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Cited by 507Attention Deficit Hyperactivity DisorderObsessive-Compulsive Spectrum DisordersBehavioral and Psychological Studies

Treatment of ADHD in children with tics: A randomized controlled trial

The Tourette’s Syndrome Study Group·2002·Neurology
DOI 10.1212/wnl.58.4.527
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Abstract

BACKGROUND: The treatment of children with attention deficit hyperactivity disorder (ADHD) and Tourette syndrome (TS) has been problematic because methylphenidate (MPH)--the most commonly used drug to treat ADHD--has been reported to worsen tics and because clonidine (CLON)--the most commonly prescribed alternative--has unproven efficacy. METHODS: The authors conducted a multicenter, randomized, double-blind clinical trial in which 136 children with ADHD and a chronic tic disorder were randomly administered CLON alone, MPH alone, combined CLON + MPH, or placebo (2 x 2 factorial design). Each subject participated for 16 weeks (weeks 1-4 CLON/placebo dose titration, weeks 5-8 added MPH/placebo dose titration, weeks 9-16 maintenance therapy). RESULTS: Thirty-seven children were administered MPH alone, 34 were administered CLON alone, 33 were administered CLON + MPH, and 32 were administered placebo. For our primary outcome measure of ADHD (Conners Abbreviated Symptom Questionnaire--Teacher), significant improvement occurred for subjects assigned to CLON (p < 0.002) and those assigned to MPH (p < 0.003). Compared with placebo, the greatest benefit occurred with combined CLON + MPH (p < 0.0001). CLON appeared to be most helpful for impulsivity and hyperactivity; MPH appeared to be most helpful for inattention. The proportion of individual subjects reporting a worsening of tics as an adverse effect was no higher in those treated with MPH (20%) than those being administered CLON alone (26%) or placebo (22%). Compared with placebo, measured tic severity lessened in all active treatment groups in the following order: CLON + MPH, CLON alone, MPH alone. Sedation was common with CLON treatment (28% reported moderate or severe sedation), but otherwise the drugs were tolerated well, including absence of any evident cardiac toxicity. CONCLUSIONS: Methylphenidate and clonidine (particularly in combination) are effective for ADHD in children with comorbid tics. Prior recommendations to avoid methylphenidate in these children because of concerns of worsening tics are unsupported by this trial.

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  • For clonidine, there exists some evidence that it may reduce tics in frequency and severity, as well as improve ADHD symptoms; but worsening of tics may be seen in about a quarter of cases.

    “For clonidine, which is only occasionally used in Europe to treat TD and/or ADHD, but recommended by some authors (especially where TD is the predominant disorder) [116], there exists some evidence that it may reduce tics in frequency and severity, as well as improve ADHD symptoms; but on the other hand, worsening of tics may be seen in about a quarter of cases [3].”

    From European guidelines on managing adverse effects of medication for ADHD (2011) · cites this paper as [3]

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Authors
The Tourette’s Syndrome Study Group
Corresponding author
The Tourette’s Syndrome Study Group
Venue
Neurology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2002-02-26
Volume
58
Issue
4
Pages
527-536
ISSN
  • 0028-3878 (ISSN-L)
  • 1526-632X
DOI
10.1212/wnl.58.4.527
OpenAlex
W2266471137
Cited by
504
References
40
Citations by year
2026: 13 · 2025: 9 · 2024: 18 · 2023: 15 · 2022: 13 · 2021: 15 · 2020: 14 · 2019: 18 · 2018: 13 · 2017: 14 · 2016: 18 · 2015: 19 · 2014: 17 · 2013: 11 · 2012: 37
FWCI
19.19
Type
journal article
Language
en
Open access
closed
Locations
  • Neurology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01ns033654-04)
  • National Institute of Neurological Disorders and Stroke (1R01NS33654)
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, methylphenidate, clonidine, combination therapy, impulsivity, hyperactivity, inattention, sedation
MeSH terms
Adolescent, Adrenergic alpha-Agonists, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Clonidine, Double-Blind Method, Drug Therapy, Combination, Female, Humans, Male, Methylphenidate, Surveys and Questionnaires, Tic Disorders, Confidence Intervals, Treatment Outcome

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