ADHD Symptoms The Link Between Tic Disorders and ADHD By Keath Low Keath Low Keath Low, MA, is a therapist and clinical scientist with the Carolina Institute for Developmental Disabilities at the University of North Carolina. She specializes in treatment of ADD/ADHD. Learn about our editorial process Updated on March 13, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Carol Yepes / Getty Images Tics are characterized by repeated, sudden, jerky, involuntary movements of one’s face, shoulders, hands, legs or other body parts. Movements may include eye blinking, shoulder shrugging, neck twisting, facial grimacing, sticking out tongue, flaring nostrils, clenching fists, jerking arms, kicking, and curling toes. Tics can also be vocal. These vocal tics may include throat-clearing, sniffing or snorting, grunting, dry coughs, clicking, hissing, barking, or even words or phrases. These movements and/or vocalizations may occur frequently throughout the day or they may occur only occasionally. They tend to increase under excitement, physical or social stress, anxiety, or if the individual is very tired. Some medications are also believed to exacerbate tics. Tics occur less often when a person is relaxed and calm. Tics do not occur during sleep. Treatment Treatment for an individual with a tic disorder may include medication to help control the symptoms. The older "typical" neuroleptics such as pimozide and Haldol are often used to reduce tics, in addition to the newer "atypical" neuroleptics/antipsychotics such as risperidone. Clonidine and guanfacine, types of anti-hypertensive agents, may also be used for mild to moderate tics and may be better tolerated than the neuroleptics. How Common Are Tic Disorders? The most common tic disorder is called provisional tic disorder (PTD), which was previously known as transient tic disorder, which is common in children. Tics which last one year or more are called persistent tics, which are also known as chronic motor or vocal tic disorders (CMVTD). Tics occur in about 20% of school-age children. Approximately one in five children age 6-17 years old may develop a tic, but may sometimes start as early as two years of age. Tic disorders do appear to have a genetic link, as they tend to run in families, and have also been linked to environmental factors. Chronic tic disorders affect about one percent of children and may indicate a more serious disorder called Tourette Syndrome (TS). Tourette Syndrome Tourette syndrome is a genetic, neurological disorder whose primary manifestations are the presence of motor and vocal tics. Tourettes is commonly associated with ADHD, obsessive-compulsive disorder, behavior problems, and learning disabilities. The National Institute of Neurological Disorders and Stroke report that approximately 200,000 Americans have the most severe form of Tourettes, while as many as one in 100 display Tourette syndrome and other chronic tic disorders. Though Tourettes is a lifelong condition, symptoms tend to peak during the early teenage years with improvement in later adolescence and adulthood. Tourettes affects males approximately three to four times more often than females. ADHD A 2016 study found that 35–90% of children with Tourettes also had ADHD. Research has found that chronic tic disorders, Tourette syndrome, and obsessive-compulsive disorder may share some underlying genetic and neurological origins, and an individual with any of these conditions is also quite likely to have ADHD. In children who develop tic disorders and ADHD, the ADHD usually develops two to three years before the tics. There has been some controversy over whether stimulants, the most common form of medication therapy for ADHD, worsen or even cause tics. Studies indicate that most children with co-occurring tics and ADHD do not experience an increase in tic severity while on low to moderate doses of stimulants. However, there does appear to be a small proportion of children for whom this is a problem. It is not clear if the stimulants actually cause the tic or if the stimulants trigger tics that were already pre-existing, but not yet obvious. It is also possible that tic disorders may look similar to ADHD in their early stages. So the tic may have developed whether or not the child had been treated with stimulants. If your child with ADHD develops tics, report it to your child’s doctor. Together you will weigh the risks and potential benefits of different medications, as well as explore alternative medicines to stimulants. 8 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Madruga-garrido M, Mir P. Tics and other stereotyped movements as side effects of pharmacological treatment. Int Rev Neurobiol. 2013;112:481-94. doi:10.1016/B978-0-12-411546-0.00016-0 Qasaymeh MM, Mink JW. New treatments for tic disorders. Curr Treat Options Neurol. 2006;8(6):465-73. doi:/10.1007/s11940-006-0036-4 Cavanna A, Coffman K, Cowley H. Tourette Association of America. The Spectrum of Tourette Syndrome and Tic Disorders: A Consensus by Scientific Advisors of the Tourette Association of America. March 20, 2017. National Institute of Neurological Disorders and Stroke. Tourette Syndrome Fact Sheet. January 2012. Oluwabusi OO, Parke S, Ambrosini PJ. Tourette syndrome associated with attention deficit hyperactivity disorder: The impact of tics and psychopharmacological treatment options. World J Clin Pediatr. 2016;5(1):128–135. doi:10.5409/wjcp.v5.i1.128 Coffey BJ. Complexities for Assessment and Treatment of Co-Occurring ADHD and Tics. Curr Dev Disord Rep 2, 293–299 (2015). doi:10.1007/s40474-015-0061-7 Ogundele MO, Ayyash HF. Review of the evidence for the management of co-morbid Tic disorders in children and adolescents with attention deficit hyperactivity disorder. World J Clin Pediatr. 2018;7(1):36–42. doi:10.5409/wjcp.v7.i1.36 Millichap JG. Risk of Tics with Psychostimulants for ADHD. Pediatr Neurol Briefs. 2015;29(12):95. doi:10.15844/pedneurbriefs-29-12-6 Additional Reading Black KJ, Black ER, Greene DJ, Schlaggar BL. Provisional Tic Disorder: What to tell parents when their child first starts ticcing. F1000Res. 2016;5:696. doi:10.12688/f1000research.8428.1 Center for Disease Control and Prevention. Diagnosing Tic Disorders. Reviewed May 2, 2019. Harvard Health Publishing. Tics. May 2017. Martino D, Ganos C, Pringsheim TM. Tourette Syndrome and Chronic Tic Disorders: The Clinical Spectrum Beyond Tics. Int Rev Neurobiol. 2017;134:1461-1490. doi:10.1016/bs.irn.2017.05.006 By Keath Low Keath Low, MA, is a therapist and clinical scientist with the Carolina Institute for Developmental Disabilities at the University of North Carolina. She specializes in treatment of ADD/ADHD. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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