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

The DOI matches its Crossref record; 40 of the 40 references it cites were found in a registry or an index.

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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Research works printed but not linked: 7

  1. Walkup JT Khan S Schuerholz L et al. Phenomenology and natural history of tic-related ADHD and learning disabilities. In: Leckman JF Cohen DJ eds. Tourette’s syndrome: tics obsessions compulsions. New York: Wiley 1999; 63–79.
  2. Kurlan R Trinidad KS. Treatment of tics. In: Kurlan R ed. The Treatment of Movement Disorders. Philadelphia: JB Lippincott 1995; 365–406.
  3. Tanner JM. Growth in adolescence 2nd ed. Oxford: Blackwell Scientific 1962.
  4. Atkins MS Pelham WE Licht MH. The development and validation of objective classroom measures for conduct and attention deficit disorders. In: Prinz R ed. Advances in behavioral assessment of children and families Vol 4. Greenwich CT: JAI Press 1988; 3–33.
  5. Leckman JF Towbin KE Ort SI Cohen DJ. Clinical assessment of tic disorder severity. In: Cohen DJ Bruun RD Leckman JF eds. Tourette’s syndrome and tic disorders. New York: Wiley 1988: 55–78.
  6. Scahill L King RA Schultz RT Leckman JF. Selection and use of diagnostic and clinical rating instruments. In: Leckman JF Cohen DJ eds. Tourette’s syndrome tics obsessions compulsions: development psychopathology and clinical care. New York: John Wiley and Sons 1998; 310–324.
  7. Conners CK, Barkley RA. Rating scales and checklists for psychopharmacologic trials. Psychopharm Bull . 1985; 21: 809–854.

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Metadata

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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