guanfacine and extended-release clonidine, and tricyclic antidepressants. 3 Recommendations for the management of children and adolescents with ADHD vary depending on the patient’s age. 1,2 Children with ADHD typically have difficulties with hyperactivity, impulsivity and maintaining attention. ![]() Its incidence ranges between 5% and 12% in developed countries. Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder in the pediatric population. ![]()
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