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Cited by 105Attention Deficit Hyperactivity DisorderObsessive-Compulsive Spectrum DisordersSchizophrenia research and treatment

Meta-Analysis: Risk of Tics Associated With Psychostimulant Use in Randomized, Placebo-Controlled Trials

Cohen, Stephanie C., Mulqueen, Jilian M., Ferracioli-Oda, Eduardo, Stuckelman, Zachary D., Coughlin, Catherine G., Leckman, James F., Bloch, Michael H.·2015·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2015.06.011
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Abstract

Objective Clinical practice currently restricts the use of psychostimulant medications in children with tics or a family history of tics for fear that tics will develop or worsen as a side effect of treatment. Our goal was to conduct a meta-analysis to examine the risk of new onset or worsening of tics as an adverse event of psychostimulants in randomized, placebo-controlled trials. Method We conducted a PubMed search to identify all double-blind, randomized, placebo-controlled trials examining the efficacy of psychostimulant medications in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). We used a fixed effects meta-analysis with risk ratio of new onset or worsening tics in children treated with psychostimulants compared to placebo. We used stratified subgroup analysis and meta-regression to examine the effects of stimulant type, dose, duration of treatment, recorder of side effect data, trial design, and mean age of participants on the measured risk of tics. Results We identified 22 studies involving 2,385 children with ADHD for inclusion in our meta-analysis. New onset tics or worsening of tic symptoms were commonly reported in the psychostimulant (event rate = 5.7%, 95% CI = 3.7%-8.6%) and placebo groups (event rate = 6.5%, 95% CI = 4.4%-9.5%). The risk of new onset or worsening of tics associated with psychostimulant treatment was similar to that observed with placebo (risk ratio = 0.99, 95% CI = 0.78-1.27, z = -0.05, p = .962). Type of psychostimulant, dose, duration of treatment, recorder, and participant age did not affect risk of new onset or worsening of tics. Crossover studies were associated with a significantly greater measured risk of tics with psychostimulant use compared to parallel group trials. Conclusion Meta-analysis of controlled trials does not support an association between new onset or worsening of tics and psychostimulant use. Clinicians may want to consider rechallenging children who report new onset or worsening of tics with psychostimulant use, as these symptoms are much more likely to be coincidental rather than caused by psychostimulants.

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Authors
Cohen, S. C., Mulqueen, J. M., Ferracioli-Oda, E., Stuckelman, Z. D., Coughlin, C. G., Leckman, J. F., & Bloch, M. H.
Affiliations
  • Yale University (US)
  • Universidade de São Paulo (BR)
Corresponding author
Bloch, Michael H.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2015-09
Volume
54
Issue
9
Pages
728-736
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2015.06.011
OpenAlex
W1555659507
Cited by
105
References
67
Citations by year
2026: 9 · 2025: 7 · 2024: 21 · 2023: 7 · 2022: 8 · 2021: 6 · 2020: 9 · 2019: 7 · 2018: 17 · 2017: 4 · 2016: 8 · 2015: 2
FWCI
1.42
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute of Mental Health (K23MH091240, T32MH018268)
  • National Center for Research Resources (UL1RR024139)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD070821)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
tics, psychostimulants, attention deficit hyperactivity disorder, adverse drug reactions, children, crossover trial
MeSH terms
Adolescent, Amphetamine, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Humans, Methylphenidate, Severity of Illness Index, Odds Ratio, Randomized Controlled Trials as Topic, Tics

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