How is attention deficit–hyperactivity disorder (ADHD) treated in Tourette syndrome (TS) and other tic disorders?

Updated: May 30, 2019
  • Author: William C Robertson, Jr, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP  more...
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Answer

ADHD can be significant in patients referred for treatment of TS. Stimulants such as methylphenidate or dextroamphetamine represent the oldest class of psychotropic drugs still in common use, and have known safety profiles. They are the most effective treatments of ADHD. Methylphenidate may be better tolerated than dextroamphetamine in people with TS. [205]

Stimulant use in people with ADHD does not cause future drug abuse and may even prevent it. [206] A comorbid tic disorder should not be considered a serious contraindication to the use of stimulants for treatment of ADHD. [207] Several studies have shown that stimulants do not cause lasting worsening of tics. Their labeling includes warnings that they may cause tics, [205] but several recent prospective studies show that their effect on tics is at worst temporary, even with continued use. [208, 209, 210, 178]

Clonidine has also been proven useful for ADHD in people with TS. The benefits of clonidine and methylphenidate are additive. [178] Guanfacine most likely has similar effects.

RCTs have also shown that desipramine and atomoxetine help with ADHD symptoms in people with TS [181, 182] ; tics also improve slightly.

A double-blind RCT showed possible benefit for selegiline on ADHD symptoms and tics. [211]

Bupropion may benefit ADHD but may temporarily worsen tics. [212]

See the article Attention Deficit/Hyperactivity Disorder for further details on the conventional pharmacologic and behavioral treatment of ADHD.


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