Attention Deficit Hyperactivity Disorder (ADHD) Treatment of Tourette syndrome

stimulants (such adderall , ritalin) underused in treatment of adhd when tics present.

patients tourette s referred specialty clinics have high rate of comorbid attention-deficit hyperactivity disorder (adhd), treatment of adhd co-occurring tics part of clinical treatment of tourette s. patients have adhd along tourette s may have problems disruptive behaviors, overall functioning, , cognitive function, accounted comorbid adhd, highlighting importance of identifying , treating other conditions when present.

the treatment of adhd in presence of tic disorders has long been controversial topic. past medical practice held stimulants (such ritalin) not used in presence of tics, due concern use might worsen tics; however, multiple lines of research have shown stimulants can cautiously used in presence of tic disorders. several studies have shown stimulants not exacerbate tics more placebo does, , suggest stimulants may reduce tic severity. controversy remains, , pdr continues carry warning stimulants should not used in presence of tic disorders, physicians may reluctant use them. others comfortable using them , advocate stimulant trial when adhd co-occurs tics, because symptoms of adhd can more impairing tics.

the stimulants first line of treatment adhd, proven efficacy, fail in 20% of cases, in patients without tic disorders. current prescribed stimulant medications include: methylphenidate (brand names ritalin, metadate, concerta), dextroamphetamine (dexedrine), , mixed amphetamine salts (adderall). other medications can used when stimulants not option. these include alpha-2 agonists (clonidine , guanfacine), tricyclic antidepressants (desipramine , nortriptyline), , newer antidepressants (bupropion, venlafaxine , atomoxetine). retrospective case series published in 1993 suggested treatment bupropion (trade name wellbutrin) can worsen tics, there no data placebo-controlled trials support this. there empirical support use of desipramine, bupropion , atomoxetine (brand name strattera). atomoxetine non-controlled food , drug administration (fda) approved drug treatment of adhd, less effective stimulants adhd, associated individual cases of liver damage, carries fda black box warning regarding suicidal ideation, , controlled studies show increases in heart rate, decreases of body weight, decreased appetite , treatment-emergent nausea.