"Tics, Tourettes, ADHD and Stimulants"

Question: What is the association between Tics/Tourette’s and ADHD/stimulants?
Answer: Tics are sudden muscle movements, jerks, or spasms. They are most common in the head (eye blinking, facial twitches), neck (head turns), or arms/shoulders. They usually start in early childhood and tend to get better with age. They sometimes persist into adulthood, and ironically, the most severe cases are in adults. Tics occur in 1-2% of kids.
Tourette’s is a more severe form of tic disorder and includes some form of vocalization, not limited to speech. This may take the form of a cough or throat clearing. I have made the diagnosis in several people over the years who weren’t aware they had tics of Tourette’s Syndrome (TS). In TS tics usually precede vocalization by 1-2 years.
Both of these disorders are more common in kids/adults with ADHD or OCD. In fact, Tourette’s is 10x more common in people with OCD than in the general population. Tics/TS are genetically based and involve a hypersensitivity to dopamine.
Because stimulants (e.g., Adderall, Concerta) increase dopamine activity, and the most effective treatments for tics/TS are dopamine blockers (Haldol, Orap), it was previously thought stimulants were contraindicated. Also, since sometimes tics first show up in a child taking a stimulant, it has been thought that the stimulant was the cause. Current evidence does not support this. Some kids with tics/TS do better on Concerta, some better on Adderall, and some can’t take either without aggravating their tics.
Before using Haldol/Orap, I usually first try milder meds like clonidine (blood pressure med), Tenex, or milder dopamine blocking agents like Abilify or Risperdal.
It is important to be aware of the frequent association of tics/TS with ADHD and OCD and to recognize the symptoms are sometimes subtle because there can be adverse effects, especially social. Most of the time, symptoms can be well controlled.

FAQs: ADHD