Meta-Analysis: Treatment of Attention-Deficit/Hyperactivity Disorder in Children With Comorbid Tic Disorders
Open accessAbstract
Objective The Food and Drug Administration currently requires the package inserts of most psychostimulant medications to list the presence of a tic disorder as a contraindication to their use. Approximately half of children with Tourette's syndrome experience comorbid attention-deficit/hyperactivity disorder (ADHD). We sought to determine the relative efficacy of different medications in treating ADHD and tic symptoms in children with both Tourette's syndrome and ADHD.Method We conducted a PubMed search to identify all double-blind, randomized, placebo-controlled trials examining the efficacy of medications in the treatment of ADHD in the children with comorbid tics. We used a random effects meta-analysis with standardized mean difference as our primary outcome to estimate the effect size of pharmaceutical agents in the treatment of ADHD symptoms and tics.Results Our meta-analysis included nine studies involving 477 subjects. We assessed the efficacy of six medications-dextroamphetamine, methylphenidate, alpha-2 agonists (clonidine and guanfacine), desipramine, atomoxetine, and deprenyl. Methylphenidate, alpha-2 agonists, desipramine, and atomoxetine demonstrated efficacy in improving ADHD symptoms in children with comorbid tics. Alpha-2 agonists and atomoxetine significantly improved comorbid tic symptoms. Although there was evidence that supratherapeutic doses of dextroamphetamine worsens tics, there was no evidence that methylphenidate worsened tic severity in the short term.Conclusions Methylphenidate seems to offer the greatest and most immediate improvement of ADHD symptoms and does not seem to worsen tic symptoms. Alpha-2 agonists offer the best combined improvement in both tic and ADHD symptoms. Atomoxetine and desipramine offer additional evidence-based treatments of ADHD in children with comorbid tics. Supratherapeutic doses of dextroamphetamine should be avoided.
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A recent meta-analysis indicated that treating ADHD in children with tic disorders is safe and effective.
“A recent meta-analysis indicated that treating ADHD in children with tic disorders is safe and effective [276,277].”
From European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD (2010) · cites this paper as [276]
In ADHD comorbid with tic disorders, supratherapeutic doses of dextroamphetamine should be avoided.
“meta-analyses of stimulants and other ADHD medications in the treatment of ADHD comorbid with tic disorders concluded that supratherapeutic doses of dextroamphetamine should be avoided in this population.”
From Advances in understanding and treating ADHD (2011) · cites this paper as [51]
In ADHD comorbid with tic disorders, methylphenidate gives the best control for ADHD.
“These studies also indicated that methylphenidate gave the best control for ADHD and that α-2-agonists produced the best improvement in both tics and ADHD [51,52].”
From Advances in understanding and treating ADHD (2011) · cites this paper as [51]
In ADHD comorbid with tic disorders, alpha-2-agonists produce the best improvement in both tics and ADHD.
“These studies also indicated that methylphenidate gave the best control for ADHD and that α-2-agonists produced the best improvement in both tics and ADHD [51,52].”
From Advances in understanding and treating ADHD (2011) · cites this paper as [51]
Several recent reviews indicate that stimulants are adequately safe in patients with both ADHD and tic disorders and should not be disregarded when planning treatment for ADHD in these individuals.
“Several recent reviews [24, 119, 124] indicate that stimulants are adequately safe in patients with both ADHD and TD and should not be disregarded when planning treatment for ADHD in these individuals.”
From European guidelines on managing adverse effects of medication for ADHD (2011) · cites this paper as [24]
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- Authors
- Bloch, M. H., Panza, K. E., Landeros-Weisenberger, A., & Leckman, J. F.
- Affiliations
- Yale University (US)
- Corresponding author
- Bloch, Michael H.
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2009-09
- Volume
- 48
- Issue
- 9
- Pages
- 884-893
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC3943246
- OpenAlex
- W2001006163
- Cited by
- 270
- References
- 57
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 7 · 2023: 9 · 2022: 16 · 2021: 9 · 2020: 26 · 2019: 10 · 2018: 12 · 2017: 16 · 2016: 16 · 2015: 17 · 2014: 23 · 2013: 21 · 2012: 24
- FWCI
- 15.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eli Lilly and Company
- Yale University
- American Psychiatric Institute for Research and Education
- Child Study Center, Yale School of Medicine
- National Institutes of Health
- National Institute of Mental Health (K05MH076273, K23MH091240, T32MH018268)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- attention deficit hyperactivity disorder, Tourette syndrome, tic disorders, comorbidities, psychostimulants, methylphenidate, d-amphetamine, alpha-2 adrenergic agonists, clonidine, guanfacine, atomoxetine, desipramine, selegiline, supratherapeutic dosing, children
- MeSH terms
- Atomoxetine Hydrochloride, Contraindications, Adrenergic alpha-Agonists, Attention Deficit Disorder with Hyperactivity, Child, Dose-Response Relationship, Drug, Double-Blind Method, Tourette Syndrome, Humans, Methylphenidate, Propylamines, Psychotropic Drugs, Tic Disorders, Comorbidity, Randomized Controlled Trials as Topic
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